The health care debate-3: Why profits should not be a factor in health care

(For previous posts on the issue of health care, see here.)

It is important to realize that in the single payer or socialized systems, everyone is covered and no one is denied coverage for lack of employment, pre-existing conditions and the like. Does that mean that one will be able to have any treatment that one desires whenever one desires it? Of course not. Whenever there is greater demand than resources available, there will always have to be decisions made as to how those resources are to be utilized, and invariably some treatments may be denied or delayed for some people.

The point is that this occurs even now in the private health insurance system that we have in the US. The difference, and it is a huge one, is that the private health insurance decisions about whom and what to treat are made by bean counters who are driven by the insatiable drive to make profits for their companies and who seek every means to deny treatment. There is almost nothing that ordinary people can do when they get shafted by the companies, because they are expert at giving you the run-around.


In single-payer and socialized medicine, decisions about how to allocate resources are made by collectively by physicians, other health professionals, and public policy makers who try to maximize the benefits of the system with the resources they have. There is usually some kind of board that is responsible for the workings of the system, but unlike the boards of directors of private, profit-seeking health insurance companies, they do not personally benefit financially by limiting treatment. And if we do not like how the system is run, then we have power to change things in that we can either vote to give the system more resources (the way we vote levies for schools and libraries) or we can vote for a government that will make the changes we desire. The public ultimately controls the health care system, which is as it should be.

It is also important to realize that in both single payer and socialized systems that are in existence in other countries, people still have the option to buy private health insurance if they want extra services, so those people who want premium services can still have them.

Those who think that they have good insurance now in the US from the profit-seeking private health insurance companies and resist change towards a single-payer or socialized system might be in for a nasty shock when they actually get ill because the health insurance industry has entire teams of people whose sole job is to find ingenious ways to deny coverage. The US health care system is truly wonderful as long as you do not get sick. Reporter Lisa Girion of the Los Angeles Times of June 17, 2009 reports on how the insurance companies cancel the medical coverage of sick people after they are diagnosed, a practice known as ‘rescission’.

An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.

It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.

Denial of coverage is mostly done by using the infamous ‘pre-existing conditions’ loophole. Insurance companies will go to great lengths to dig up something, anything, that can be used to deny claims and cancel coverage altogether. “A Texas nurse said she lost her coverage, after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne… One employee, for instance, received a perfect 5 for “exceptional performance” on an evaluation that noted the employee’s role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.”

Michael Moore’s film Sicko (see my review) interviewed people whose job was to do this and get rewarded for it by the insurance companies. This should be no surprise. After all, then president Richard Nixon approved of setting up the present employment based private health insurance system only after he was assured by his aide that “Edgar Kaiser is running his Permanente deal for profit… All the incentives are toward less medical care… the less care they give them, the more money they make… the incentives run the right way.” The present system is running exactly as they envisaged.

In May 2008 my younger daughter graduated from college so she immediately ceased to be on our health plan. But her job started only in August 2008 so we had to go through the dreary business of shopping around to get temporary coverage for the months of June and July before she got on her new company’s plan. That kind of irritation alone should be enough for people to want to ditch the present system in favor of one where coverage is decoupled from one’s employment status. For most people, the biggest nightmare about losing their job, or even changing it, is how to ensure health care for them and their families.

But that’s not all. When my daughter later went to the doctor for some minor treatment, the insurance company would not pay unless she could prove that it was not a ‘pre-existing condition’, which meant that we had to go back and get all the documentation about her two month temporary coverage. Even that was not enough and we had to get the paperwork of the coverage she had before that and submit that too. All this took a lot of time and the matter still has not been resolved. In the meantime she left that job and got a new one, so we don’t know what will happen now. But if she had not taken the precaution of getting temporary coverage for the two-month period of June and July 2008 (which happens to many people between jobs), and if we had not been conscientious about keeping all the paperwork, they would have simply denied her claims and she would have been on the hook for the entire amount. And there is nothing that we could have done about it.

