Politics USA: Healthcare Insurance: Single-payer systm 'inevitable,' says economics thinker Rick Ungar; Co-ops possible
"The inevitability of an American single-payer health system," by Rick Ungar (click blog-entry title just above to read Ungar's vital article appearing on the Policy Page, True/Slant (Sep20,2k9). This article, tho not from my own viewpoint, is vital reading in these days.
Virtually all large health insurance companies are publicly held; and public companies have a life force that is unlike any other. They are driven by the desire of current management to show improved profits of about 10% each year so as to sustain share price increases for the shareholders and compensation increases for management. Also understand that while public companies like to talk about the “long term”, the phrase has no true meaning to them.So severely distinguishing, Ungar has laid bare how the general capitalist investment ethos in North America, is deadly to the specific corporate interface between healthcare itself and insurance tailored to the task of the separate and sovereign sphere of providing that medical professional care (a signficicant part of "healthcare") in regard to the role of specifically medical healthcare insurance.
Management and shareholders worry about this year’s numbers with an eye towards next year’s – and that is as far as it goes. Most shareholders and managers have no expectation of being around in the ‘long term.’ [Especially at the scale of coporations that are "too large too fail."]
Thus, while current management [personnel] of the large health insurance companies may very well realize that they cannot sustain their business model for the longer term, this is not something they can afford to worry about. Their shareholders want returns on their investment as management wants boosts to their compensation and they are looking for it now. The future will be someone else’s problem.
Take virtually any failed industry in America and you will see that the dynamic set forth above is inevitably true. Whoever ran General Motors before the CEO in charge when the industry fell apart probably knew what was down the road for the company. But it wasn’t his problem. An adept shareholder in GM who got out five years ago, really didn’t care where the industry was headed, nor did a CEO who had no plans to be around when the balls in the air crashed to the ground.
So, when the price of health insurance reaches the point where most Americans truly cannot afford it – and the numbers make it more than clear that the point will be reached and reasonably soon – what then?
Will ‘free marketers’ be out there arguing that we should just let the health insurers fail? After all,that’s how a pure, capitalist system is designed to work, right?
Unstated presupposition of the Ungar article: the only options for reform of American healthcare insurance is either the single-payer system (a socialist conception in origin -- but not necessarily socialist when advocated today, lest we fall prey to the genetistic fallacy [Albert Wolters] which often crops up in theoretical thawt and policy decision-making and -advocating) or an alleviated free-market system (on behalf of which many "conservative" public thinkers and rhetoricians are making extreme claims today). Capitalism ossified into an absolutist ideology -- regarding healthcare insurance, of all things!
Update, 2nd update Oct29,2k9; 1st, Sept28,2k9:The next vital article I recommend to your reading today (second of three) is found at the webs+t of the rather conservative intellectual policy-organization, Heritage Foundation. The study I have in mind (they call it WebMemo #2493). Health Care Co-Operatives: Doing it the right way ," by Edmund F. Haislmaier, Dennis G. Smith, and Nina Owcharenko.
The latter three authors attempt to provide a working definition, at the outset of their brief, under the heading What are co-ops?, immediately contextualizing the question by making reference to Senator Ken Conrad's legislative efforts to write co-ops, independent of govt (thus, jettisoning the single-payer system), and thus, introducing more competition into the overall healthcare insurance industry. In that industry, various models of business enterprise -- individually owned, family owned, partnerships (these can be extremely simple as to internal structure, or very complex involving many persons).
Ungar does us the great service of showing how one form of business enterprise in the healthcare industry in the USA is that of the publicly-traded stockholder-owned legally limited to making a profit for the owners. This one form structures the entire industry and drives the exorbitant rise in fees to patients/clients/consumers of medical help.
Back to Haislmaier, Smith and Owcharenko: the authors of my second recommended article explains that
farmers established co-ops to market and distribute their produce, workers in some industries organized financial co-ops called "credit unions," purchasing co-ops offer members access to a variety of goods and services at favorable terms, and when the term "co-op" is used in New York city, the speaker most likely means an apartment building collectively owned by its residents.Ungar is blind to all these possiblities. He cannot offer an alternative to stockholder-owned healthcare insurers the stocks of which are traded publicly and legallybound to generate as much profit to the anonymous stockholders as possible (a good capitalist ideologue woud immediately add "in the long term"). Ungar shows why the present capitalist system of healthcare insurance in the USA cannot but help to continue driving the whole healthcare system into life-diminishing continuous crisis, if not collapse.
