The Affordable Care Act (aka Obamacare) is the latest MacGuffin in the decades-long struggle to figure out health care in the United States. Meaning, in the current debate it appears that the key to solving health care lies in enforcing and/or fixing and/or repealing Obamacare. However, I think our focus has been misdirected from the true underlying issue, which is that over the last several decades we have moved to a health care infrastructure that is primarily for-profit.
To illustrate, picture if you will a theoretical health care organization, let’s call it Proactive Preventative Health Associates (PPHA). Now picture that PPHA lives up to their name in that they proactively manage the health of their patients and foster proven preventative measures to significantly reduce the incidence of manageable health issues (cardiovascular problems, diabetes, cancer, etc).
If PPHA is a for-profit organization, their success in creating a healthy customer base will result in a reduction of profits, and the better PPHA does at reducing or preventing recurring, long-term, expensive health care issues the worse they will do as a business entity, until such time that they could conceivably put themselves out of business by being good at what they do.
If PPHA is a non-profit organization, however, the improvement of the health of their patients means they are successful, and frees their resources to focus on more urgent or needy patients and issues, because there are no stockholders or investors watching the bottom line.
So, a for-profit health care organization has two conflicting and irreconcilable motivations. First, the (assumed) goal of maximizing the health of their patients, and second, the fiduciary goal of maximizing the health care expenses and profitability of their patients.
These two adversarial forces cannot be reconciled – they simply cannot. Health care and profits do not go together, because if they are combined we are creating a situation where those who we trust to keep us healthy will actually be motivated to maximize our healthcare spending.
These are not theoretical noodlings, fyi. If you were to read this article, you would find a case of a for-profit hospital that was allegedly sedating patients until they had trouble breathing, and then performing unnecessary tracheotomies at great expense (and profit). Not only would this constitute fraud, it also may have resulted in the deaths of patients who would have otherwise survived.
Less sinister, but also illustrative, this article discusses (among other things) a study that indicated that for-profit nursing homes appeared to use significantly more sedatives and significantly fewer staff to manage those in their care. While this might be good news to a profit-motivated investor, it would be disheartening if it were your mother they were keeping sedated because it was cheaper than creating an active and engaging environment for her.
You may find the concept of a completely