Is Your Life Cost Effective ?

Where does one start? For that matter, where does one end? I'm referring to health care. More specifically, America's health care. In trying to prepare for this topic, I've pored through hundreds of documents and news articles, attempting to get some sort of grip on where the problems actually begin. To find the root causes which might lead to a fix. And I find it's similar to a physician examining symptoms in order to gain clues as to their cause. As with any patient, if diagnosed correctly and tackled head-on, it could improve the overall health and possibly save their life.

But in this case the patient is the health care system. And what I've found is, though the symptoms are many, the diagnosis is typical and the prognosis fairly predictable. When physicians become businessmen and -women, health care becomes a numbers game. And when profiteers control and run the system, the rewards become a matter of quantity, rather than quality. Rewards that move up the ladder as profits, rather than down to the patient level in the form of care.

The root cause is not very surprising. It can be found throughout our society, busily infesting the heart of most all of our ills, whether at the highest levels of industry, finance or government, or at the lowest levels in our relations within our own communities. Money and greed. No earth-shaking revelation there. But we're beginning to see it become pervasive at every level.

Admittedly, that's what capitalism is all about. But I don't believe that every man for himself was the battle cry shouted on numerous battlefields by American soldiers, under a proud flag which supposedly unites us. It doesn't work on the battlefield. And it doesn't work in our lives, for much the same reasons. And yet, it's become the credo which governs the way we do business, the way we treat our fellow Americans, and the way we manage our health.

Which brings us to the downside of a system based on money, where profits matter more than people. Wherever, whenever there is an opportunity for money to be made in large amounts, it might just as well be blood in the water of a shark tank. The resulting frenzy which occurs causes larger and larger amounts of capital to be injected, creating larger and larger profits. Often, as we see in the typical Ponzi schemes, it becomes the ongoing greed itself which generates the wealth, largely due to its own inertia. This in turn creates irrationally inflated bubbles, as with the dot-coms and the financial derivatives which have put us in our current predicament. But, though we all tend to suffer the consequences when these bubbles burst, it must be noted that it was greed which created them, inflated them, and ultimately caused them to burst.

There is also another type of bubble, differing in that it is not created as simply another vehicle for accumulating wealth. At least, not in the beginning. But once it is discovered that large amounts of money can be made, the blood is in the water and the sharks begin to swarm. The most attractive and notable difference with this bubble is its potential longevity. For this bubble is the health care of the citizens of the United States. And the potential for profits, at least for the short-sighted, is endless. It's not based on consumer wants or the cycles of financial markets. It is a profit machine whose longevity is guaranteed because every man, woman and child has to have it. They have no choice.

A diabetic or a cancer patient is clearly not a consumer. And these are not consumer choices. And yet that is exactly the dialogue you will hear in the private health care industry when they speak of increasing profitability, gaining market share, and marketing their health care products and services. And of course, "increasing efficiency", which means essentially giving less care for more money.

You see, in the for-profit corporate world, executives move freely between diverse industries. There's no need to have any particular expertise in these industries because it's all just a matter of widgets. Knowing how to generate profits. And in the health care industry, we are the widgets. It begs us to ask the question: Do we really want our care, if we are in an accident or suffer a serious illness, to be decided according to whether we are profitable or cost-effective for a provider or an insurer?

Unfortunately, that is exactly where we are. So it seems that to take the profit motive (i.e.-cash cow) out of our health care, or to at least mitigate its influence, would be a no-brainer. For the nearly 72% of Americans in favor of a public option, it is. But for the rest (as well as our representatives and governments) our current system, bad as it is, is enough. As President Obama has elaborated, people tend to be afraid of change. So much so, that they're often willing to stick with "the devil they know". But this isn't some sappy song which declares to know, know, know him, is to love, love, love him.

In an article to be published in the August issue of the American Journal of Medicine, a study by Harvard University researchers found that 62% of all bankruptcies in 2005 were medical-related. That was up from 51% in 2001. And these bankruptcies all occurred before our recent economic downturn (and despite a 2005 law making bankruptcies more difficult). If you're thinking this was obviously due to the 46million uninsured, the study also found that 78% of those medical-related bankruptcies were filed by people who had insurance. One can only imagine what those numbers look like now. (That LA Times story can be found here.)