The co-op concept is also longstanding and widespread in the insurance sector, where it is known as a "mutual" insurance company. Thus, such large well-known companies as Mutual of Omaha and Northwestern Mutual Life are in fact cooperatives. There are also successful smaller, niche-market mutual insurers, such as Church Mutual (which offers lines of property, casualty, and liability coverage for member religious institutions) and Jeweler's Mutual (which offers similar coverage lines for members engaged in making or selling jewelry).
When it comes to health care, a group that "organizes" coverage provided by insurers could be structured as a co-op, and a company that provides insurance could also be structured as a co-op. Both could be present in the same market.
Lots of organizations, some of which are member-owned cooperatives, help their members get access to various goods and services on preferential terms. For example, AARP performs this "organizing" function for its members when it arranges to get them access to discounts on travel, entertainment, and insurance. Members of a farm bureau often have access to similar products, such as financial and insurance benefits.
When it comes to buying health insurance, there are employer-based groups, such as the Lubbock Chamber of Commerce and the Cleveland Council of Smaller Enterprises (COSE), that organize coverage for their members' workers. It is also not hard to envision applying the same model to other groups of individuals. Any of the sponsoring organizations could be member-owned cooperatives.
In the case of cooperative or mutual insurers, while they are a longstanding feature in most other insurance markets, they are not found in today's health insurance market. Instead, current health insurers are organized either as stockholder-owned companies or as non-profits operated (at least in part and at least in theory) for charitable purposes beyond simply selling health insurance. ...
The article by Hailmaier et al, "Healthcare Co-operatives: Doing it the right way," helps advance my own knowledge of predecessors of the kinds of co-ops we need today. But where the trio mentions once and in passing, actually twice I see but vaguely, the faith- values-dimension of healthcare insurance. The Office of Faith- and Community- Initiatives has tawt us to speak first of the Faith factor, which I will do, and not miss the fact the "Community-Iniatives" are basically conceived as local, where "the community" is somewhat geographic.
But in regard to healthcare insurance, for the sake of relevance it is important to talk first of a faith-based healthcare insurance co-op. Doing so is only to be realistic about the American situation, its societal forces, its differing communities of values and mores, its religious demographics and their societal expression, as in the case of healthcare, and in the segment of the healthcare demographics is a desire for a christianly-principled healthcare insurance, with a differentiated moral distinction between it offerings and their costs as stipulated for various policies.
The co-op company here envisioned woud have an inner core of members, nationwide, who woud also maintain and participate in policy discussions, elect a board, assure the professional excellence of all employees. The policy discussions woud take place in local centers wherever they have been formed, across the country. The healthcare policies generated, launched (involves actual selling of policies), and maintained (processing, awarding, and denying claims) by the co-op company woud, lest there be any doubt, made available to all persons desiring to be a purchaser/client of the company and its clients, regardless of their creed or absence of such. They get an actuarially excellent cost-reductive healthcare policy, according to the requirements of the law (for instance, possible new federal legistlation that woud bar the co-op from denying policy purchases to persons who are living with pre-existing medical conditions. Pre-existing conditions that woud make some percentage of our customers / clients more of a risk than the average level of risk involved when the client-pool contains "no pre-existing conditions." But that is expected to become the law nationally and universally.
What a rapid rise of faith-based health insurance co-ops woud do to advance competition with the greed corporations that dominate the present healthcare insurance industry is thinkable today in America.
The final article reflects yet another dimension to be considered: like the old greed corps in the healthcare industry, the new Christian-principled national healthcare co-ops also woud be fashioned to comply with the new regulations, as pertinent.
Brian Wingfield and Aleksandra Kuczuga, "Financial Regulatory Blitz: A barrage of hearings this week is likely to revive opposition to key proposals" presented by Treasury Secretary Timothy Geithner (Forbes.com, Sept22,2k9).
The Treasury Secretary is expected to make the case for the creation of a Consumer Financial Protection Agency, and he'll say that regulation must prevent taxpayers from having to foot the bill for future government-funded bailouts, such as those for Citigroup, American International Group and General Motors. He'll also say that the administration's regulatory proposals will not establish a "fixed list" of firms of so-called Tier 1 financial holding companies, also known as firms that are too big to fail.
