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Dear Pret,

I am sorry that you are so dismayed, but I respectfully object to your assertion that I am ignorant and in denial. Neither is the case.

Nor do I embrace the status quo. Indeed, I agree wholeheartedly that the current situation is untenable. It does appear, however, that we disagree is in the priorities that should be set in fixing the system, and in the best approach to achieve those priorities.

The federal government, though probably well intentioned, has broken the system by implementing tax law that interferes with the health care consumer's ability to exercise choice, by providing huge subsidies and creating tangled bureaucracies that massively drive up the overall cost of care and by failing to implement and/or enforce appropriate regulations to prevent apparent abuses by insurance companies and HMOs, or to ensure that the information that consumers need to make sensible choices about their insurance and their health care is easily available.

The question is, what needs to be fixed and how should it be fixed? My answer, and, I expect that of most on the list, is strongly influenced by my beliefs about the role of government and the market in general, and of charity and social wellfare systems. I believe, based on my education and experience, that the market, with appropriate regulatory oversight, has a much better chance of fixing the problems than does the federal government. You have a different opinion. Fine. I respect that, and would ask you to do the same.

One last point. Do you really believe that any company, whether it sells cars, food, health care services or inhalers, can afford not to give a rat's ass, as you say, about it's customers, or is that just your frustration with the current system coming out? I don't see how a company with shuch an attitude could survive, unless some external entitiy such as the government props it up, but I freely admit I might be missing something and am open to being educated on the subject.

Kind regards,
John Annen




________________________________
From: "Bjorn, Pret" <pbjorn at emh.org>
To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
Sent: Monday, July 27, 2009 11:18:27 PM
Subject: RE: [MailServer Notification]Content Filtering Notification

Hogwash.  Something like fifty million Americans can't afford even the
most basic coverage, in spite of all the juicy competitive rates.  And
anybody with any of an increasing list of preexisting conditions is
completely SOL.  

It doesn't translate to other business models.  This isn't in the least
analogous to Porsche vs Toyota, lobster or meat loaf.  For millions of
Americans it's a matter of getting their infections and diabetes and
high blood pressure under control.  

These folks don't need hair plugs or liposuction.  They want an inhaler
for their kids' asthma.  And the Market doesn't give a rat's ass.

Fine.  Embrace the status quo.  Use our ED's for primary care, and
wonder why the premiums you and I can still afford have risen tenfold in
a couple of decades.

Happy ignorance.  Proud denial.  It's all so corrosive and dismaying.

Pret



-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of John Annen
Sent: Monday, July 27, 2009 4:46 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: [MailServer Notification]Content Filtering Notification






________________________________
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


      

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