04 January 2008

Does your doc work for Cigna?

Warren Pease has a brilliant essay titled "So... what's this here single-payer health care thing all about anyway?" at the Online Journal. Here's his answer:
Well, surprise, surprise, it's not socialized medicine. The federal government won't set up shop in every doctor's office and medical facility. Unlike the current system, in which privatized pests occupy a permanent position overlooking every doc's shoulder, governmental bureaucrats won't be making harassing calls to doctors offices every five minutes to second-guess whether a patient actually needs that procedure, or that test, or that prescription.

Let's say your doc has his own small family practice, which he runs as an LLC. He probably accepts payment from a couple dozen different insurance carriers. Does that mean he works for, say, Blue Cross or Cigna or Aetna? Of course not.

Under single-payer, he would no more work for the government than he now works for an insurance company. He gets paid by the feds, but runs his own business exactly as he has for many years.

So docs and hospitals continue to operate as they always have, although for-profit facilities must convert to non-profits.
Pease begins with an intro to corporate law, and then moves quickly to a good analysis of what happened to 17-year-old Nataline Sarkisyan, and then to what will cure our "murderous system":
By law, the only obligation of a publicly owned, for-profit US corporation is maximizing return for its shareholders. That's it. Nothing about good corporate citizenship, the public good, saving lives or anything else that isn't related to jacking up the price per share and maintaining a reasonable price-earnings (P/E) ratio.

If Cigna had been operating outside the rules, perhaps we could simply discipline that one company, levy stiff fines, jail a couple of high-ranking execs and serve notice to the rest of the industry that such behavior won't be tolerated. But that's not the case. Cigna was following the rules. The problem is that the rules are insane. That's why this profit-driven disaster of a medical system must be replaced.

We need to dump this murderous system entirely. It's too far gone to tinker around the edges. We simply have to get rid of the profit motive as the driving factor in determining who lives and who dies. We need to decouple the idea of health care from the idea of health insurance, since the two have absolutely nothing in common.
He describes single-payer perfectly: "a national health care program, funded by a modest and progressive tax, and generically called 'single-payer,' meaning that the insurance industry's multiple payers are replaced by a single entity, usually a state or the federal government."

Pease also has an informative link to a (hmmm) "scholarly treatment" on single-payer and other "stupid liberal ideas."

The neo-conservative godfather Leo Strauss believed that the masses needed to be kept divided in order to keep a natural aristocracy (i.e., Cheney) on top. Along those same lines, Krugman believes racism is at the heart of why we don't have universal health care — Pease agrees, adding that of course pr has been masterfully used to prejudice us against the idea of a common cause. Nope, we're rugged individualists, all smoking Marlboros and driving SUVs because it might snow one day.

Pease writes,
The insurers have As one California psychologist who serves on several managed care rate negotiating teams in the Santa Cruz area told me a while ago, "They have become adept at providing the illusion of health care, while avoiding the messy and expensive reality of having to actually deliver it — to the extent legally possible. And you'd be amazed at what's legally possible. Most of the time you can't even sue them so, at some point, the consumer literally has no recourse but to beg for his or her life. Increasingly, those pleas fall on deaf ears as the race to maximize profits obliterates what's left of basic human kindness."

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