Thursday, October 15, 2009
Tell me where it hurts, Mr. President.
What's killing you, Barack, is what's killing us all: an evil germ called "Medical Loss Ratio."
"Medical Loss Ratio" [MLR] is the fancy term used by health insurance companies for their slice, their take-out, their pound of flesh, their gross - very gross - profit.
The "MLR" is the difference between what you pay an insurance company and what that insurer pays out to doctors, hospitals and pharmacists for your medical care.
I've totted it up from the raw stats: The "MLR," insurance companies' margins, is about to top - holy mama! - a quarter trillion dollars a year. That's $2.7 trillion over the next decade.
Until the 1990's, insurers skimmed only about a nickel on the dollar for their "service," Wendell Potter told me. Potter is the CIGNA insurance company PR man who came in from the cold to tell us about what goes down inside the health insurance gold mine. Today, Potter notes (and I've checked his accuracy), porky operators like AIG have kicked up their Loss Ratio by nearly 500 percent.
The industries' slice is growing to nearly a quarter of your insurance bill. All of it just paperwork and profiteering.
President Obama is never going to pull the insurance company piggies from a trough this big, especially when the industry has made room for Congressional snouts.
So what's the Rx? Easy: Kill the pigs and call the fire department.
The only solution to Loss Ratio piggery is to kill the pigs: eliminate health insurers from the health industry entirely.
We can't cure our ills, as our president has attempted, by attacking the problem ass-backwards. No, Mr. Obama, we don't need HEALTH INSURANCE for everyone, we need HEALTH CARE for everyone. There's a giant difference. Instead of concentrating on PAYMENT, we need to focus solely on providing the health SERVICE.
From my London days writing for The Guardian, I can tell you the British do NOT have national health insurance. They have a National Health Service.
The government builds hospitals, hires doctors and, when you need the service, you just go and get it. It's kind of like the fire department. When your house is on fire, you don't call your fire insurance company, you call THE FIRE DEPARTMENT. We care first about the service, not the payment.
The British government hires the doctors, like firemen, and Brits use them, like firemen, as they need them.
It works. My mother-in-law, a nurse, on a visit to England, was stunned at the speed, quality and absence of mad paperwork to fix her broken arm.
But, you might say, that's, that's SOCIALISM! Well, yes, it is. And I'm not afraid to use the S-word: Socialized Medicine. Just like America's Socialized Fire Departments. (Fun fact: socialized, i.e. publicly funded, fire departments were 'invented' by the revolutionary Ben Franklin.)
And Yes We Can get socialized medicine passed into law.
Really. It's simple: we sneak it in with the kids.
We can learn from Lyndon Johnson's sale of Socialist Medicare. Johnson knew that no one could argue that Granny do without a doctor. Can the "Pro-Life" Republicans now tell us that pregnant moms and children ages 0 to 3 should be denied care? Therefore, to the Medicare program for those 65-or-older, we simply add "Kiddie Care," for those from Negative 9 months through age 3.
But instead of the wallet-busting Medicare system, in which doctors and hospitals are paid for each suture, bag of blood and pat on the head, Kiddie Care will be provided by Kiddie Care Service salaried doctors.
How do we get doctors (who now AVERAGE $240,575 a year) to take well-paid, but not pig-paid, posts? We grab'm while they're young. We pay doctors the full cost of their medical education; and we treat them as humans during internship, not as in the current system where interns are treated as medi-slaves. In return for the public paying for their medical education, the public gets the young doctors' ten-year commitment to work for the health service at a reasonable salary.
That's not my invention. The free-education idea for staffing a national health service had long ago been proposed by that wily old dog Ted Kennedy. (Damn, we miss him.)
Once the first wave of three-year-olds are about to turn four and their families face having to buy them health insurance, these millions of parents will become an unstoppable army of lobbyists screaming for the extension of Kiddie Care to age four, then to age five, then to age six and so on. Get it?
Yes, Mr. Limbaugh, I am another bleeding heart trying to sneak socialized medicine into America. Yes, I am trying to rid us of the "free-market" insurers who are causing the bleeding. Health insurers are as useful to our health care system as a bicycle is useful to a goldfish.
There ain't no such thing as a "free market" in medical care, as there is a free market in food. You can eat peanut butter instead of dining at Maxime's. But you can't tell the surgeon, "No thanks, I can't afford a new kidney this week - I'll just have a broken arm."
A free-market for-profit insurance system means that, when you need a new pancreas, your fate is left to an insurance company computer programmed by Franz Kafka, Dr. Kevorkian and his accountant. It's you versus the Medical Loss Ratio. Good luck.
In olden days, doctors would attach leeches to suck a patient's blood. Today, we have insurance companies' Medical Loss Ratio. Both can kill you. If Obama and America want to end this sickness in the body politic, start with Dr. Kennedy's sure-fire cure: a national health service for kids - and get rid of the bloodsuckers.
I Quit: A Personal Note
I learned of the Kiddie Care solution during my brief and ill-starred tenure at the Center for Hospital Administration Studies at the University of Chicago "Billings" Hospital. I couldn't make up that name. Years later, they hired Michelle Obama as their vice president for community affairs.
In my time, three decades ago, "Billings" handled the affairs of that poor community by shipping the uninsured, sometimes bleeding, to poor-folks hospitals. One wounded patient died on the poverty shuttle.
I quit, and swore that one day I'd write about it. I just did.
Forensic economist Greg Palast is author of the New York Times bestseller, "The Best Democracy Money Can Buy." His investigations for BBC TV and Democracy Now! can be seen by subscribing to Palast's reports at www.GregPalast.com.
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