Tom Hayes: The profit motive is great, but...

There was a time when the concept of community was strictly geographic - in practical terms, what happened to people who directly affected your chance of survival was what mattered. Money and technology have profound ramifications for how we see communities and how they function.

We're all utterly interconnected.

Here's an overview, with excerpts, of the recent article, "Communities of Interest" describing the debate over health care insurance reform from a moral and community perspective at the Actualizers blogsite:

In the richest, most technologically advanced nation in the world, the United States of America, we are debating the merit of extending health care coverage to tens of millions of our closest friends and neighbors by making it affordable. Tens of millions of American citizens have no health care insurance.

Yet, rather than examine the successes in other countries and adopting their best practices, big business interests in this debate are spending millions of dollars every day (collected from health care premiums) to influence the men and women in Congress, who are sorely outnumbered by the lobbyists. It's a travesty - a sham - that makes a mockery of the alleged reliance on free markets to insure efficiency and improvement of goods and services.

One way or another, we pay.  One way, with only some of us insured, we not only pay for the costs of treating the uninsured, including potentially their bankruptcies, we also pay 8-digit salaries and bonuses to CEOs and lobbyists who profit from rising costs that have outstripped inflation for three decades.  Those costs do get spread across the area where the insurers do business, of course.

There's certainly no "perfect" system, and there's big money riding on keeping things "as is,"  but one thing has become obvious to even the most casual observer:

There's lots of room for improvement in the current scheme, for finding a fairer way to distribute the costs while controlling the expenses, and the benefit of improvement will flow to you, and me, and our community - no matter if you think of community as the neighborhood, the city, the country, or the planet.

The "profit motive" is great. It brings consumers choices for fair trade coffee, and tea parties, and "out-of-season" blueberries, and Blackberries™, and a veritable plethora of choices for our transportation, wardrobes, and more. It also brings the cost of MRIs down in Japan, by orders of magnitude when compared to what we pay in the USA - why is that? Because we've let the system of paying for health care mimic a competitive market, and fallen for the eristic rhetoric that preserves the profits of these gargantuan companies, sometimes operating as virtual monopolies. In practice it's not possible for a consumer to make a real, let alone well-informed choice, about health care costs or insurance.

The Congressional Budget Office has notified Congress that tethering a public option to Medicare reimbursement rates would save the government $110 billion! That's more than even a "public option" in which the government has to negotiate rates with doctors and other health care providers, which the GOP seems so opposed to. There are LOTS of ways to improve the bottom line -- but the bottom line is:
It's time to get the profit motive out of health care insurance.

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Health care isn't the problem - health insurance costs are

Some people who say the government "can't do anything efficiently" also now say a public insurance system competes with private insurers unfairly – these fear it will out-compete big business? CEOs earning tens of millions of dollars per year fear free market competition?

The cost control problem is that the idea of controlling health care costs is contrary to earning insurance company profits - what incentive there is only applies to their own costs of operation. When the cost of health services go up the big insurance companies just make a cut of a larger price-tag.

That's why U.S. health care costs have tripled the rate of inflation for three decades. Insurers have no incentive to moderate health care costs, only how much they profit -- so naturally they insure the healthiest, and make it hard to get help with pre-existing and/or expensive conditions.

Sometimes they even countermand medical decisions. Bureaucrats worrying about their bottom line can over-rule a licensed doctor's prescriptions and treatment orders to protect the corporate profits.

There's no real choice when an individual enters the health insurance market. They bundle in with the group at work, which has a very narrow range of choices - and every insurance company makes about the same markup on the same basic services, so the costs (concealed in overly complex plans) aren't all that different.

The government's role in fixing the system for our mutual benefit is to model efficiency - at least until big insurers learn to deliver their services efficiently - to compete.

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