Origin & Nature of Market Medicine
BACK to GUIDE TO FREQUENTLY ASKED QUESTIONS
-
Isn't the present crisis in what you call "market medicine" a result of the non-profit institutions and the fee-for-service system that preceded it? ANSWER
-
Is all managed care bad? ANSWER
-
Why attack existing corporate structures? So what if profits are not regulated in health care (as for most industries)? If a system can be adopted that provides for everyone even with profits allowed as presently, what's the harm? ANSWER
-
For-profit and not-for-profit systems have coexisted in the U.S. for quite some time. If care is so much better with a not-for-profit then why hasn't that shown up in enrollments? ANSWER
-
Hasn't managed care been the one factor holding back uncontrolled exorbitant increases in prescription costs? How can we afford a green light to any and all prescriptions? ANSWER
-
Is the nature of our current system with private insurance about to kill itself off, now
that we will be able to genomically assess much risk, thus rendering obsolete the need for insurers
to assess risk within certain age, income and other defined pools? ANSWER
-
Why haven't we come up with another way of organizing our health care system, if it is so obvious that management for profit is so terrible? ANSWER
QUESTION: Isn't the present crisis in what you call "market medicine" a result of the non-profit institutions and fee-for-service system that preceded it?
The fee-for-service system and the practices of many hospitals - for-profit and not-for-profit -- did both result in escalating health care costs. Still, replacing the excesses of the fee-for -service system with those of a fee-for-non-service system does not necessarily represent a positive transformation.
There is a diminishing difference between the for-profit and not-for-profit sector in health care. Today too many for profits and not-for-profits act almost identically. Too many are obsessed with price-competition, emphasize the bottom line, and have top down management styles. Like their for-profit counterparts, not-for-profit hospitals dramatically reduce length of stay, waste millions in advertising and marketing and pay CEOs exorbitant salaries.
Nonetheless, the data are conclusive that for-profit corporations have been far less responsive to community needs than their not-for-profit counterparts. That's because for-profit corporations owe their fiduciary responsibility neither to their patients nor communities, but to their shareholders (and the executives who hold tremendous amounts of company shares). Their legal obligation is to maximize the return on their shareholders investments. Whenever there is a conflict between quality care and profit, CEOs and boards of directors must resolve that conflict in favor of profit. Of all their manipulations the best corporate move will always be to insure the young and healthy, letting public programs take care of the sick and frail.
QUESTION: Is all managed care bad
Not all management of care is bad. Management and coordination of care is still needed in our health care system. Under fee-for-service, as we have said, too many specialist services were used, there was too little emphasis on prevention and education, and care was highly fragmented. Specialist physicians often failed to coordinate care with primary care physicians. And there was far too little collaboration between physicians and nurses, and physicians and other clinicians.
Large health care corporations are not primarily interested in managing, coordinating nor integrating care. What they are doing is damaging and disintegrating care as they manage money. In the process care is being managed right out of the health care system. What they strive for more than anything is to cover the healthy and those most likely to remain healthy without need for large outlays for care. In common parlance "managed care" refers to this current U.S. system of health care, it does not refer to the concept of managing health care in general and especially not for the benefit of the population.
QUESTION: Why attack existing corporate structures? So what if profits are not regulated in health care (as for most industries)? If a system can be adopted that provides for everyone even with profits allowed as presently, what's the harm?
It is unlikely that the health insurance industry and taxpayers will be able to agree on insuring everyone in a new system which continues with the primary objective of keeping corporate profits high. The people currently excluded from coverage are often those most likely to need regular and expensive treatments. If agreement were reached between taxpayers and insurers on a reformed system which provided universal health care and maintained the current "market-driven" structure, this would be an enormously expensive system. Probably the government (taxpayers) would be asked to subsidize the final "fill-in" programs which provided insurance to those the industry could not "profitably" insure.
Even if such an agreement were made, we would still be budgeting the health care that could be afforded, taking as a given the excessive profits that had been preserved and this would still not be humane. That is to say, it is not humane to talk about which transplants our state can afford to include and which people to let die, while we are in tacit agreement (not discussing) that the heads of Aetna, Cigna and the others must continue to reap tens of millions annually personally (for an example of some the waste in the system). The health insurance industry and the taxpayers are unlikely to agree on insuring everyone in a system which continues (as today's) with the primary objective of keeping insurance profits high and securing absurd salaries and benefits for top CEO's (enough to cover thousands of annual premiums)..
QUESTION: Look, for-profit and not-for-profit systems have coexisted in the U.S. for quite some time. If care is so much better with a not-for-profit then why hasn't that shown up in enrollments?
It's a question of marketing and price structures. Much of what public teaching hospitals used to support, for example, is not well-reimbursed. Now in the present climate with federal reimbursements cut, such institutions are suffering and indeed hard pressed to survive, while for-profit institutions have no plan to provide the threatened services.
The erosion of enrollment from not-for-profit is mostly due to their demise and conversions to for-profit, which both follow from their inability to continue supporting the needed services they used to provide.
QUESTION: Hasn't managed care been the one factor holding back uncontrolled exorbitant increases in prescription costs? How can we afford a green light to any and all prescriptions?
In fact, prescription drug costs have not been contained during the 1990's and into the next century, but have to the contrary been a leading factor in driving up health care costs for the nation. So managed care hasn't been able to contain those costs, even though it is true that insurers would like to contain those costs.
There is no reason to assume that a UHC system will not provide some regulation of which drugs should be prescribed (like completely efficacious lower-cost generics in many cases). In fact the state or federal government would probably negotiate prices in bulk for the medications its population needs, much as the military and veteran's administration do currently (at great savings). Note also that Americans who have no drug coverage pay much higher for their drugs than do the insurers who cover the same drugs for other Americans. The least insured, pay the most in our system. Read more about financing a UHC system.
QUESTION: Is the nature of our current system with private insurance about to kill itself off, now that we will be able to genomically assess much risk, thus rendering obsolete the need for insurers to assess risk within certain age, income and other defined pools?
Several people have suggested that this is the case, notably physician and author Robin Cook in the NY Times in May of 2005. We understand the underlying logic of thinking that private insurance will be unnecessary if individual risk can be assessed with some accuracy, since population pooling according to non-health factors would make little sense. Our project though raises two objections. First, even with advancing genetic analysis, factors such as income or educational level and age may predict much of the risk for poor health. Perhaps much better than any genetic analysis.
Second, we consider that the logic and efficiency of the insurance system already makes no difference to those formulating policy. Instead, the current system persists because it is an efficient means of funneling public dollars over to powerful corporate interests. Consider that new and brilliant idea of "reinsurance". Insurers are increasingly specialized in collecting large premiums from those at low-risk while excluding (or passing over to a public pool) those who stand a good chance of needing care. With this twisted logic and ultimate purpose of our system, we may well witness a closer scrutiny of who is eligible for low-risk high-premium private coverage.
QUESTION: Why haven't wel come up with another way of organizing our health care system, if its so obvious that management for profit is so terrible?
Actually we have come up with another way. Although little attention has been paid to it, the US Public Health Service came up with a blueprint "Healthy People 2010" of health goals for 2010 and some strategies including universal health care. Corporate lobbyist power prevails in Washington (which is why Project EINO emphasizes state efforts for UHC), but our public health experts are well aware of how to merge a renewed public health system with universal care to achieve the optimal results in terms of a healthy nation. The only question is whether we will demand our resources and labor be spend on a healthy nation (as a first priority) or the healthiest return on investment for a handful of CEO's, top administrators and large investors.
| 