Thursday, February 02, 2006

Healthcare comments

(This is a continuation of the previous post.)

(Aside: It is also linked with last year's Groundhog Day post. This blogging stuff gets to be messy when you have an idea connected with a distant post. I am reluctant to clean things up by simply deleting the other post, because it is still in the Google cache and, getting a few search hits I don't want to miss, especially if I have something more or better to add to what attracted the reader. I'm sure geeks will one day work it out. In the meantime, we know the Chinese will be protected from radical new ideas, don't we? I'm waiting until Homeland Security figures out that they can do the same thing here in America to keep ideas like mine under control.)

Healthcare and employment should not be connected.

This notion runs counter to everyday thinking, but it begs a question: How does anyone receive health chare who is unemployed or underemployed?
Commentators calling themselves conservative are advancing the idea, which makes me suspicious of the alternatives that might be under consideration.
But the main point is one with which I agree completely.
Listen to this (only two and a half minutes).

Once again there are people worshiping at the altar of the marketplace. I don't hear how the marketplace is prepared to turn a profit from sick or injured unemployed people, others with chronic conditions that make them unemployable, or (this is my favorite group) old people who are on their way to dying, a population that we all will join -- but only if we are lucky.

We know how life insurance companies make money. Statistics. Actuarial science, it is called. Since they can be certain that every policy-holder will die (there are no known examples of immortality) their only challenge is to determine how many in any given population can be expected to die, set premiums accordingly, and collect the difference between policy payoffs and collections as profit. They are betting you are going to die, while you bet that you are not. Heads they win, tails you lose.

We have learned how managed health care does the same thing. Figure out which poplulation is apt to need insurance and how much, then set collections and payouts accordingly to insure that stockholders are able to profit from the difference. Of course this involves creating a category of people who are (love this word) uninsurable for one reason or another.

So-called not-for-profit outfits work essentially the same way as life and health insurers, setting rates according to -- guess what-- the marketplace! Whee! In the end, those who can afford the best get the best, while those who cannot afford to pay simply get by as best they can, then endure until they can do so no longer. The not-for-profit sector relies on squeezing the most from those who can best afford to pay while getting the rest in and out as rapidly as possible with the least possible expense...otherwise they would soon put the for-profit people out of business. And we all know how that might disrupt, guess what, the marketplace.

Pretty picture, no?

I don't know how much longer we can remain in denial about national health care. Perhaps a generation of sick, aged, dying parents and grandparents will have to touch every family before reality sets in. As children witness their inheritances vanish because their parents and grandparents are "spending down" perhaps then the marketplace can come up with an answer.

Spend down is depleting private or family finances to the point where an individual is sufficiently poor to meet the eligibility criteria for Medicaid. The spend down processand transition to poverty can involve multiple losses, including loss of control, choice, and dignity for elders and their family members.

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