Behind health care crisis: Drive for profits

Most press reports on the health-insurance crisis in the United States and the struggle to expand the States Children Health Insurance Program (SCHIP) ignore its human costs. Some 47 million people, according to the Census Bureau, have no health insurance, and accordingly get sicker, suffer more and sometimes die unnecessarily because they lack assured access to health care.

Even for many who have health insurance, the co-pays—their share of the costs of care—can be so high that they have to forgo that care. Insurance companies also have hundreds of reasons for denying a claim, from calling the symptom a “pre-existing condition” to designating a treatment “experimental” or “out of network.” Insurers often deny legitimate claims routinely, expecting that many insured will not pursue the claim further.

Those with health problems are not the only ones who suffer from a lack of health insurance. Their families and society as a whole lose what these individuals would contribute, and often must devote resources to the patient’s care.

In addition, without insurance, someone whose condition could be treated cheaply in a doctor’s office must often visit a high-cost hospital emergency room instead. Someone’s stroke—caused by untreated high blood pressure—might have been avoided if the person had had access to relatively inexpensive blood-pressure medication. Post-stroke care, on the other hand, could cost hundreds of thousands of dollars, an expense that might need to be absorbed by a charity.

Health insurance was first offered in the U.S. during World War II as a benefit to attract workers, when employers couldn’t offer higher wages. Health insurance became a benefit of many jobs when the Internal Revenue Service ruled in the early 1950s that its costs would not be taxed as income.

More than $2 trillion is spent for health care in the U.S. annually, or 16 percent of the U.S. gross domestic product. The Commonwealth Fund claims in its report “Mirror, mirror on the wall,” that, “The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States under performs relative to other countries.”

The report studied six countries—Australia, Canada, Germany, New Zealand, the United Kingdom and the U.S.—and asserts the U.S. ranks last. It goes on, “Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and ... the U.S. is last on dimensions of access, patient safety, efficiency, and equity.”

The Commonwealth Fund’s complete 2007 report can be found by going to commonwealthfund.org and then searching for “Mirror, Mirror.”

The U.S. population spends $6,100 per capita per year on health care. In Canada, the country with the next most expensive system of the six studied, the figure is $3,100. The people in the U.S., however, get miserable and misery-causing results. The question, then, is why does the U.S. keep the system it has?

The debate about the SCHIP program hints about the answer to this question. SCHIP provides health insurance to children whose families’ incomes are too high to qualify for Medicaid, but too low to afford private health insurance or for family coverage from an employer, coverage which can cost up to $350 a month. Medicaid covers only extremely poor families.

The number of children without insurance is increasing. Both the House and Senate passed bills expanding SCHIP’s coverage and allowing states to include families whose income is as much as 450 percent of the poverty line; that is, families with annual incomes of $82,000 and under qualify.

The White House reaction was brutally frank and anti-working class: “This bill essentially extends a welfare benefit to middle-class households,” stated the White House Office of Management and Budget. (Washington Times, Sept. 4) President George W. Bush repeatedly expressed his intention to veto any SCHIP bill based on the House or Senate provisions because it “clearly favors government-run health care over private health insurance.”

When it was clear that Congress would override any veto, the White House tried a run-around. Bush set regulations that would effectively make it impossible for states to expand their coverage.

Basically what the White House has done is preserve the profits that flow to the private insurance companies that provide health insurance. The Bush administration even ignored misuse of government funds by these companies. According to a congressional report, “Private insurance companies participating in Medicare have been allowed to keep tens of millions of dollars that should have gone to consumers, and the Bush administration did not properly audit the companies or try to recover money paid in error.” (New York Times, Sept. 9)

It is the capitalist drive for profits, the tremendous profits that arise from the $2 trillion spent on health care each year, that keeps the health care system in the U.S. expensive and inadequate.