Healthcare: Profits and Prophets14 September, 2009
I have some weird friends. They’re good people, but some of them are severely disconnected from reality. I find myself trying to explain things calmly and rationally. And with no effect.
I’ve told her that yes, Obama really is an American. His mother is a citizen, therefore, no matter where he was born (that would be Hawai’i (an actual state of the United States)) he would still be a US citizen and no, he does not kill babies. I’ve told him (yeah, more than one) that high tax rates on the rich, massive public investment in infrastructure, and strong labour unions have, historically, lead to much more rapid economic expansion than supply side economics. And I have, patiently, explained to both of them that ‘death panels’ already exist — they are run by for-profit insurance companies.
And here is a case in point: nine states allow insurance companies to treat domestic violence as a pre-existing condition! And, of the 16 largest insurance companies in the US, eight of them actually do.
From a profit stand point, this makes sense. As Pandagon notes,
Domestic violence is one of the most powerful predictors of increased health care utilization.
And the health care utilization (damn, what a sterile term for personal injury inflicted by a spouse/partner) increases over time.
. . . Once a man has hit a woman, the odds of him doing it again are astronomical, and the odds are that he will escalate the level of violence as well, because part of being an abuser is testing your boundaries and seeing how much you can get away with before she leaves. For those of us in the humane world, the fact that a woman who has been slapped today is in grave danger of receiving a massive beatdown in the next few months or years is a tragedy that we should seek to prevent. From the insurance company’s perspective, however, a woman who is slapped today is likely someone who will incur a massive hospital bill in the future, and that’s all they need to know. (from Pandagon)
From a public health standpoint, this is appalling idiocy. Early intervention in domestic abuse cases means fewer injuries, less damage (physical and psychological), and, possibly, a lower recidivism rate. And it is cheaper. If the problem is spotted and dealt with early, the chances of the battered partner ending up in emergency surgery is severely reduced.
Unfortunately, the ‘greater-profit-at-all-cost’ approach of some for-profit insurance companies acts as a disincentive to report or treatment of spousal abuse. Women may fear reporting abuse, or may avoid treatment for their injuries, because they may lose their insurance coverage (not listing a ‘pre-existing’ condition is a frequent excuse for recision) which virtually guarantees more and more horrible injuries.
So, Chuck, who is rationing care? Who has ‘death panels’? Treating domestic abuse as a pre-existing condition (rationing care for greater profit and increasing the likelihood that a battered spouse will die) is exactly the kind of behaviour that greater federal regulation and a robust public option will limit. At some point, we need to realize that making money is not necessarily a public virtue.
So on the one hand, my bud Chuck (not his real name) fears ‘the government getting involved in my (or my parents) health-care decisions.’ On the other, we have Mary (again, a pseudonym (yeah, I am a coward (which is why I blog pseudononymously))) who wants to through Obama out of office and eliminate all abortions.
Not to worry, Mary — down in Florida, a group has a plan to do just that (from Library Grape):
A nationwide anti-abortion group launched an effort in Florida Friday to outlaw all abortions and certain types of birth control, including oral contraceptives and the morning-after pill.
The religion-infused movement, called “Personhood Florida,” would define conception in Florida’s constitution at the “biological beginnings,” supporters said — when the sperm meets the egg. The group filed its amendment today but the exact ballot language is still being worked out, said Secretary of State Spokeswoman Jennifer Krell-Davis.
The amendment seeks to outlaw all abortions, even in cases of rape and incest. Also criminalized: the morning-after pill and oral contraceptives taken by women, known as the pill. “There are some (birth control) methods that kill a child,” said Pat McEwan, who is leading the Personhood Florida group.
Yes, you read that correctly. A group thinks that (a) birth control pills kill babies and that (b) making contraceptives more difficult to obtain will mean few abortions. This will make abortions more frequent (at least among the middle and upper class (the poor won’t be able to drive to another state for treatment)).
Some observations here.
First, the religious right wants the government to be involved in health care any time it involves sex. At the same time, the radical religious right has fully embraced death panels, teabaggerism, and the (bizarre) idea that government has no say in national healthcare or health insurance policy. How does anyone embrace those mutually exclusive ideas without brain (foecal?) matter hitting the walls?
Second, the right is obsessed with the idea that the free market will solve any problem if, and only if, regulations are gutted. Yet, as we see from just one example (domestic abuse as a pre-existing condition), for profit companies will, if allowed, screw the consumer twelve ways from Tuesday. The job of a for-profit insurance company is to make money! Insurance companies do not exist to pay for health care, keep customers healthy, or make life easy. They exist to make money for their investors.
Follow the money. The religious right needs abortion as a wedge issue to raise money. The for-profit insurance companies are fighting tooth and nail against any reasonable and effective regulation. Watch the stock prices: every bump in the road to effective health insurance reform, the prices go up. Every time the progressive cause moves closer to the goals of a majority of Americans, the stock prices go down.
I have contacted my representative and both senators asking them to continue to fight for effective regulation, a robust public plan to compete with the private plans (and keep them honest), and as close to universal health care as we can get. The question is, how long are we willing to sacrifice our national health care system on the altar of profits and prophets?