24 October 2008

Profit motive: leading cause of being uninsured.

From November 2007: One of the state's largest health insurers set goals and paid bonuses based in part on how many individual policyholders were dropped and how much money was saved.

Woodland Hills-based Health Net Inc. avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006. During that period, it paid its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies, documents disclosed Thursday showed.

This is the dream of free-market fundamentalists, y'all. Profit, profit, profit! Informed consumer choice! But in the reality-based community, informed consumers have no choice, when insurers won't cover them because the consumer will cost them money.

This all profit, all the time motivation has screwed up health care in this country so incredibly horribly. It's the reason state governments have had to mandate that insurers cover certain diagnoses, procedures, and medications. It's the reason the population of the uninsured is partly full of the uninsurable - people whose pre-existing conditions make premiums on the individual market impossibly expensive, if they can even find an insurer willing to give them a rate quote.

How many of you have time to read all the medical literature to be a fully-informed consumer of health care? How many of you can understand medical literature - the jargon, the stats, the pathophysiology? I work in health care, and I don't keep up with all the literature. It isn't possible.

Yet fans of consumer-driven health care (another product of the free market fantasy) believe that informed consumer choice is the ultimate in rational care. It's bullshit. It isn't. Patients rely on their physicians to be up to date on the best practices in their fields and to give them advice. It's not like buying a washing machine.

Is the insurance system in the US fundamentally fucked up? Hell yes. Would scrapping it and starting over be any better? Hell no. So we work with the shit we have to make it less shitty all around - for the patients. The consumers, if you will. I advocate single-payer plans like in France, Germany, and Taiwan. Getting there from the cobbled-together nonsense we have, let alone overcoming the modern American "fuck you, I got mine" ideal, is going to be really hard.

Some days I honestly think it would be easier to pack off to Berlin and be done with the heartless, selfish compatriots in this country.

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