Monday, August 31, 2009

The Death of Private Insurance Has Been Greatly Exaggerated

I am no fan of health insurance companies, as people who follow this blog know, with one important caveat: It is not the concept of insuring citizens' health that's the problem, it's insurance the American way.

Plenty of other countries have health care systems that rely, to a different extent, on private insurance for health care coverage: Germany, Japan, Switzerland, France, the Netherlands and, yes, Canada, are just a few examples. The difference between health insurance in those countries and in the United States is government regulation.

In the above-mentioned countries, government has set strict regulations on what providers can charge, who is covered, the maximum financial exposure each individual can have in a given year, and what services are covered by basic insurance. Basic, by the way, does not mean "poor", it simply means the services everybody should have access to without the need for additional, optional insurance. The distinction, then, is between basic and elective. In other words, organ transplants are basic health care, because a person's life depends on them; cosmetic surgery is not.

Additionally, none of the countries that rely on private health insurance allow denial of coverage for pre-existing conditions, nor do they allow caps on lifetime coverage, unlike the United States does.

The basic difference between other countries and the United States is that health care outside the United States is seen as a basic human need and, yes, a basic human right. In the U.S. health care coverage is seen either as the individual's responsibility or, in some cases, the employer's job. Consequently, it would not be a stretch to say that other countries are more civilized than the United States, at least as far as health care is concerned.

In the United States all health insurance companies, even those nominally not-for-profit, aim to make a profit, which is used to pay for real estate, equipment, personnel and a host of other expenses and, in the case of for-profit insurance companies, shareholders' profits and executive compensation that would rightly outrage anyone outside our borders. Their main objective is not to cover the insured, but to limit reimbursements and payouts to the maximum extent allowed by law, and since the laws of the states where they operate are designed to protect corporate interests above and beyond the protections offered for patients' health, it is easy to understand why we are in such a mess and why we are literally at the mercy of insurers.

As T.R. Reid put it in an op-ed tied to the recent release of his latest book, The Healing of America, that's why "[i]n terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero."

There is room for insurance in this country's health care future: Health insurance companies can either accept to play as a public service, as they willingly do in other countries, or they must accept a greatly diminished role as providers of additional services not listed as basic health care necessities. Imposing either role is our right as a people, just as it is a company's prerogative to refuse it. However, if the experience of other countries is anything to go by, companies will play by the rules that "we the people" set for them. They will still make plenty of money, just not the immoral ransom that they impose on captive patients so they can pay their CEOs millions of dollars in salary and hundreds of millions in other compensation.

In the end, any nation that considers the right of a corporation to make as large a profit as possible at the expense of the health of its citizens is in no position to claim moral superiority in the community of nations, or to present itself as an example to the world, and its economic superiority is not only an illusion: it is downright immoral.

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