HEALTH CARE SYSTEMS: BIG PICTURE

LONG-TERM REFORM:
REPLACE FOR-PROFIT WITH NON-PROFIT INSURERS.

Strong capitalist countries such as Japan and Switzerland provide better health care outcomes at lower costs than the USA by relying on nonprofit insurance companies rather than for-profit or single-payer insurers. (See PBS Frontline documentary, Sick Around the World http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld )

Forty or fifty years ago, many USA health insurance providers – such as Connecticut’s Blue Cross and ConnectiCare — were nonprofits. Today, dominant for-profit insurance companies pervert traditional doctor-patient relationships, deny needed medical care, and impose devastating costs on health care providers, families and businesses.

For-profit health insurance is a business model with no moral justification. The federal government should reduce the influence of for-profit insurance companies by funding competitive grants for actuarial models of nonprofit insurance that delivery better outcomes at lower costs, and then provide seed money for selected startups that can vanquish for-profits in the competitive marketplace.

At the same time, intelligent, coordinated, relentless citizen coalitions must neurtralize insurance industry lobbyists and dethrone their “pay for play” elected officials.

Can we do it? Yes we can with leadership from the Obama-Biden administration!

– nathanhale

 

IMMEDIATE REFORM:

MEDICARE BUY-IN BY 50-64 YEAR-OLDS.

For-profit insurance companies pillage the incomes and devastate the well being of aging Americans not yet eligible for Medicare.

An obvious solution is allowing 50-64-year-old Americans to buy into Medicare’s large pool at affordable premiums. This could also reduce insurance rates for younger Americans by creating a separate pool of higher-risk older Americans.

– nathanhale

3 Responses to “HEALTH CARE SYSTEMS: BIG PICTURE”

  1. Hippocrates Says:

    What about the national insurance pool recommended by several Democratic Presidential candidates, including Barack Obama and Hillary Clinton? Wouldn’t they be not only non-profit insurance companies, but also subsidized in the case of low-income people?

  2. Bur Says:

    Comment from Amy Kalafa

    Until the federal government prohibits agribusiness and pharmaceutical corporate giants from determining food and health policy in America, our population will continue to be the sickest and fattest of all industrialized nations. Food policy is prevention. Small scale, diversified farms have been nearly wiped out in our country, resulting in factory farmed and highly processed foods being the cheapest, most available and least healthy options.

    The best health care is prevention, currently only 1% of the entire health care budget in the US. President-elect Obama must insist that schools clean up their food environment by connecting the curriculum and the cafeteria. We need to create a nationwide food literacy initiative, much as JFK instituted physical education during his Presidency. Wouldn’t it be great if First Lady Michele Obama takes on school food as her mission?

    A single payer system that gives incentives to medical professionals as well as individuals for maintaining wellness would bring health care costs down for everyone. There are wonderful models in Europe – really – I have elderly family members in France who are 100% satisfied with the care they receive.

    Until the federal government prohibits agribusiness and pharmaceutical corporate giants from determining food and health policy in America, our population will continue to be the sickest and fattest of all industrialized nations. Food policy is prevention. Small scale, diversified farms have been nearly wiped out in our country, resulting in factory farmed and highly processed foods being the cheapest, most available and least healthy options.

    The best health care is prevention, currently only 1% of the entire health care budget in the US. President-elect Obama must insist that schools clean up their food environment by connecting the curriculum and the cafeteria. We need to create a nationwide food literacy initiative, much as JFK instituted physical education during his Presidency. Wouldn’t it be great if First Lady Michele Obama takes on school food as her mission?

    A single payer system that gives incentives to medical professionals as well as individuals for maintaining wellness would bring health care costs down for everyone. There are wonderful models in Europe – really – I have elderly family members in France who are 100% satisfied with the care they receive.
    amy@angrymoms.org
    Amy Kalafa
    http://angrymoms.org
    0

  3. Leslie Wile, CSW, ACSW Says:

    A single payer system is definitely the answer, and I certainly agree with the above comments about the importance of prevention and the clamping down on the influences of agribusiness and the pharmaceutical corporations. For more than a dozen years (along with my private psychotherapy practice), I worked for Managed Care companies reviewing psychiatric cases, both inpatient and outpatient. The insurance companies hire the managed care entities to save them money, yet interjecting this intermediate layer brought huge, and in my opinion, unnecessary profits to the managed care entities. It was my task to review symptoms and the treatment given–and to determine whether continued treatment at a particular level was “medically necessary.” Inpatient cases were reviewed daily, and over the course of my tenure, the criteria for continued inpatient stays and the number of outpatient sessions became tighter and tighter. The last company I worked for also had a medical department which worked in the same way. By the time I retired, inpatient cases were having to be brought for “supervision” to our chief psychiatrist daily. If a patient’s stay began to exceed five days, there was pressure toward discharge. When I first began working for these companies, an intermediate supervisor advised me, “Always do what’s in the best interests of the patient,” which advice I never deviated from, even if it meant I was a bit “disloyal” to the company. My rationale for this was that by the end, criteria had “evolved” to the point where it was said that it was OK to discharge a patient who was still having psychotic symptoms (hearing voices, etc.). To me, this was unconscionable. As a “senior clinician,” my judgment was infrequently questioned.

    Another problem was reconciling the decisions of the medical department with those of the psychiatric department. These days, when many constellations of psychiatric symptoms are intimately related to neurological causality–and because MRI’s, brain scans, etc. are so expensive, patients are often given superficial treatment–frequently a cocktail of powerful drugs (pushed by the pharmaceutical industry) which can allay symptoms in a trial and error way, but which never really uncover root causes. Many of these medications can have immediate and disturbing side effects or eventual devastating results–e.g., irreversible stiffness of the body, neuroleptic malignant syndrome and even (yes, listen to some of the TV ads) death.

    In any case, over the course of my work for managed care, there were certainly a number of abuses uncovered; and discontinuance of payment to the provider and/or change of provider saved wasted money and presumably helped the patient. But, as far as I have observed, “Managed Care” as a profit making industry should be completely abolished. Review of cases (“utilization review”) could be accomplished as effectively by professionals employed by the single payer.

    I have been speaking of psychiatric cases, and the other practice that needs to be universally instituted is so-called “Parity” which is currently in effect in some states. Because of ignorance and antiquated stigma associated with mental illness, insurance companies in most states pay for psychiatric treatment at a lower rate than for physical illnesses. Frequently, those patients least able to
    pay the large differential/co-payments go untreated. Parity (equal rate of payment for psychiatric and medical treatment) is especially justified now that we have a better handle on brain function, genetics and the many newly discovered connections between neurology and psychiatry. In any case, as with so much of the vanishing of resources from our economy, corporate greed, along with a deficit of ethical accountability, seem to be the root causes of what’s wrong with our healthcare system.

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