By Ira Sharkansky
JERUSALEM–For those who are not sure that the devil is in the details, here’s an example. An American insurance company and hospitals are arguing about an administrative procedure. It has reached the point where one state legislature has enacted a law about the clerical details to be allowed in its jurisdiction, patients are being warned that they may have to change physicians, and there is a court case that could affect one million people who think they have health insurance. http://www.nytimes.com/2010/01/25/health/policy/25insure.html?hp=&pagewanted=all
Meanwhile, Congress is marking time while the administration ponders a strategy appropriate to the loss of that Massachusetts Senate seat. The proposals on the table amount to more than two thousand pages of patchworks that will add to the efforts of insurance companies and HMOs to find opportunity in the muddle. We all may hope that some patients will be better off, but no one should bet a lot of money on the prospect. Those who guess about such things are saying that the administration will have to reduce the number of people to be newly insured in order to get some Republican cooperation. What is happening in that squabble between the insurance company and hospitals provides ample indication that insurance companies will be looking after themselves while they say they are looking after patients.
The economic concerns of insurance companies should come as no surprise. That’s capitalism, and they are in business to make a profit. That they pursue profit via a concern for what they are willing to pay for medical services, and check thoroughly to be sure that each patient does not get more service than appropriate (by their criteria) means considerable outlays for administration.
They also spend a great deal on public relations, most recently to attack the president’s proposals on the grounds that it would make government a rationer of health care.
For those having trouble seeing the irony, you are on the wrong page.
The greater irony is that many Americans–enough to frustrate the president–share a fear of big government. Some of my correspondents have written about the threat of being governed like European countries as if they have not absorbed anything about that enlightened continent since the descriptions of Germany in the 1930s.
My bet is that none of them has experienced serious medical treatment that is paper free for patients. Not money free, but with fees and co-pays deducted from salaries or bank accounts, with the care providers and institutions that pay them sorting out the transfers. It helps that the rules are hammered out between the peak associations of care givers, insurance companies, and government departments. The process is not without demonstrations by groups of patients with special needs, complaints and criticisms prominent in the media. But with the ultimate decisions made by elected officials and senior bureaucrats, the process is more open to scrutiny, and arguably more fair than when decisions are taken by insurance companies concerned with their profits, and those who object must complain to their families, and seek the attention of someone who might help. Systems that suffer the label of “socialist” are simpler for patients to understand than when hundreds of HMOs and insurance companies define their own rules about coverage, co-pays, and how patients must seek care, and decide how to apply those rules to individual cases.
For those who sing the song of free enterprise, may you enjoy the paper work. You have my wishes for good luck next time it is necessary to dial an 800 number. Those of us in Israel with the benefits of health care dominated by government will get by with a plastic card that does the work for us.
And remember that residents in the bastion of free enterprise and individual freedom rank 48th on life expectancy.
Sharkansky is professor emeritus of political science at Hebrew University