List Archives

Mon Jul 27 21:45:55 BST 2009

________________________________
From: "Bjorn, Pret" <pbjorn at emh.org>
To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
Sent: Monday, July 27, 2009 9:04:45 PM
Subject: RE: [MailServer Notification]Content Filtering Notification

[SNIP]

> The commercial insurance industry is not beholden to society, but to
> executives and investors who measure success not by excellent
> evidence-based services -- much less the enhanced health of the customer
> -- but by financial profit.  The commercial interests have already
> signed up all the responsible citizens who are aware of their morbidity
> and protective of their fortunes (provided they could afford the
> premiums).  
>
The industry as a whole is not beholden to the executives and owners, rather the individual companies are, and they compete against each other. That, of course, is not only true of insurance companies, but of almost all for profit businesses in the US. You could make the same arguments about any business. Should we just get rid of private enterprise all together and let the government take over all industries. Seems to me quite a few countries tried that,  with generally very poor long term outcomes.

Yes, insurance companies are in business to make a profit, but no individual company can be profitable without customers, and at least for now, the customers of an insurance company can, theoretically, vote with their feet. Consumer choice is an important market control mechanism, but its effectiveness in the health insurance market is greatly diminished in the US by several factors, three of which I would like to address here.

For one thing, most people get their health insurance through their employer, which severely limits the amount of choice they have. Even if the employer provides for a choice of policies, they are often all from the same provider, and the rules attached to paying the premiums with pre-tax dollars also limit the possibility for changing providers to one time per year, at least that's the way it was 10 or so years ago when I last worked in the US.

Furthermore, the employer's provide the coverage makes the employer the customer of the insurance company, whereas the employee is the consumer of the health care. That disconnect also makes it next to impossible for the individual patient to influence the insurance company directly.

Lastly, and, IMO most importantly, there is far too little information about the individual insurance companies available to the market. The above problems notwithstanding, if consumers could go to an independent Web site or order a report by mail and find out that for similar coverage costing similar amounts, Company A denies 40% of claims, Company B 20% and Company C 2%, how long would it be before consumers are flocking to Company C, forcing Companies A and B to change their practices or get out of the market?

> And with the focus off actual disease control (which would regrettably
> run counter to marketing), then the quickest way to amplify the
> quarterly net revenue is sadly predictable: by denying the illness or
> delaying its treatment.  Every month a policy goes unclaimed is another
> incremental accrual of capital.
> 
> These guys've got a business to run, after all.
> 
> But that's America, ain't it?  God forbid we should criticize
> capitalism.  Let's instead imply that people who can't afford or qualify
> for insurance are inherently undeserving and/or insufferable whiners.

Again, you could make these arguements about most any business. What about auto mechanics who install inferior parts to increase their profits, or supermarkets that restamp sell-by dates on meat (and perhaps ship it to a market in a poor neighborhood) or or or....? Should the government take over the repair of automobiles and the sale of groceries? As in those cases, what is called for in health insurance is a balance of sensible regulation, including criminal sanctions for the worst violators, and a market that is allowed primarily to regulate itself.

And that's just considering the issue of insurance companies' blocking access to care to increase their own profits. IMO a much more releavant (based on my understanding of the purpose of the federal government) and important (based on the long-term effect on the average American) issue for the federal government to consider than the access or quality of care issues is the massive cost of healthcare. Once you start considering the cost to society as a whole and what we get (or don't get) for what is spent, the argument for fixing the problems with market controls in healthcare and health insurance rather than having the federal government take a bigger role in governing those industries becomes stronger still - indeed many times stronger.

Let's fix what's broken in the system we have and give it a chance to work, before we replace it with a system that has at best a questionable chance of succeeding and at worst will further drive up the already massive cost of healthcare while driving down quality.

Respectfully,
John Annen

> Sigh.
> 
> Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Gross, Ronald
Sent: Sunday, July 26, 2009 6:59 PM
To: 'Trauma-List [TRAUMA.ORG]'
Subject: FW: [MailServer Notification]Content Filtering Notification

...

Now, look at the rest of the labor force - yeah, the very same folks
that we provide health care to - and tell me how many of those that
demand and expect health care as a God given right have earned their
paychecks, and have earned the right to the same quality care that you
and I pay for.  Sorry to sound so damn cynical, but therein lay the
basic problem that has rotted the infrastructure of our society as we
know it today.  I am tired of looking at the elephant in the room and
calling it a G*$-D@*$#!' mouse!

OK - fire away.

Ron

Ronald I. Gross, MD, FACS
Chief of Trauma & Emergency Surgery Services
Baystate Medical Center
Assistant Professor of Surgery
Tufts University School of Medicine
759 Chestnut Street
Springfield, MA  01199
413-794-4022  phone
413-794-0142  fax
ronald.gross at baystatehealth.org

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

List Archives

For your convenience, find the Trauma List Archive Below

[MailServer Notification]Content Filtering Notification