Suzie Madrak relates an awful story about the hassle she went through when she injured her ankle. Because the injury occurred when she fell while getting down from a truck, her health insurance and auto insurance companies kept passing the buck to each other as being the party responsible for paying for treatment. This kind of thing simply would not happen in a single-payer or socialized system.

Anyone who has had to deal with the health insurance companies knows the aggravation that occurs routinely. The funny thing is that most Americans think this is normal because they have never known anything better. People in countries that have single-payer or socialized health systems never have to deal with an profit-making insurance bureaucracy that seeks to make money by denying treatment.

It is important to always bear in mind one undeniable fact: In the current system, it is that the primary mission of the private health insurance industry is to maximize the profits of their shareholders, not to provide good service to sick people.

The fact that finding ways to deny coverage is an important part of their profit-making strategy emerged once again when during congressional hearings last month, Rep. Bart Stupak, the chairman of the House Subcommittee on Oversight and Investigations asked each of the heads of the major health insurance companies whether he would at least commit his company to immediately stop rescissions except in cases where they could show intentional fraud. All of them said “No”, thus confirming that denying coverage to sick people by any means possible is a deliberate profit-seeking policy of these companies.


POST SCRIPT: Bill Maher makes a commercial for the American Medical Association


  1. Jared says

    I am sure that there have been countless lawsuits where people have tried to get insurance companies to pay out after being denied coverage based on “pre-existing conditions” or simply being rescised.

    What I wonder is if anyone has ever tried to sue a health insurance company for return of all premiums after this happens. Presumably the grounds would be that the insurance company accepted payment for services they planned to deny regardless of circumstances. Given their teams of lawyers, I suspect that it wouldn’t win, but it would make an interesting point.

  2. says

    There is one assumption you are making in all of this: you are assuming that it should be a value of our society to ensure that people get the health care that they need when they are sick.

    Sadly there is a large minority in this country that doesn’t believe this; they have the mentality that “hey, life is hard, and if you get sick and are denied coverage, tough luck”.

    Of course, no politician could survive while saying that, so they couch their views.

    See Paul Krugman’s book “Conscience of a Liberal” and check out his chapter on health care.

  3. Albert says

    Sadly, there is really no such thing as no profit organization that would do something if it weren’t for money. Health care costs money, a lot of money, and people simply don’t have it, and programs are doomed to fail if they don’t have funding. That is why the ways to make money online is now becoming more of a norm for businesses. I hope health care also proceeds to take that action as well.

  4. Jon says

    I think healthcare costs are affecting not only the consumers but the small business owners as well. Take my case. I run a wool area rugs business. The kind of healthcare I have to pay for my employees is eating into my profits.

  5. says

    If we paid less money to pointless celebrities and idiots who knock balls around a field with or without a stick then there might be more money for a decent healthcare system. In the meantime we can all take care of our own health by eating better and exercising more there is plenty of exercise equipment available so we each have an obligation to look after ourselves too.

  6. says

    I believe we should ensure that people get the health care that they need when they are sick.

    The small population of people that believe the contrary are pretty selfish in their opinion. I am in MLM and will be self-employed very soon. I hope that the issue of health care our country faces will soon be resolved.

  7. says

    Ohhh… the old health care debate again! Will it ever end? Probably not, eh? I used to operate a computer repair business and providing health care got really expensive for me.

  8. vijaysb says

    What I wonder is if anyone has ever tried to sue a health insurance company for return of all premiums after this happens. Presumably the grounds would be that the insurance company accepted payment for services they planned to deny regardless of jewelry buyer Houston circumstances. Given their teams of lawyers, I suspect that it wouldn’t win, but it would make an interesting point.

  9. says

    A debate on this argument should not even exist .. everyone needs health care and everyone should have the right to it .. especially in countries like the US .. I am sure in about 20-30 years everyone will have free access to health care .. every single person in this world !

  10. says

    In the UK, we had a great free healthcare service (the NHS), but successive governments have been determined to undermine the basis of why it works: its universiality. We have to fight for what we believe in.

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