May 30, 2009
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I've never been good at believing conspiracy theories. Most of them presume conspirators who are supernaturally smart, know things they couldn't possibly know, and are inhumanly successful in organizing and carrying out devious plots and grand schemes.
Yet in the current rococo debate about overhauling our health care system I find myself drawn to the argument that the health-insurers are trying to maintain a system that extracts profits from the misfortunes of sick people and poor people. I invoke the notion of moral hazard: a policy that tempts entities to do morally questionable things.
Example: In 2003, when I had chest pains, I was whisked through tens of thousands of dollars worth of tests and a hundred thousand dollars in triple-bypass surgery. It probably prolonged my life, though less expensive treatments might have done just as well. Who knows?
Of course, I was a temptation to health providers they could hardly resist: an otherwise healthy non-smoker, non-drinker, non-obese person who mowed my own lawn and bicycled all over town. Even better, I had federal employees health insurance that would pay for anything and everything a doctor ordered. It made me wonder if those of us who are insured, reasonably affluent and/or homeowners aren't viewed as cash-cows by the insurance, medical and pharmaceutical sectors.
... I dashed off those four paragraphs Memorial Day morning. Then, vaguely remembering that I had written about moral hazard before, I searched my computer files and found that I had - ten years ago ("No easy remedy for curing health care woes" Record-Courier 2/21/99) Here are some excerpts:
"In policymaking there is an oft-cited notion of 'moral hazard' - the argument that something intended to reduce or encourage certain behaviors will tempt people in the opposite direction. For example, laws requiring seat-belts may encourage people to drive faster and take more chances; Social Security discourages people from saving for their old age; guaranteeing bank deposits spurs banks to make riskier loans. ...
"One of the biggest pots of money available in the U.S. today is from the premiums for health insurance. The moral hazard is real here, and proved. Private health insurers do, as far as possible, avoid the poorest, sickest, and more costly elderly clients, and 'cherry-pick' the healthy, affluent, younger ones. They also spend liberally for advertising to compete for desirable clients. ...
"The present system  is bad enough, but now a plan has been proposed for the government to offer a subsidy (like a voucher) with which people could buy their own health insurance. Such a plan would be likely to tempt the insurance industry to price health insurance just as much above the subsidy as the traffic would bear - the amount that the largest number of people would be willing or able to pay above the subsidy. Insurers would compete, not to provide the best care to the largest number of people for the least price, but to provide the least care to the best clients for the biggest increment over the subsidy....
"If we are serious about supplying health care to everyone regardless of their ability to pay, the most effective and least costly solution would be a single payer system, in which the government directly pays medical personnel and hospitals for all health care services."
In 2009 little has changed. In ten years we still haven't addressed the moral hazards of paying for health care , or indeed the fundamental moral standards we need as a society.
Our highest moral values include caring for our neighbors, helping them in adversity, treating them as we would be treated, not harming them, and being fair in sharing the riches, risks and hardships of life on this small planet. This is not socialism, but community, and finally no society can long survive without such basic values.
We must all be touched by the stories of medical crises of some of the 70 million uninsured and under-insured people in our nation. But until the 230 million of us who have health insurance stop mooing about socialized medicine and the greedy undeserving poor while we are being milked by the insurance industry, nothing is going to change.
As it was ten years ago, our system presents a moral hazard - not to ordinary people trying to get decent medical care but to the private sector trying to make money for shareholders. This needs to be fixed, if only because we should feel humanly, morally obligated to provide every human being with access to medical care as needed.
The universal health insurance option recently proposed by Sen. Sherrod Brown is designed to keep the health insurance industry alive in a few giant corporation, from which each of us would have to choose one and pay its premiums and take whatever benefits it offers. It is intended to persuade us cows that our milk is buying our care and protecting our freedoms to shop for "good deals" in bypass surgery or colonoscopies.
The only option that removes profit-taking from our health care system - single payer - is not being heard from the White House, has been suppressed on Capitol Hill, and is widely ignored by the mainstream media - except for ads opposing it.
Single-payer would take private insurance companies out of the system entirely. Every person would pay some federal tax to create a pool of money large enough to cover the medical needs of everyone. That pool of money would pay providers from the private sector - doctors, hospitals, labs, pharmacies, etc. - like Medicare does now for people over age 65.
If we don't want to be treated like cows, we have to stop acting like cows. We need to assert our moral imperatives: health care is a matter of the common good - for our neighbors, our communities, our nation, and for the world.
The only human, moral option for universal health care is single payer.
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