In 2009, during the rancorous debates in Congress, Republican Senator Richard Shelby said that “America has the best health care system the world has ever known.” America certainly has the most expensive healthcare system in the world and may even have the best emergency care system in the world, but unfortunately that advanced medical technology has not translated into better health outcomes; we lag behind in list after list of comparisons with other countries.
To its shame, the US has some 51 million people without health insurance. Another 25 million are under-insured, with coverage that meets only basic needs or has high deductibles which must be paid out of pocket before coverage kicks in. We rank poorly in terms of fairness because of the great disparity in the quality of care given to richer citizens compared to those who are poorer. The Center for Disease Control places us 30th out of 31 countries in overall infant mortality rates. In 2007 the New York Times reported that, “We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care.” The Commonwealth Fund gives us high marks for preventive care like Pap smears, mammograms, blood tests and cholesterol checks, but we don’t do so well coordinating care of chronically ill patients, in protecting the safety of patients or in meeting their needs and preferences. And despite declarations by politicians, Americans hold dim views of our healthcare system. In a recent Commonwealth Fund survey of five countries, one third of American adults called for rebuilding the entire system; 13 percent feel that way in Britain and in Canada – 14 percent.
Healthcare statistics may illustrate the need to do healthcare differently, but we have not, as yet, found common ground on a solution. And unless we have some personal experience with illness, the statistics are just numbers. What do the 51 million without healthcare mean to someone who is relatively healthy and hasn’t faced the loss of a home, savings or life itself due to a chronic illness or accident? For Wendell Potter, former Vice President of corporate communications at CIGNA, one of America’s largest health insurance companies, the healthcare crisis has a face. In July of 2007 he toured a free clinic given by Rural Area Medical in rural Virginia. The British newspaper, The Guardian, described it this way: “What he saw appalled him. Hundreds of desperate people, most without any medical insurance, descended on the clinic from out of the hills. People queued in long lines to have the most basic medical procedures carried out free of charge. Some had driven more than 200 miles from Georgia. Many were treated in the open air. Potter took pictures of patients lying on trolleys on rain-soaked pavements.” It may surprise many Americans that groups like Doctors Without Borders wouldn’t have to travel outside the US to find third-world conditions where healthcare is concerned. Free clinics are not only operated in rural areas, but in cities like Los Angeles, New York, Atlanta and Chicago. For Potter, they were life-changing. Haunted by the faces of the thousands that came for care, he left his successful career with CIGNA and began to speak out against the industry. In June of 2009 he testified before the US Senate Committee on Commerce, Science and Transportation. He encouraged the members to “look very closely at the role for-profit companies play in making our healthcare system both the most expensive and one of the most dysfunctional in the world.” According to Potter, Wall Street dictates whether the average family is offered coverage, whether they keep it and how much they pay for it. The reason for-profit companies exist is to drive up the value of their stock, and to help meet Wall Street’s relentless profit expectations, insurers routinely dump policyholders who are less profitable or who get sick. In addition, they also dump small businesses whose employees’ medical claims exceed what insurance underwriters expected. And while sick people scramble for coverage, profits for health plan administrators grow. Insurers often refuse to tell customers how much of their premiums are actually paid out in claims. Potter testified that one “Houston employer discovered that its insurer was demanding a 22 percent increase in 2006 even though it had paid out only 9 percent of the employer’s premium dollars for care the year before.”
When listening to Potter, it’s even more disturbing to find who is behind all the fear-mongering and hyperbole of the health insurance debates. Hysteria over “socialized medicine” and the “government takeover of healthcare” comes from the insurance companies themselves, through the politicians whose campaigns they finance. In his book, Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care And Deceiving Americans, he writes, “If you are among those who believe that the U.S. has the best healthcare system in the world–despite overwhelming evidence to the contrary– it’s because my fellow spinmeisters and I succeeded brilliantly at what we were paid very well to do with your premium dollars.”
“And if you were persuaded that the health care bill President Barack Obama signed into law in March 2010 was a ‘government takeover of the health care system,’ my former colleagues and I earned every penny of our handsome salaries.”
For-profit providers of healthcare in the US serve one master – the bottom line. Dedicated to the best interests of the shareholders, they cannot serve the best interests of policyholders. Breaking the hold of the insurance system and removing the middleman from the equation would seem to make good economic sense, as we spend a whopping one-sixth of the GNP on our current system. Whether we decide, in the end, to adopt Medicare for all, opt for the VA model of socialized medicine, or embrace a form of the Kaiser system in California, one thing is clear – profits and health care do not mix.