Another study in July of 2008, by the Commonwealth Fund, found that some 75million are uninsured or under-insured. For instance, you may be paying $800, $1200, $1500 a month for your insurance. But with an accident or serious illness, the out-of-pocket expenses could still total in the $tens-of-thousands. And with deductibles going up, alongside premiums and the cost of care as a whole, who can afford illness?

We are then left with families paying more per month for health insurance than for their homes, yet avoiding care simply because their deductibles are so high. They're basically insuring themselves against some catastrophic illness which might one day take them by surprise. They can't go to a doctor because they can't afford it. And all the while the insurance companies happily accept their payments. Sadly, the surprise often comes when they discover that their coverage is inadequate even for that catastrophic illness they've been insuring against. And if the illness also resulted in a job loss, they are likely to lose everything.

Question: When is insurance not insurance?

Answer: When you need it.

The point is, our health and well-being should not be subject to creating wealth for shareholders, executives, or anyone else. (This includes doctors who are more businessman than physician.)

And if you're relegated to this ongoing and growing trend of every man for himself, then perhaps it's also time for those who benefit the most to pay for our armed services. Let's privatize the military. In fact, let's privatize everything. Let only those who can afford it have their blazing home saved by a for-profit fire department. Police? Let them charge for every time they respond to a call. If your credit doesn't check out, so sorry. And while we're at it, let's get rid of that quaint American flag. Instead, we can sell our nation's banner to corporate sponsors, just as we do with our sports facilities. That'd be great! Good ol' United States of Goldman Sachs ...... this year.


NEXT UP: The Devil You Think You Know

Now Would Be Good

In my previous posts I've talked about what it means to become an informed citizen, and given you some tools to help you reach that goal. I've also discussed the importance of making your voice heard. I'd intended to continue along those same lines, but instead have decided to address an issue that concerns every one of us. Coincidentally, it does fall in line with my previous posts in that it requires you to raise your voice, now more than ever.

For more than sixty years our elected representatives have been attempting, to various degrees, to address the problems of our nation's health care. Time after time, through every new administration, our governments have faced the issue simply because we demanded it. And unfortunately, those efforts have always proved to be meager at best, as we have forever witnessed our supposed representatives simply going through the motions in their attempts to appear to be doing something, while maintaining the status quo. Any fixes have tended to represent the health care industry they protect, and have amounted to applying a band-aid when a tourniquet is required. Medical malpractice of a legislative kind. Or perhaps just treating the symptoms instead of the cause.

Of course, the arguments which have worked so well in the past are being unpacked for another go-round. We hear that we don't want "socialized" medicine, even though Medicare would fall under that definition (as well as the health care coverage of every one of our representatives, paid for by taxpayers, while the same representatives vote to deny those benefits to the rest of us).

We hear that we don't want the government to decide whether we receive care or not, even though our private insurers do the same and worse, actively and routinely seeking to deny coverage, paying for investigators to unearth pre-existing conditions, and raising premiums and deductibles, all in the interests of generating enormous profits for their shareholders and executives. "You won't be able to choose your own doctor. You'll have to wait for treatments. Quality will deteriorate ..... ad infinitum."

All of these arguments have worked in the past, so it's no surprise that they're being used once again by those who benefit the most by leaving things the way they are. But for 43 million Americans, all of these arguments are becoming moot points. And with each bankruptcy caused by crippling health care costs, that message is becoming less effective. Every small business forced to close or drop its benefits due to skyrocketing premiums, every family or individual paying more per month for insurance than for housing, and every opportunity missed for reform leaves the same old arguments appearing dog-eared and worn. And with so many Americans uninsured or underinsured, and more each day, it becomes more difficult to suppress the truth. What is the truth? GREED. You've heard it from me before: Follow the money!

