Monday, September 14, 2009

Do You Want That With or Without Profit Motive?

In their never ending quest to prevent a government takeover of healthcare, except if you are under 18, or over 65, or a veteran or are indigent, the right wing has flogged this old horse repeatedly, and it goes something like this:

"I don't want the government, (or a government bureaucrat, or now a death panel), making decisions and getting in between me and my doctor! And universal [socialized] healthcare will result in rationing! And the USA will become the USSR!"

Well, if one is lucky enough to possess really good health insurance, who do you think makes these decisions? Corporate insurance adjusters who are driven by the bottom line. Bureaucrats. Their job, as in all cases where an insurance company is involved, is to find out ways their company does not have to pay out on their policies, or, to find out how to pay as little as possible. So a patient might not end up with the drug or the procedure that they were expecting to get, and that their doctor had, in his judgment, decided that patient should have.

And it should be patently obvious that by limiting the amount of healthcare doled out in the country to the above groups plus those who can afford their own insurance and those who are fortunate enough to have health insurance through their job, and thusly leaving out 40 or 50 million American citizens, is rationing healthcare.

Looking at certain situations where there is a government mandate to provide health insurance can be instructive. In one case there is the workmens' compensation situation, and on the other hand there is the no-fault automobile insurance. While both are mandatory within their respective spheres, one is administered to via a government bureaucracy and the other not.

Workmens' compensation is an imperfect system, but injured workers get healthcare they need for as long as they need, and a bureaucracy of government adminstrative judges oversee each case to prevent fraud and abuse. On the down side, workmens' compensation can be slow, often taking a long time to approve a given course of treatment. And while the insurance industry uses their own doctors to perform independent medical examinations of claimants, a claimants physician's medical opinion is given a lot of weight.

Then there is no-fault, which applies to those injured in automobile accidents. In the no-fault context there is little to no government administration. After approximately one month of treatment, a claimant is sent to see an insurance company doctor, and once a claimant is examined by that doctor there is a 95% chance any further treatment claims will be denied, no matter the actual condition of the claimant or how much pain they are in or how much therapy they really require. And the opinion of the claimant's doctor does not matter for a hill of beans. That's a private insurer directly affecting patient treatment and rationing care in order to protect their bottom line.

Then there is single payer healthcare, like Medicare. A claimant goes to her doctor, a treatment is prescribed, and the doctor is paid, though perhaps not as much as he would like [but who is?]. And patient satisfaction with Medicare is through the roof. And it is socialized. And patients get all the care they require. The same goes for the Veterans' Administration. And so far the USA hasn't become the USSR. Hmmm....

So, we are at the crossroads of healthcare reform. And the arguments of evil government bureaucracy and rationed care are revealed to be empty arguments, mere chimeras without real substance. And went you get to the bottom line do you want medical decisions made by a corporate bureaucrat worried about the bottom line, or by a bureaucrat who is only seeking to avoid fraud and abuse?

1 comment:

  1. When Obama complains that the United States spends more money on healthcare than any other industrialized country, I wonder if that number includes the unconscionable amount of money wasted on no-fault treatment for plaintiffs trying to build up lawsuits based on soft-tissue injuries. You know, where an internist, chiropractor, acupuncurist and physical therapist rent space in the same building and bill the crap out of No-Fault giving redundant and often fradulent treatment.

    Do you think Obama is taking about this when he talks about saving $500 billion in "waste, fraud and abuse"?