FORBES: ‘A Gift? Health Care Without The Business.’

By  Elaine Schattner, Forbes, Contributor

Christmas is a holiday I enjoy through the celebration and joy of others. And I love it – the time of giving and singing and being with family and thinking of people who are needy.

Which is why I’m thinking of what the U.S. desperately needs, and what other countries have: a universal health care plan. One that Obamacare might have been, but so far isn’t: a system that provides appropriate medical care to everyone who needs it, without possibly causing their debt or bankruptcy of those who are ill.

The ideal system would lack all the paperwork, except for medical records. Your health information, including past x-ray and MRI results, pathology reports and images, doctors’ notes, lab tests for Lyme disease and your blood type – basically everything – would be accessible to all doctors who have your consent to look at them, and to you, the patient.

There would be no bills, and no billers, and no insurance companies to choose from. That whole industry – and the amount of dollars, computers, Cloud-space and workers – could be put to other use. Yes, I’m dreaming…

A few days back the State of Vermont realized or decided that its single-payer system wasn’t working. The gist of the reasons Vermont gave up on this potentially wonderful program (if only it were a health care tech start-up!) was economic. Part of the problem was that the Vermont plan posed a burden to local businesses, including a hefty pay-roll tax.

And that’s similar to the problem we’re encountering nationally – that businesses don’t want to provide insurance for their employees. The reason is simple: it’s too expensive. So companies are opting out, or offering cheaper plans that may not sufficiently help people when they’re ill and may need a lot of care, including critical aid from specialists at hospitals that may not accept their insurance.

I’m concerned that the U.S. Supreme Court is taking up a new threat to the Affordable Care Act (ACA), the case of King vs. Burwell. The issue has to do with the legality of federal subsidies for states that have declined to set up ACA insurance exchanges.

Which leads me to the key question, about which we all might agree: Can and should health care be run as a business?

Nurses and doctors and others who work in health care should receive fair, even generous, compensation for what they do, of course. People or companies who supply needed goods, such as machines and medicines, should be paid for what they provide, reasonably. But hospital networks (and the patients who populate those) as investment opportunities?

Profit as a healthcare endpoint? No. I reject that. Because we – people with breast cancer, scoliosis, diverticulosis, depression, whatever it is that you might have or had, or might develop in the future – are not commodities.

You may wonder how I can write here on expensive cancer drugs and high-quality screening while supporting a single-payer system. But I see no conflict at all. I believe that we can afford to provide those to all U.S. residents if we use our resources wisely.

The insurance industry, in itself, accounts for over 20 percent of U.S. health spending, and administration of care (including insurance) 30 percent, according to this 2013 Bloomberg piece. Our complicated plans feed on resources that might, instead, be used to cover the costs of preventive care for people who are well, and better treatment for those who have illness and wish to receive it.

Having been through a series of health care visits this fall, one operation and stacks of (yes, still) hand-written forms to complete, I am appreciative of the terrific care I received. And I don’t take for granted, for one second, that I am feeling well, or even OK – not in pain, able to walk, speak, smile.

Not everyone is so fortunate. If I could give a gift to everyone, it would be the quality of medical care I have received.


Categories: Business

1 reply »

  1. No enterprise, be it government or private, can exist indefinitely if it does not pay it’s bills and have enough to re-invest and grow with the needs of it’s constituency. Let’s not confuse a publicly traded company whose main duty is to shareholders with the fiduciary responsibility of a small business. Both are required to make money. The key difference is WHO pays them and WHO do they serve.

    A small business serves it’s customers, who also pay them. A publicly traded company ultimately answers to it’s shareholders; and I agree with the author, that is not a scenario I favor for healthcare.

    However, is political/bureaucratic/governmental self-interest somehow more noble economic self-interest? I say no. Do we really want government deciding what is humane or essential treatment or who gets a breast MR or just a plain mammogram; or how many breast biopsies are done? Do we really want an agency deciding how much our healthcare workers get paid? Again, I say no.

    With all its shortcomings and snares, I will trust the market (millions of people working towards their own goals in productive endeavors with common rules, and boundaries) over the bureaucracy any day. The problem as I see it, is that we do not yet have a healthy free market in healthcare that is able to solve the problems because their is too much reliance on third-parties both on the government and the private side.

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