By Don McCormick
Who is willing to take on the problem of health care that neither government nor employers nor private insurers are trying to solve? Is it to be the physicians and patients? If so, how will they do it? There is no one else to lead except they come from the groups of healers and those in need of healing. Business and government bosses are morally and practically bankrupt in regard to solving this problem.
In our town, as elsewhere, we have the managed health care of HMOs and PPOs, Medicare for most of the seniors, and Medicaid and some charity for the poor. Still, more than 25 percent of the population cannot afford to pay for medical care and cannot seem to get insurance coverage in any form. Catastrophic coverage which excludes pre-existing conditions for one year and starts after the first $5,000 in medical expenses cost about $500 a month for an individual and $1,500 a month for a family. That price is considered a bargain for people under age 65. It is not. It is just a club for the very rich to protect themselves from robbery by the very rich when they have terrible accidents and sicknesses. It has nothing to do with the average person and especially nothing to do with the poor.
This problem is not likely to change in the near future because employers do not address it, the government has not enough political support to address it, and the organized charities do not have the resources to address it. The default solution in every community is to let the doctors, nurses, and hospitals simply take care of people in an adversarial way and then write off the cost of their care. Or, let the patients go without the advice and treatment of physicians. Of course, these are not solutions; they are sources of class conflict, anger, social unrest, financial disaster, and disease. The Patient Protection and Affordable Care Act is an attempt to address the health care problems, but it has much opposition from Republicans and it is not clear whether it will result in more access to health care or just more taxes and higher premiums.
The current laws concerning health care access in hospitals coupled with the large numbers of uninsured patients has become a strange form of involuntary taxation of the medical profession in that they often give care to people who can’t pay them. It is also gross neglect of the poor who must be cared for even though they have no money to pay for it.
We do not intent to wring our hands and complain about this sorry state of affairs. We know well why our government and our businesses do not work for the good of all of the people in solving this problem. It is all about the money and the privileges of leaders in our country who would have us think that poverty and lack of access to care is a problem for the individual to solve using aggression, shoe laces, and the spirit of commerce. They are the spirit of John Calvin Coolidge, who said, “The business of America is business.” Perhaps that spirit is wrong and our real business is the welfare of our people, their lives and their fortunes.
The first step in the process of health care reform is getting control of the care and outcomes in the health plans from which physicians seek reimbursement. The private fee-for-service (employer sponsored plans) and government fee-for-service plans (Medicare and Medicaid) have been out of control since they began. In our culture paying for what you get, when you get it, at prices that are measured and fair seems perfectly reasonable. Of course, the assumption is that the providers of services have no incentive to do more or less than is necessary and are focused on the medical care and not on the money. Sometimes that is true. Many times that is not true. After all, is not the Coolidge spirit our light?
Several years ago a major Independent Physician’s Association (IPA) that operated in Texas failed. That IPA controlled both the money and the relationships between the physicians and most of the major insurers. This failure was a huge financial shock to thousands of physicians and hospitals throughout the city. It made clear to the physicians how risky it was to let a third party control who patients choose as their doctor. After the IPA’s failure, the doctors were told by the insurers that they had to be accepted into an approved IPA within thirty days or the patients would be moved to other physicians who were in these approved IPAs. The physicians who were not accepted by the new IPAs or were delayed in making the new contract lost from 1/3 to 1/2 of their total income.
Faced with this challenge, physicians in the Houston area either formed their own IPAs or joined the few that were open to having them, or they made direct agreements with the insurers. The end result of this shakeup was that a dozen IPAs that were newly formed failed within a few years and the insurers got most of the physicians under direct contracts and the percentage shares of money from the gross premiums paid by employer sponsored health plans and government health plans increased for the insurers and fell for the health care providers.
The health care outcomes for the patients got worse and the numbers of uninsured people grew. This Coolidge spirit really works well.
What new spirit shall we summon? Let us consider a quote from Peter Maurin:
“In the first centuries of Christianity the hungry were fed at personal sacrifice, the naked were clothed at a personal sacrifice; the homeless were sheltered at a personal sacrifice. And because the poor were fed, clothed, and sheltered at a personal sacrifice, the Pagans used to say about the Christians, ‘See how they love each other. ‘ In our own day the poor are no longer fed, clothed, and sheltered at a personal sacrifice, but at the expense of taxpayers. And because the poor are no longer fed, sheltered, and clothed at a personal sacrifice, the Pagans say about the Christians, ‘See how they pass the buck’.”
Was Peter Maurin right? Can we really solve the health care financing and delivery system problems by “personal sacrifice”? There is a recent example of the extraordinary positive impact of personal sacrifice in improving health care. Dr. Paul Farmer and his organization, Partners in Health,” deliver better health care with less money for more people than whole governments have done since the dawn of time. Read about his work in Haiti, in Russia, in Africa, and in Peru. Then look at what we do with many qualified people and more resources that any nation on earth. What we have done, and are doing is shameful.
We kill more people in the attempt to deliver health care to those who are financially qualified than we are killing on purpose in the Middle East. In some ways, the ones that are neglected entirely may be better off. Here is the only lesson I have learned: Do good works with a purpose, use the best science you can, cooperatively, and get rid of the leadership in Government and Business who cannot see beyond their personal power and greed. (Don’t think that changing the legislators, the judges, and the President is changing the leadership. The vast majority of these government employees would be replaced by other pawns of the top-out-of-sight-class.) A real change will have to come from among the people who actually want to solve the problems, do the good works, and leave power and greed behind. If such people emerge then change through personal sacrifice can work and it won’t seem like sacrifice at all.