GUEST EDITORIAL: Health care should be about people, not profits

John Danahay


St. Augustine

Health care builds hospitals, etc., employs physicians and nurses and spawns a plethora of health care-related manufacturers for all of whom the first item of business is … business. If not a great opportunity for significant wealth, investment would be attracted to another industry.

Turning to ObamaCare/RyanCare, Vice President Pence says, “Obama’s health care law is making it difficult for businesses to grow.” With absolute clarity he states Republican primary legislative motivation, business. No surprise, as it is the instant directive for all Republican legislation.

Pence and Ryan are in full accord with President Trump’s shrewdness for “the deal,” readily documented in his money-grubbing. Ask his ripped-off students and construction contractors for starters.

Foremost, the GOP plan is good for the scope of business interests, corporate growth and profits, in support of what it’s all about — executive compensation, bonuses, incentives and stock packages.

Business always makes a bundle from those sick or hurt.

How many people will be so affected this year? The answer is a function of the insurance industry. For decade sit has been accurate in predicting the numbers of persons who will be sick or hurt. They just never know whom. Still, they are expected to pay the lion’s share of the cost.

Paupers or billionaires: all experience medical costs. However, it does set up a scale illustrating who can always expect the best care, down to who may not receive care at all, or its bare minimum. And this is not right.

Once again, the whole issue is money. Not availability or quality of care … money!

Who generates the bills regardless how they are paid? The vast majority is by the physicians, hospitals, labs and pharma, paid for by insurance, patients or government.

Yet it is permanent government involvement that sets the equation of morbidity/cost/payment into a tizzy. It’s not likely to change, so we are obliged to live with it.

It is an unlivable expectation for the GOP RyanCare structural design to solve cost by laying it on the backs of those forced to lose or have severely reduced coverage. RyanCare also proposes, most hardheartedly, to ID who will be ineligible for benefits.

High deductibles, co-pays and caps on maximum benefits are not unreasonable for those who can afford it. But this burden is laid on those least able to pay. One Republican legislator (doctor) is on record reasoning, these most destitute for medical care “don’t want insurance!” Penalties are cheaper than premiums, so pay the penalty. Some cannot afford even the penalty.

Then there’s the ‘big deal” tax credit which will be grossly inadequate for a great many below the federal poverty income level. That is if they even have net taxable income from which to take the credit. It is for these, for whom ObamaCare admirably tried its hardest to reach. The GOP would, for the most part, write them off. Their lost benefits would fund a significant part of the GOP plan. These are human beings, not numbers on a ledger page easily erased.

I must conclude, a “tax credit” is applied against the federal income tax. No other GOP explanation is proffered. Ergo, an individual who has no taxable income receives $0 help.

Lowest income families yield negative business profit margins. Demographically, they have the highest incidence of use and highest total cost for care.

This factor, incidence/cost, should most obviously be addressed in the nation’s health care, focusing sharply on the poor, elderly, children, mentally ill and veterans. Surprise … this is not where the wealth of the nation is concentrated. In fact, they cannot pay for most all of the health care they need or will incur.

This is what every insurance plan, public or private, faces and addresses with two factors — morbidity prediction (the number of sick/hurt) and pooled risk of insureds. With surprising accuracy they appraise the cost to pay for any year’s total claims. Considering necessary reserves, the total is proportionally spread among those insured, thus, the premium. This is a simplification but in the ballpark.

Politicians have danced around a solution, often mentioned during the presidential campaign.

Ready? Universal Medicare — meaning universal health care enrollment, but with scaled premiums. And, as a kicker, federal and state legislators and government employees must enroll.

This is not complicated. The health insurance industry has thousands of actuaries and investment managers who have been doing this for over 100 years. We’ve just never called on them to unify and take on the needs of the entire nation. It is only a bigger solution, not a harder one. Expectedly, insurance executive compensation must sublimate to the design of a federal program.

Why shouldn’t every citizen be entitled to (and help pay for) a high standard of health care?

But there is a huge problem. Partisanship. Federal and state politics must agree to a non-partisan pursuit of this solution. Do they individually and collectively have the courage, fidelity, vision, forgiveness and moral and spiritual fortitude to embark on such a momentous quest?

Of a more practical note, can President Trump look beyond his ego to support such, or, using it as an asset, will he take up the reigns and crack the whip?