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Allan Ghitterman: Monetization of Health Care

Medical care should not depend on whether insurance companies make a profit

The health-care industry has made money the fulcrum upon which it moves, a sort of cost vs. benefit equation that prevents us from dealing with the delivery of medical care to those who are suffering from ill health. Even though our main concern is providing accessibility to medical care to our entire population, we are unable to attack the real problem: monetizing the treatment of medical problems. As long as cost is an ingredient of medical treatment, we are unable to evaluate the quality of programs to provide universal health care. Thus the issue is and always will be health insurance vs. health care, and as long as our lawmakers will support the insurance industry, we are unlikely to solve the problem.

Allan Ghitterman
Allan Ghitterman

The current problem with obtaining health care is directly related to the insurance companies controlling what treatment a doctor can provide, or which physicians you can see, by compelling the doctor to seek their approval before authorizing any treatment beyond an office visit.

Until we decide that spending 15 percent-plus of our income on health insurance (note: not health care) is counter-productive to good health, we will continue to suffer without adequate health care.

Yes, the saying is that if you have enough money, the place to get the best care is in the good old USA. But if only the top 10 percent of the income earners are financially qualified to receive such treatment, do you think the United States is providing good health care to the other 90 percent — particularly if they don’t have health insurance?

As proof of the foregoing proposition, we need only look at the free clinic that operated for two days a couple of weeks ago in one of our states and the amazing turnout that happened. And don’t forget the people who couldn’t receive any treatment because the lines were too long.

Maintaining an adequate income to encourage doctors to continue to practice medicine is a curious mixture of the willingness to provide medical care to satisfy one’s need to feel that they are contributing to society and at the same feel that the choice of endeavor does not penalize their desire for a comfortable lifestyle. How to accomplish this is the nub of the issue.

There probably aren’t too many medical practitioners around today who can remember the pre-World War II days wherein the local doctor actually lived in their neighborhoods beside their patients and worked with them to help them deal with the medical conditions prevalent in the ‘hood. Most of these doctors were family practitioners. Payments for medical attention were sporadic, with lots of accounts receivable. When a particularly obscure disease or injury manifested itself, it would be time to seek a consultation with a specialist. No need to ask the insurance company if the patient could be referred; just go ahead and do it. The reason this conduct was happening was because nobody had insurance. At least, none of the middle class had any.

But following WWII, health insurance became the magic condition that induced workers to sign up with particular employers, and, by the early 1960s, employers were offering it as a fringe benefit to their employees, often in lieu of increases in wages, because it was cheaper.

The net effect was to increase doctors’ incomes and make their incomes more certain. Collections then became a thing of the past because the carriers made regular payments of all treatment approved. This encouraged the medical practitioner to solicit approval from the insurance company and, suddenly, the doctor had a partner who sent him money. And the medical profession traded its independence for a secure income.

Insurance companies are in the money business and it quickly became apparent that this was a money pot. And, once they determined that by denying requests for expensive treatments, because they could claim it is experimental, usually because it had only been recently developed (within the preceding five years or less), they could reduce many expenditures, and concurrently increase their profits. From there it was an easy step to decide that if they could find an excuse to cancel the policy when it became apparent that certain large expense treatments couldn’t be avoided, they could further reduce expenses and, thus, they would be making more money, and, of course, more profits. Moreover, from a legitimate excuse, it became the practice that any excuse, irrespective of its reasonableness or relationship to recommended treatment, would suffice.

You should remember when the heads of the five largest insurance companies testified before Congress a few weeks ago, they stated quite firmly that it would continue to be their policy to cancel insurance policies on any pretext, irrespective of the relationship of the suspected misstatement to the requested treatment.

While the issue is medical care, as long as we argue about medical care we are missing the problem. The problem is medical insurance and the power the industry wields over the medical profession. Remember, I said that the doctor recommends treatment, but the treatment cannot be given because unless it is approved by the insurance company, the doctor and the hospital that provide it will have to depend on the patient to pay. And most patients, while making a living, can’t handle expensive treatments — because that is why they bought health insurance in the first place.

Medical care should not have to depend on whether insurance companies make a profit, and doctors should be able to provide treatment that is in the best interests of their patients. There are problems that exist because a doctor may recommend treatments that require treatment at a satellite facility that he or she has a financial interest in, but that can be cured by legislation prohibiting referrals to any facility in which the doctor has such an interest.

President Barack Obama has a difficult problem, because irrespective of his desire to provide health care at a reasonable cost, the lawmakers who receive campaign contributions from the insurance industry will not support his program. And do not let them kid you: When they take that money, you can be sure how they will vote. And when these are added to the lawmakers for whom cell phones is too much civilization you can see his problem.

The current misinformation given to the general public that somehow their medical-care rights are going to be adversely affected because of the proposed health-care bill is having an effect on the people, since it takes a scholar to sift through the garbage being circulated to get down to the meat of the program. The failure of Congress to inform the public contributes massively to the concerns of the people, and there is no need for this secrecy except to allow the insurance industry to play on the fears they are generating.

— Allan Ghitterman is a certified specialist in California workers compensation law and is now somewhat semi-retired; a member of the boards of Foodbank of Santa Barbara County, Legal Aid Foundation of Santa Barbara County and the Rehabilitation Institute Foundation; and a not too-good tennis player.

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