Hi Mimi! I love your enthusiasm! Apologies that your message somehow got lost while I was busy traveling, doing Christmas, getting used to being back in the U.S., etc. I love the sentiment you express. I did feel on top of the world on Rapa Nui. It's certainly different being back here in Pittsburgh, but I'm watching the snow outside right now and enjoying how peaceful it is, even while life for people in LA is anything but peaceful. Sending you my best wishes for 2025, and hugs!
Thank you for writing this excellent and important column. Our family has received excellent health care in four countries that provide universal coverage—Czechia, Switzerland, the UK (for our son), and France (after a bad fall from an e-bike while on vacation). These four countries have four different systems, ranging from government-funded single payer (the UK) to fully private, with no government insurance at all (Switzerland). But what unites them is that healthcare is exclusively nonprofit. Even in Switzerland, all the insurance companies are private nonprofits and are strictly regulated.
I think this is the key difference between the crappy system in the US and the mostly functional systems everywhere else in the developed world. The profit motive is far too corrupting: it skims off money that ought to go to care and hands it over to rich shareholders instead; incentivizes doctors to run unnecessary tests, perform unnecessary procedures, and prescribe unnecessary drugs in order to make money; causes hospitals to lie about which treatments are covered, leaving patients stuck with outrageous bills; and pushes insurance companies to deny legitimate claims in order to save money.
On another note, those are fantastic pictures from Easter Island. What an adventure!
Hi Mari! Thank you for this excellent comment and for carefully outlining the differences between the health care systems you've used in Europe and the U.S. system--profiteering on the U.S. side vs nonprofits on the European side. I wish more Americans were willing to try and understand the differences. Capitalism in health care just doesn't work because, as you say, it means that companies skim money--lots of money--off the top instead of using it to pay for care. And now many hospitals are doing the same thing, even if they're not-for-profit. SIGH.
My trip to Rapa Nui/Easter Island was wonderful. Thanks for your enthusiasm!
There's a genius to your response here, David--the model of insurance companies is to deny care, not deliver it. Succinct, to the point, and right. You laid out the whole problem in a nutshell. I also like the labels "insane, inhumane." Those are good words, too. And of course that level of craziness deranges people--because the rules are insane and it's impossible to know in advance what will or won't be covered. Thank you for writing and sharing your sharp, smart comments.
You are correct, Theresa, in that 2 things can be true at the same time. I also agree that cold blooded murder is NOT the answer.
What I very often tell my patients is that they need to understand that their commercial insurance carriers have a FIDUCIARY obligation to maximize profit for their SHAREHOLDERS and not their POLICYHOLDERS. So, legally, they are required to operate their businesses to make as much profit as possible. Full stop. This is perhaps a smart business model for most industries, but NOT HEALTHCARE. Most people don't understand this.
And, yes, it is a very complicated business, and it would be very presumptuous for me to suggest a simple fix. But...if we are not ready to provide universal healthcare to all in our country, some have proposed that as a nation, we should regulate health insurance companies similar to how some utilities are managed, by placing a limit on profit as a percentage of collections. In other words, (arbitrarily) pick 15% as the limit for how much a company can earn, and anything more than that goes back to those who subscribe to their plans. The actual dollar amount can increase by providing more competitive services, cutting costs, etc. That is where better business acumen separates the various companies. Again, this is too simple an idea as presented, but perhaps it is a starting point.
Thanks for your timely comments addressing this issue.
Theresa happy holidays !! You look on top of the world ! What a rush !! Hope you are soaking all that goodness up !
You look like you are !!!
Cheers and safe travels
Excellent , thought provoking writing !!love it!!!
Always
My best
Mimi
Hi Mimi! I love your enthusiasm! Apologies that your message somehow got lost while I was busy traveling, doing Christmas, getting used to being back in the U.S., etc. I love the sentiment you express. I did feel on top of the world on Rapa Nui. It's certainly different being back here in Pittsburgh, but I'm watching the snow outside right now and enjoying how peaceful it is, even while life for people in LA is anything but peaceful. Sending you my best wishes for 2025, and hugs!
Thank you for writing this excellent and important column. Our family has received excellent health care in four countries that provide universal coverage—Czechia, Switzerland, the UK (for our son), and France (after a bad fall from an e-bike while on vacation). These four countries have four different systems, ranging from government-funded single payer (the UK) to fully private, with no government insurance at all (Switzerland). But what unites them is that healthcare is exclusively nonprofit. Even in Switzerland, all the insurance companies are private nonprofits and are strictly regulated.
I think this is the key difference between the crappy system in the US and the mostly functional systems everywhere else in the developed world. The profit motive is far too corrupting: it skims off money that ought to go to care and hands it over to rich shareholders instead; incentivizes doctors to run unnecessary tests, perform unnecessary procedures, and prescribe unnecessary drugs in order to make money; causes hospitals to lie about which treatments are covered, leaving patients stuck with outrageous bills; and pushes insurance companies to deny legitimate claims in order to save money.
On another note, those are fantastic pictures from Easter Island. What an adventure!
Hi Mari! Thank you for this excellent comment and for carefully outlining the differences between the health care systems you've used in Europe and the U.S. system--profiteering on the U.S. side vs nonprofits on the European side. I wish more Americans were willing to try and understand the differences. Capitalism in health care just doesn't work because, as you say, it means that companies skim money--lots of money--off the top instead of using it to pay for care. And now many hospitals are doing the same thing, even if they're not-for-profit. SIGH.
My trip to Rapa Nui/Easter Island was wonderful. Thanks for your enthusiasm!
Thanks Theresa for your voice about medical care insurance companies
It’s a system that has a business model of denying not delivering coverage for more profit
It’s insane , inhumane
There's a genius to your response here, David--the model of insurance companies is to deny care, not deliver it. Succinct, to the point, and right. You laid out the whole problem in a nutshell. I also like the labels "insane, inhumane." Those are good words, too. And of course that level of craziness deranges people--because the rules are insane and it's impossible to know in advance what will or won't be covered. Thank you for writing and sharing your sharp, smart comments.
You are correct, Theresa, in that 2 things can be true at the same time. I also agree that cold blooded murder is NOT the answer.
What I very often tell my patients is that they need to understand that their commercial insurance carriers have a FIDUCIARY obligation to maximize profit for their SHAREHOLDERS and not their POLICYHOLDERS. So, legally, they are required to operate their businesses to make as much profit as possible. Full stop. This is perhaps a smart business model for most industries, but NOT HEALTHCARE. Most people don't understand this.
And, yes, it is a very complicated business, and it would be very presumptuous for me to suggest a simple fix. But...if we are not ready to provide universal healthcare to all in our country, some have proposed that as a nation, we should regulate health insurance companies similar to how some utilities are managed, by placing a limit on profit as a percentage of collections. In other words, (arbitrarily) pick 15% as the limit for how much a company can earn, and anything more than that goes back to those who subscribe to their plans. The actual dollar amount can increase by providing more competitive services, cutting costs, etc. That is where better business acumen separates the various companies. Again, this is too simple an idea as presented, but perhaps it is a starting point.
Thanks for your timely comments addressing this issue.
Smart