Tuesday, September 22, 2009

It's the Profits, Stupid!

Let's go back to square one.

Everyone agrees that the problem with health care in this country, If nothing else, is that health care distribution is way too expensive. Of anyone in this country who has no health insurance - or anyone who pays for their own private insurance - does anyone feel that we are all not paying too much for what we get? And what we are denied even after having paid into the insurance pool for however long?

So what is it that makes the current profit-driven health care distribution system so expensive?

To me, it's easy: profits.

Take out the profits and the obscenely high executive salaries and what have you got? An affordable health care distribution system? Why, yes, as a matter of fact. And a very good one at that.

To the folks who scream that a government run insurance program would not only foretell a socialist takeover but would, in the short term, mean unfair competition with the private insurance industry, President Obama made a very good point in his health care speech before Congress. Good, as far as it went.

He compared state-run universities who do a very good job of educating us to private universities that generally acknowledged as doing a better over all. The state-run schools do not threaten private universities in any way. And no one is calling American state colleges part of a scary socialist system.

But Obama's comparison of universities to insurance companies did not go far enough. It has to be noted that private universities exist almost exclusively nonprofit organizations. They do not produce profits, they do not enrich shareholders. They do accumulate endowments. University endowments can grow quite huge but they are not disbursed to shareholders who are already filthy rich. Rather, university endowments are used as investments to sustain those institutions.

This is not what happens with insurance companies. Instead of building endowments they pay out big dividends to their shareholders. And when their coffers run dry they end up blackmailing the government for taxpayer bailouts.

Insurance company executives make outlandishly huge salaries with very generous perques. Professors and top level administrators in nonprofit, private universities make nothing like the ridiculous money that insurance execs make. But they do make very handsome salaries.

Believe me. I have worked for years among many professors and college administrators in one of the top private universities in the country. I have been a relatively low-level administrator earning a totally livable salary myself and with access to the details of the professors' salary & benefits information. If you check the statistics you will find that "college professors," especially in medical schools (who are often physicians as well as professors) are listed among the highest paid professions you'll find.

Public & private universities alike get lots of money from the government in subsidies and research funding - especially medical research. But these institutions are required to be 501(c)(3) nonprofit organizations in order to qualify for that government funding.

The current Senate bill voted out of committee requires everyone to carry health insurance. It may provide subsidies from the government - tax money - to pay for insurance for those who cannot afford it. That money will go to insurance companies.

There is nothing in the bill that requires those insurance companies to be nonprofit organizations even though they stand to receive millions in subsidies paid from our taxes. The Senate bill merely creates more customers for profit making companies who will then further enrich their shareholders and executives with our tax money.

If universities and research institutions are required to have 501(c)(3) status in order to qualify for government subsidies and research grants, why should insurance companies not be required to be 501(c)(3) organizations?

This may not necessarily be the silver bullet that cures all our health care woes, but it would be fair and reasonable.

As part of our health care system, private and State Universities are where a great deal of the research, testing and development of new drugs, technologies and treatments is conducted. This is an essential component of health care in this country and is what gives it the real value it has. This is as it should be.

The research that goes on in universities as well as in drug company laboratories is very heavily regulated by the government at both private and state run institutions as well as industry laboratories. It is regulated for the safety of subjects who take part in clinical trials and to make sure everything at this stage is done ethically and soundly according to the highest scientific standards. And so that any drugs, treatments, or devices that come onto the market after this rigorous testing are safe for general use. This is all done largely within an environment where profits are not part of the picture while costs and methodologies are strictly controlled.

Profit-driven drug companies are part of the health care system in this country too. But they are forced to submit to government regulation in the development and pre-market testing of those basic instruments - drugs, devices and all essential elements of medical practice.

Drug companies are, in fact, essential parts of our health care system. They pour large amounts of money into research and development of medical products and are therefore entitled to profit from their efforts. No one believes that medicinal drugs should be allowed to be sold on the open market before undergoing rigorous scientific testing for safety and efficacy. So testing of manufactured drugs is strictly regulated by the government and conducted largely in nonprofit university and other research environments. It is only after those drugs and devices have been put through rigorous testing that the idea of profit comes in.

Drug & device manufacturers do not profit from their efforts until they have been approved by the Food and Drug Administration and only then may be justified in pricing their goods to produce profits for their invention and work. Still, access to the most sensitive and dangerous drugs on the market is controlled by the government through requirements of prescription.

This heavy-handed application of government control is deemed appropriate by necessity. It is the role of the government to exercise this kind of control because no one would trust a profit-driven enterprise with such authority.

Manufacturers' profits are justified in the end because they have actually produced something of value and spent millions of dollars in research and development, complying with a barrage of government regulations. I hear no one arguing that drug companies who bring goods to the market should not profit from them.

But the most outrageous profits in our health care system are made by the middle men, the distributors of health care, insurance companies and their investors, who add nothing of value to the product or system but only step in after all the work is done. They step in and totally queer the system. They do nothing but reap the benefits of production, testing and labor done in industry and in the nonprofit sector, after the fact.

The astounding profits insurance companies make come without their doing anything more than gambling with the money we must pay to them for coverage. It is literally legalized gambling. The games of chance they play and force us into are carried out through strategic decision-making in matters of how health care products and services will be distributed in the market. Their decisions are necessarily based on what it takes to return the highest profit to their shareholders.

Given the fact that healthcare is by no means a luxury, what they do is way way above and beyond unfairness. It is unspeakably immoral.

It is immoral for profit-driven health insurance companies to jump in after all the work is done and take control of how much we have to pay and who will get access to treatment - life and death decisions - while taking huge obscene profits and salaries just because they can.

Insurance companies are only incidentally a part of our health care system. And they are the part that adds nothing of value to health care itself.

The only thing they do is make it expensive.

Under the current system, health insurance companies are nothing more than virtual casinos where we the people are forced to place high stakes bets against the odds that we will not stay healthy. As long as we are playing the game and not losing - that is, not getting sick - we just keep ponying up, because it is the only thing that makes us feel at all secure against the knowledge that without insurance we could lose everything. We pony up hoping for a big payoff when we need it.

But as with all casinos (suspiciously also prime attractions for organized crime) the house always wins.

That is the ultimate function of for-profit insurance companies - to make sure the house always wins.

They assure this by controlling the distribution of health care among the losers and infrequent winners who have no choice but to gamble with them - to pay into their schemes. Because there is no alternative. There is no not-for-profit choice. No government control over access and distribution in the market as there is in every other area of health care right here in America.

For those who fear that a government health care system will take away your freedom of choice, listen up! You have NO CHOICE now but to gamble with your health. Call it public option or socialized medicine if you want. We do not have it. And we are the worse off without it. The only ones who are guaranteed a benefit in the current system are those who run the system and profit from all the money you pay into it. The house always wins.

Is this practice really what the tea baggers are so up in arms about defending?

If Health Insurance companies were mostly nonprofit 501(c)(3) organizations - that is, if profits were taken out of health care distribution - then politics would also be taken out of health care to a very great extent.

Just as Universities and all other 501(c)(3) organizations are barred from participating in electoral politics and lobbying, so would health insurance organizations be barred from trying to influence legislation. This may be the biggest fear of the health insurance industry - the loss of their ability to influence legislators with campaign contributions and the loss of their ability to use propaganda targeted at ignorant angry insecure crowds to motivate them to lean on their elected representatives to keep their profits rolling in.

Americans are right to feel insecure about the health insurance system as it is and how it may be changed without giving us a not-for-profit alternative. If the tea bagging crowd is concerned about the government taking over health care in this country and forcing us into a socialist dictatorship, it's too bad they do not understand that the government already has control of healthcare in this country, as it should. The government controls every area of health care except where it comes into our lives in a meaningful way and is most needed.

And as it has had this kind of control for more than a half a century.

In the screaming matches over the politics of health care there is never any mention of the DHHS: Department of Health and Human Services - a department of the federal government that has been around since Dwight Eisenhower signed it into existence as the Dept. of Education & Welfare in 1953. It became Health & Human Services in 1979 and incorporated the National Institutes of Health beginning in 1979. DHHS includes the Food & Drug Administration (FDA), The Centers for Disease Control and Prevention (CDC) and the 27 agencies that make up the National Institutes of Health (NIH) today. After the enormous Department of Defense the DHHS represents the largest government endeavor measured in spending. This dedication of government resources is what gives us the claim to having the best health care system in the world, which we do have -- in every respect except in benefit distributions. And this is due to the lack of a governmental health distribution system.

After more than 50 years of government control of our health care system only now are we being sold the absurd idea that government involvement in health care is a socialist idea.

Clinging to power in the federal government, Repugnicans who defend the status quo profit-driven health care distribution system are the most hypocritical and immoral people in public life today. They may not be totally evil monsters driven by a desire to deprive anyone of access to health care but they are clearly driven by political lust for the power they have lost. They are, then, totally evil monsters because they are intent on reinforcing the ignorance that their tea bagger base brings to the table - by repeating debunked misconceptions, lying and crying about being shut out of the process - only as a calculated strategy to regain power. They are not interested in reforming health care distribution at this time. They only care about making the Democrats fail at the expense of the country.

Based on current and recent experience, there is no reason to trust that any Repugnicans will vote for whatever watered-down bill that comes out of this Administration. Not even the sickeningly weak bill the Senate Committee has produced that gives the profit-driven insurance companies nearly everything they want: most of all millions more unwilling profit-generating customers.

All that Repugnicans want out of the whole flim flam show is to make the Democrats look stupid or weak so that voters will go back to the Repugnican Party next election by default - in order to teach the Democrats a lesson. As usual, the Democrats are feeding right into their stupid game. But the Repugnicans are playing the dirtiest form of power politics at the expense of our lives and well being - and they know it. And it all seems to be working. In the end they are all evil monsters and we are all screwed.

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