Wingfield & Kuczuga write anticipatively of Geithner's program for economic recovery, and regulatory reform, all at once. This coud have great and grave significance for structural renewal of the American economy (restructuration). It is important to realize that the healthcare insurance industry is an exceptional kind of industry that awt to have special rules ameliorating the severities of capitalist transaction for the mega-corporate healthcare insurance companies, like Humana (the fourth largest, and of considerable notoriety at the moment).
But, before further mentioning Humana, we move back a moment to the anticipation of regulatory Geithner (pronounced: Gayt•ner, I believe), wondering how these regulations may/coud apply to the unique industry where healthcare becomes a series of actuarial strategies to achieve the greatest profit possible for investors, not the care of healthcare policyholders. Healthcare insurance is only somewhat an industry in the economistic sense of maximizing profits for investors and stockholders. Towards a consumer protection scheme regulating the big banks and financials, Geithner and allies sawt to prevent exploitation of credit cardholders. This is it? This protects healthcare consumers from the two structural defects presented by Ungar.
As for the credit cardusers' protection, this has been set in motion, apparently. The ground was cleared in advance to a considerable degree:
The announcement by Representative Barney Frank, of Massachusetts, comes after weeks of consultations with other members of the fractious financial services committee that he heads. "White House pares its financial reform plan," by Stephen Labaton (Sept24,2k9, NYT)I think that's a good thing -- the
By slightly modifying the administration’s plan, Mr. Frank appears to have found a middle ground to support the creation of a robust new consumer financial protection agency over the vigorous objections of the banking industry. The agency’s core mission would be to protect consumers from deceptive or abusive credit cards, mortgages and other loans.
Mr. Frank also announced an ambitious schedule to complete the House’s work on the legislation over the next two months. Recognizing that the revisions increased the odds of the bill’s passage, the Obama administration quickly embraced the changes.
Here's a tidbit on what the Humana corporate elite think of themselves, corporately speaking:
Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health and supplemental benefits companies, with approximately 10.3 million medical members. Humana is a full-service benefits solutions company, offering a wide array of health and supplementary benefit plans for employer groups, government programs and individuals.There's a case-study tragedy in the midst of all this present round of publicity regarding Humana's having sent recently a letter to its all elderly and disabled folks who, as managed by Humana, are dependent upon the US's Medicare programs in these days when some assure the Medicare is or is almost bankrupt. Humana, no matter how exploitive it may hypothetically be (I do not know in any regard at present, but I've railed on about greedy profit-driven healthcare corporations) -- yet, it is my point here that Humana's letter is only a practice of due diligence toward those in its finanicial medical care, its elderly clients/patients, writing them about the uncertain horizon created for Medicare by the Congressional twists and turns, and the President's stance, regarding the reform of healthcare insurance.
Over its 48-year history, Humana has consistently seized opportunities to meet changing customer needs. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health plan experience throughout its diversified customer portfolio.
One of the largest private health insurance providers in United State Humana sent a letter to its customers telling them they may lose some benefits if the government goes on with the Health Care reform and cuts funding for Medicare Advantage Plans. According to NPR "the Feds told the company to knock it off." The letter has spurred spats with Feds. ..."Humana letter enlists Medicare customers against cuts," by Tyler Woods, PD, exclusive to E-Max Health (Sep23,2k9).
"The Centers for Medicare & Medicaid Services (CMS), which oversees the Medicare program for the elderly and disabled and privately-run Medicare Advantage options, told Humana to stop all associated outreach until an investigation was concluded. CMS stated that Humana's letter suggests “that current health care reform legislation affecting Medicare could hurt "millions of seniors and disabled individuals who could lose many of the important benefits and services that make Medicare advantage health plans so valuable."' The letter could violate federal regulations, it added"
As of this morning the America's Health Insurance Plans which is an industry trade group, expressed outrage that these plans would be excluded from corresponding with their members at a time when proposed cuts "will have a devastating impact on the health security of the more than 10 million seniors enrolled in the program. If these cuts are enacted, seniors will face premium increases, reduced benefits, and, in some parts of the country, will lose access to their Medicare Advantage plan altogether."
House Republican Leader John Boehner attempts to get the last word in by stating; "Would the Administration impose this sort of gag order if seniors were being given information promoting the Obama health care plan?