LIFE AS TEACHER

Years ago, I worked for an insurance company. I was employed in one of their large branch offices. At the time the company was owned by American Express, a very well capitalized parent company, indeed. That should give you some idea of the money to be made in insurance. I recall, at the beginning of a particular year, they had announced their income projections for the next twelve months. I also recall, six months later, when it appeared they would not meet their projections, the insurance company was instructed to begin dropping policyholders. That meant anyone who was any kind of risk whatsoever was to have their policy canceled. They would meet their projections, one way or another. It was all about the money. It still is.

That was an early lesson that did not go unnoticed by me. And that is why now, as in the past, when insurers in particular begin to offer cost cutting measures in good faith, when they openly acknowledge the crippling costs of coverage and volunteer to become caring partners in the health and well being of all Americans ..... I hear only dishonesty and desperation .

And I also hear the pleas of an entire industry that has been charged with the health care of all of our citizens, our mothers and fathers, sisters and brothers, our families and friends. I hear a $1 trillion industry that knows full well if Americans are given a choice, the continuing larceny of business as usual will at last come to an end. And the devastating costs of health care, along with their predatory profits, will die. This is why they are willing to do whatever it takes to deny you that choice. It's why, right now, you need to raise your voice and be heard. The industry is spending a lot of money to plug the ears of our representatives, and it will take every one of us in order to get through.

In my next post we'll examine some of the arguments being tossed around, as well as look at the cold hard facts which will inform you so that you can decide for yourself. But many Americans don't need facts and figures to be convinced. Their lives have already been touched and they have suffered the results.

I'll end with just a few noteworthy facts which lead us, as always, to our number one rule: Follow the money!


AMOUNTS SPENT BY HEALTH CARE LOBBYISTS IN THE FIRST QUARTER :

• $6.4 million - 5 largest private insurers and trade group America's Health Insurance Plans

• $1.5 million - United Health Group

• $809,000 - Aetna, Inc.

• $1.2 million - Wellpoint, Inc.

• $ 370,000 - Humana, Inc.

• $ 6.1 million - Pfizer, Inc. ($3.3 million in fourth quarter of 2008)
  

Follow The Money

In our United States of America, we happen to live in a capitalist society. Not such a bad thing, really ..... in good times. In bad times, as we are finding out, capitalism can be ruthless, unjust and uncaring. That should come as no big surprise. After all, by definition a capitalist society is one in which capital and its accumulation has been made a priority. Sometimes that priority gives it precedence over all other considerations. And that is not such a good thing. Especially when one considers capitalism's inbred cannibalistic nature. In short ..... it eats its own.

Luckily, we also live under a democratic form of government. I say luckily with some ambivalence, simply because the idea of majority rule appears to have become no more than a "quaint notion". I can recall when NAFTA (the North American Free Trade Agreement) was first passed. An overwhelming majority of Americans were opposed to it, and lit up the switchboards of their supposed representatives to let them know. NAFTA passed, just the same. Even though most of those representatives could not tell you what the treaty contained. They hadn't read it.

We're seeing much the same " business-as-usual" representation now with the public's demands for healthcare reform. Polls have shown that nearly 70% of Americans favor a single-payer plan for their healthcare coverage. Yet, even though the present costs of healthcare are crippling families, businesses, and the economy ..... our representatives do not seem to be listening. In initial hearings on the topic, single-payer was not even on the table for discussion. No one was invited to speak.

The great promise of democracy, at least on the surface, is that a government will be required to govern according to what is in the best interests of the greatest number of its citizens. Else, through the ballot box, the greatest number of citizens will elect a replacement who is more sympathetic of their needs. At least, that is the promise.

But, capitalism and democracy are not synonymous. And unfortunately, though they can and do coexist at times in a mutually beneficial relationship, they are most often at odds with one another in a powerful tug-of-war for supremacy. Given the choice, I will cast my lot with democracy. Capitalism is fine, so long as it takes a back seat to the will of the people within a nation, a state, or a community. At the moment, it happens to be in the drivers seat.

