Health Insurance Over Health Care is Not a Choice

March 1, 2017

bernie-health-insuranceSeveral weeks ago a tragedy occurred in a small town in western Massachusetts that should resonate with us all. A 63 year-old veteran took his own life in a public way. For some time Daniel Dowd had for weeks been seeking treatment at a detox center in Franklin County and was not accepted. He finally lost hope and gave up in a way which may focus attention upon our health care insurance system and how it drives some to despair. He shot himself in that center.

According to reports Dowd’s core complaint focused on the center’s apparent inability or, in his mind, unwillingness to take him into its detoxification program. The reasons for this may be various but one is certainly the current state and influence of the nation’s health insurance industry, an industry that is mistakenly but intentionally referred to as a Health “Care” Industry by those who support it. But health insurance is not health care.

Many, of course, object to this characterization and the suggestion that our nation’s insurance “system” (systems are usually systematic, not erratic) may have had a central part in the death of Dan Dowd. Some blame the detox center itself or those employed there, but whether there were mistakes made by the center or not I think a valid argument can be made that the largest factor by far are the effects of our health insurance laws. The detox center itself is hamstrung by the limiting factors of the laws it works within.

As a matter of fact, the statistical content of one article suggests the significant role the insurance system played here. Of its 1393 words of reportage explaining the basic questions posed by the incident 48% had to do with insurance.

For instance, we learn that centers such as the one in Greenfield may not be supported by state funds or Medicaid but rely instead on private funding which may be unreliable and unpredictable at best. With a universal, single payer health care system this would not be at issue.

Much of what the event of Dan Dowd’s death reveals speaks to the hodge-podge nature of the insurance system that exists now: one riddled with inherent obstacles to good reliable care because it is set up to reap profit not good health outcomes. In this specific case one person close to the center observed “We try to contract with every insurance provider out there, Some of them just won’t pay for detox services.”While another stated that “having zero insurance is better than having the wrong insurance … once you have (insufficient) insurance, you can’t pretend to have zero insurance. That’s fraud.”

Profit, not care, is at the center of our system. In it care is reliably doled out only to those who are insured and insured well: those with sufficient resources to pay and increase the bottom lines of middle-men: our insurance corporations —the industry that stands between men like Dan Dowd and his doctors or other care-givers.

As is made clear by Dowd’s case most of the Recovery Center’s patients arrange admission by telephone, so when they need care insurance issues have been resolved. But life is often not as orderly as that spelled out in insurance system protocols. If someone needs help during a detox center’s off hours, a center erratically funded, one not universally backed by the society it operates within that person may be temporarily admitted and treated but summarily ditched and shunted to somewhere that will take his insurance and continue care. And if there is no such place what then? Tough luck, this is the land of profiteers not care.  

Again, these problems would be gone with single payer.

Finally, there are the contradictory demands and circumstances our present system places upon hospitals, the ERs of which are obligated to provide care with or without insurance, often losing thousands of dollars in uncompensated care (and driving up health insurance costs for others).

But at the center of this tragedy is a simple truth —an almost simplistic one— that cannot seem to make its way into the hearts of minds of those in government who are supposed to represent the people but who, as cases like Dan Dowd’s show, represent instead the insurance industry. This simple truth was eloquently and simply stated by Sheriff Christopher Donelan, another (detox) task force co-founder.  Donelan said he hopes to work with the task force to push state officials in Boston to consider changing rules. “Let’s focus on the crisis first and the insurance second,” he said.

This, certainly, is exactly right. But immediately following that particular goal should be a national non-ideological, non-insurance industry driven commitment to create a health care system in line with the established and successful systems of most developed countries.

In this light, what the ACA tried to do was to insure as many Americans as possible despite the political morass created by (largely) Republican obeisance to the insurance industry. It put in place what it could against the political obstacles it faced, and went a long way in doing that successfully. Whatever its flaws, they are significantly the effects of barriers put up by lobbyists of insurance corporations made effective by Republican (and insurance industry cowed Democrat) intentions to make the ACA as flawed as possible. The resulting insurance cob-job we’re stuck with, this profit-driven system, is about life and death for millions and fortunes for others and, arguably, has more to do with Dan Dowd’s frustration and loss of hope than the consequent actions of the detox center.

Jim Culleny
2/19/17

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