Saturday, March 5, 2011

Healthcare Reform: Control and the Insurance Industry

[This is a post in reponse to a discussion thread about healthcare reform.]

There are a couple of very interesting threads going here. I'll try to steer a course through the "control" statement so you can see where I'm coming from.]

One individual said, ". . . the true crux of the conversation . . . can be reduced further to a single word: CONTROL" Now, I sense the implication was that control, the kind that tells me what I can and cannot do, is a bad thing. If I've misread that, I do apologize.

While I don't know if the statement was intended to ferret out who is "with us" and who is "against us," you have to acknowledge that without an abundance of control, there is chaos. The FAA "controls" airspace. That's a good thing. The USDA "controls" much of the practice of raising commodity crops. Many farmers chafe at that, but it does bring stability to the commodity pricing structure and worldwide demand situation. Despite lots of laws, lack of adequate oversight (or control) seems to have played a role in the banking collapse in September of 2008. Why do we pay so much of the national defense? Control! Yet there is very little control over what I say in public or over how many guns I own. There is a place for control and a place for it to be set aside. Balance is the tricky part.

To those who say we need to get the government out of everything, let me invite you to move to the Republic of Somalia where there is, effectively, no government. But apparently that isn't paradise either, because we have so many Somali immigrants here that I have to translate patient education materials into Somali to help advance their level of health literacy.

Government and business have very different roles in our society. If you need to establish ownership of your home and request a title search, you go to a business, a title or abstract company, to do research using documentation gathered and preserved by governmental entities. If you need a permit to build a house, the builder doesn't keep data on the land, soil samples, flood planes, ownership, easements, etc. You go to your local government to get the information. And those pesky inspectors that try to prevent you from building a structure that is unsafe -- oh, that's the ultimate in control. Until, that is, the place collapses and insurance doesn't want to settle the claim. Then they take it to the court system -- another governmental intrusion -- that has to sort out legalities and determine what's fair. If the person on the other side of the courtroom attacks you, the police step in to re-establish -- you got it -- control.

I guess at this point, I'd assert that there are many things that government does that are necessary and that are done quite well.

There is a valid point of view that says everyone should participate in a healthcare payment system so that the liabilities and benefits are available to the greatest number of people. (Have you ever tried not paying the Defense Department portion of your Income Tax?)

To denigrate the capabilities of the federal government because they can't meet someone's expectations for the cost of Medicare and Medicaid begs the question: Why is it that the elderly, the disabled and the veterans -- the most expensive groups to care for -- get their care from the federal government. If the free-market capitalistic system is so efficient and admirable, why are the most costly groups dumped on the government. I'd say it's because no one can turn a profit on those groups, and thus, will not accept the responsibility. (Using "pre-existing" conditions was another way of excluding those that didn't fit into a profit model.)

Government, in addition to many other things, does what would otherwise not get done. When's the last time Exxon-Mobile built, staffed and funded a facility for veterans? Or an insurance corporation, for that matter, provide coupons for free meals to the homeless or families needing food? If not for government, what kind of education would be available in rural Wyoming? How much of the technology we take for granted had the basic research funded by government grants? Why does the CDC worry about getting the flu vaccine "recipe" correct when it is the insurance companies and healthcare organizations that will be spared enormous costs?

Repeatedly, it is the government that has taken up the humanitarian torch for our society.

Why don't we have orphanages filled with disabled kids like some of the eastern bloc countries? Government intervention, regulation and direct care.

Now, tying the issue of control to the issue of healthcare reform, I agree that much of the fight is about control. But I see it as the insurance industry fighting to maintain control of the enormous amounts of money they absorb to support the industry that is providing little if anything to advance the health of the people. Other than providing a lot of jobs, I have a hard time making a case for the existence of a for-profit insurance industry.

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