And yet, there are still those occasions when democracy has been able to push back, to limit capital's excesses which might harm the many, to the benefit of the few. It is still a powerful tool for an informed public armed with the facts. Considering this, what would be to the advantage of a powerful and well connected minority, in the face of an active and well informed public?

In keeping with my habit of including Thomas Jefferson, here are some more of his thoughts, written in a letter to Justice William Johnson , in 1823:

" ... The doctrines of Europe were, that men in numerous associations cannot be restrained within the limits of order and justice, but by forces physical and moral, wielded over them by authorities independent of their will. Hence their organization of kings, hereditary nobles, and priests. Still further to constrain the brute force of the people, they deem it necessary to keep them down by hard labor, poverty and ignorance, and to take from them, as from bees, so much of their earnings, as that unremitting labor shall be necessary to obtain a sufficient surplus barely to sustain a scanty and miserable life. And these earnings they apply to maintain their priveleged orders in splendor and idleness, to fascinate the eyes of the people, and excite in them an humble adoration and submission, as to an order of superior beings."

Nearly two centuries have passed since that letter was written. But one could go back two centuries more, and another two centuries before that. There have always been the extremely wealthy few who have sought to maintain the status quo, insulated from the masses and the will of the people. And as Jefferson observed in the governments of Europe, the best way for the priveleged to maintain "business-as-usual" is to keep the majority ignorant, struggling, and submissive.

This has been a very roundabout way of offering you some tools I had promised, which we can all use in becoming informed citizens:

>Rule #1 Follow the money!

> Rules 2-10 Follow the money! This is the most important filter you can apply when considering anything and everything ... and the who-what- when-where-why and how of all that occurs. (In a capitalist society, in which it's essentially become all about the money, very little occurs that does not lead to someone's financial gain.) Follow the path to the trail's end and you're likely to discover all you need to know.

> Rule #11 Always get a second opinion. Or a third. Good advice whether you're preparing for surgery or searching for the truth. Don't depend on a single source for your news or your facts. No matter which way you lean on the political spectrum, look for opinions and news from all sides. Years ago, during the Iran/Iraq war (as with many wars), both countries inflated the casualty figures of the enemy, while reducing their own counts. One had to consider both sets of numbers and the truth was usually somewhere in between. It's the same with politics and big business. Each side will commonly point to the evils of their opponent's positions. They may both be right. But you'll never know if you only listen to one voice.

> Rule #12 You can't know everything ... and that's OK. Always be on the lookout for new facts and information. It's not a sin to be passionate about the facts as you know them. Likewise, it's no sin to admit your opinion is based on those facts as you know them. If someone offers you new information, hear 'em out ..... and then check 'em out. It's better to find out if it's true, than to simply dismiss it out of hand.

> Rule #13 Resist the "herd mentality". In every issue there are those who may attempt to start the stampede by appealing to your emotions ... first and foremost. Check out the facts for yourself and then decide how you feel about it. If you're outraged by the facts (and nothing but the facts), then by all means ... be outraged! Emotion is a powerful motivator. Unfortunately, there are some who will try to bypass the facts and go straight for the gut. Especially when all else has failed, or if to use facts would be detrimental to their interests.

There are a number of other tools which can be helpful in becoming an informed citizen. But, in essence, don't believe half of what you hear. And always .....ask yourself who benefits. Follow the money!

Lastly, I can't help but return to the healthcare debate. We have an historic opportunity to end this fleecing of the American family and finally provide affordable healthcare for all. The fear-card being played by the corporate sector is that you'll have some bureaucrat in government deciding whether or not you receive care. This is not true. And even if it were, how different can it be from some bureaucrat of an insurance company deciding whether or not you receive care, especially when the number one concern is making profits? Since when has a large corporation truly cared about what was best for the people? Follow the money!

I'll end with a bit more of the writings of Thomas Jefferson:

" I join in your reprobation of our merchants, priests, and lawyers for their adherence to England and monarchy, in preference to their own country and its constitution. But merchants have no country. The mere spot they stand on does not constitute so strong an attachment as that from which they draw their gain. "