June 21, 2008

Amonia! Amonia!

There's an old New Yorker magazine cartoon showing an alien humanoid crossing the desert on hands and knees, pleading aloud to the barren landscape: "Amonia! Amonia!" This of course is a parody of the cartoon of an exhausted man crawling across an earthly desert, crying "Water! Water!"

It's time for a similar cartoon, this time showing a typical American family, crossing the desert together on hands and knees, with the father pleading for "Insurance! Insurance!"

But lack of insurance is not the problem, particularly for our health. We have health insurance, for those who can afford it. What we don't have, and desperately need, is universal health care.

Yet we ask for insurance, not health care. We might as well ask for amonia.

In the sixties, Kaiser Hospitals discovered that merely by managing the Medicare program for its own members, it would increase profits by $3-million a year. No new services or further medical care, just shuffle the paper and increase your profit margin. Blue Cross and all the other HMOs had the same epiphany. This established the Medicare model of health care as a commodity rather than a service, and the search for the bottom line was shielded from ethical scrutiny by multiple layers of insurance accountants. Now, the more that is spent on health care, the better -- so long as the HMOs and insurance companies get their cut.

Doctors, who are now free to advertise their services and incorporate themselves (to escape liability), are quite happy to be shielded from responsibility of managing costs as well, and eager to point helpless fingers at everyone else, beginning with patient demand, unscrupulous lawyers, and terminally befuddled juries.

Other factors accounting for the failure of our medical system are the subversion of the university research system to serve industry rather than need, and the failure of government to regulate science and industry sufficiently to protect citizens from predation and abuse.

We have allowed the creation of a health system that is run by insurance and pharmaceutical companies. Using their wealth, they have leveraged their power to control the direction and scope of medical research in our universities. It used to be our wealth, our health, and our science. Now it's theirs.

We need to take it all back, to manage and regulated it so it serves our needs, not theirs. And if this can't be done without "destroying the system," then it's time to destroy the system.

No comments: