Is your health insurance company traded on Wall Street?
If so, is Wall Street deciding your medical care?
It's hard to recall that for-profit corporations were once kept out of health care -- in fact, for most of the 20th century. During this time, the nation's medical system was built largely by non-profit and charitable organizations, which is why so many hospitals are named for saints. Courts across the country ruled that for corporations to profit from medical care was simply "against sound public policy." In the early 1980's, however, when the financial and airline industries were deregulated, a similar process occurred for American medicine. For-profit corporations became newly encouraged to take leadership of health care. Deregulating health care into the free market was intended to drive down costs and to improve care. After all, medical care in 1980 consumed a whopping 9.1 percent of the nation's GDP.
Never mind that after 30 years in the free market, health care costs have doubled to consume 18 percent of the GDP (with a third of these precious dollars wasted on bureaucracy). Never mind that health care has gotten increasingly inaccessible to the uninsured and even the insured, or that American health care has become an international poster child for reform.
The real issue is that modern medical care has simply, finally, gotten so effective. Today, even cancer and AIDs are no longer death sentences, and if organs fail, you try to get a new one. But prior to the discovery of antibiotics and vaccines in the 1930's, leeches were routinely applied, and medicine was steeped in superstition. Between 1918 and 1920, three percent of the world's population was wiped out -- by the flu.
The fair and effective distribution of life-sustaining resources like food, water and shelter, is the very story of civilization. Yet now, thanks to centuries upon centuries of civilization and scientific inquiry, we have at last, a new life-sustaining resource -- modern medical care, which is less than 80 years old.
How should this powerful new resource be distributed? I believe that medical care shouldn't be considered an ordinary product, like athletic shoes or flat screen TV's. Rather, it is quickly becoming essential, like water. Yet there will be no easy answers when it comes medical care, in this brave new world in which DNA is already being tweaked to grow completely new organs. We are embarking on a new, complex and long chapter of history.
I can't help but think that health care reform isn't over, and wasn't concluded with the signing of the Patient Protection and Affordable Care Act in March.
I believe that health care reform will be our entire future.
In the meantime, for now, how is modern medical care, a new Prometheus' fire, being distributed and decided in the United States?
Physicians and patients sit face to face and discuss medical decisions -- about whether a life-sustaining cardiac bypass surgery is warranted, or whether a new liver should be gotten. But ultimately, the purse strings on medical care are held by health insurance companies.
The new health reform laws will obligate insurance companies to provide "coverage" even when patients become sick or if they have a "pre-existing condition" or what I will call "illness." The PPACA has a provision on "administrative simplification" scheduled to take effect in 2014, which aims to streamline the process of doctors and health care providers asking for approvals from health insurance companies before treatments are rendered.
But even after the new laws are implemented, health insurance companies, many of them for-profit corporations traded on Wall Street, will continue to hold the purse strings on medical care.
Our recent health reform efforts are landmark progress in the right direction.
However, in the last thirty years, the values of Wall Street have so infiltrated the values of American society that seemingly all aspects of life are impacted, even medical care of the human body and mind, even the everyday life or death decisions that happen in doctor offices and hospital rooms.
© 2010 Dora Calott Wang, M.D., author of The Kitchen Shrink: A Psychiatrist's Reflections on Healing in a Changing World
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