It has been apparent from the beginning of the health care debate that the private health insurance industry has been pulling the strings. As the charade plays out, it is becoming even more apparent that in the future we are going to be more under the thumb of private insurers that ever. So the question I ask is this: Is private for-profit health insurance a moral undertaking?
Within the framework of right wing thought, of course, it is absolutely moral. Within the framework of left wing thought (mine, anyway), it is highly immoral.
Say that an observer is looking down at our planet from a spaceship. From his view, everything we do on this planet is amoral – nothing is right or wrong. We are, after all, living beings that need to eat other living beings to survive. “Evil” is a human construct. In nature, the wolf will attack an elk calf and kill it, and then share it with the rest of the members of his pack. All the wolves in that pack will benefit. Within the pack, the activity is necessary for survival of wolves, and might therefore be considered “moral”, so far as wolves are concerned. Elk might disagree.
A grizzly bear will attack an elk calf for his own nourishment. He will start eating it while it is still alive, inflicting horrible pain on it during its last surviving moments, and forever traumatizing the mother. The killing is necessary for the bear’s survival, though not the suffering the bear inflicts on the calf. Nonetheless, we don’t call it evil. It all as part of life and death on this planet.
Killing within our own species is usually frowned upon – the Christian Bible says that it is wrong. And yet the Catholic Church and other Christian sects accept the concept of “just war”, wherein we have the right to defend ourselves against aggression. We have a habit of defining everything we do as self-defense, but what it really means is that there are no constraints against killing people in other countries. “Thou shalt not kill” really means “Thou shalt not kill your own kind.”
Within each country, killing citizens of that country is frowned upon, except in self-defense. The death penalty is sometimes meted out, but only after thorough legal review of the circumstances surrounding the crime. We are very constrained about killing our own kind.
So this is our moral posture: It is wrong to kill your own kind, except in self defense.
By the means outlined above, we have attempted to introduce a bit of kindness into our cruel world. Call it morality, if you must.
Hannah Arendt in her work Eichmann in Jerusalem: A Report on the Banality of Evil described atrocities committed by a lowly and uneducated man, Nazi war criminal Adolf Eichmann. She wondered how a man who behaved well within his own society, and who (supposedly) felt love and compassion for his own family and friends, could commit mass atrocities.
The answer lies within our societal structures. We delegate the responsibility for committing evil acts to subordinates, and insulate ourselves from having to witness those acts or their effects.
In the military, chain of command is essential to success of military operations. Orders given above must be carried out below without question. Otherwise the military enterprise cannot succeed. Within large corporations, the same structure exists, though less rigid, as employees have more options before them than soldiers. Nonetheless, the control exercised from above is critical to the success for both corporations and the military. (I might add that since the American military is really an agent in service of transnational corporations, that the military chain of command is subordinate to the corporate chain of command.)
So officers in large organizations have the ability to give orders and not be exposed to the consequences of those orders. A man can sit at his desk in Washington, DC, and order a bomb launched into a marketplace in Baghdad,and go home that evening to enjoy dinner with his children and sex with his wife, as if nothing horrible had happened. He is a “desk murderer”.
By unplanned circumstances health insurance in the United States came under the purview of large for-profit corporations. During calmer times, when costs were less and greed was not worshiped, it wasn’t much of a problem. But in 1965, 40% of senior citizens were without health insurance. Government stepped into cover their costs. That program, known as Medicare, now serves every citizen over age 64 in this country.
The plight of seniors in 1965 was indicative of a problem with private health insurance. It was internally contradictory – since it was a for-profit enterprise, payment of claims resulted in lower profits. Old people tended to have more claims, and so health insurers avoided them. To be profitable in the health insurance business, companies have to avoid sick people and avoid paying claims.
So by its very nature, for-profit health insurance has untoward effects. People die for lack of care, can’t get insurance at all, and even have their coverage taken away when they get really sick. This is all the result of decisions made by corporate executives who do not see or feel the pain and anguish they inflict on others. They are insulated. Because 20,000 people die each year in this country due to treatable and preventable diseases and injuries, responsibility for those deaths lies with the executives who made the decisions to exclude, deny, and rescind. They are desk murderers.
From the right side of the political spectrum, this is all a natural byproduct of the natural distribution of wealth, and is therefore a moral outcome. If private citizens want to help those who cannot help themselves, fine. But for government to do it, as with Medicare, is wrong. Right wingers fought Medicare from the beginning, and many still oppose it as immoral: in order to provide care, government must first take money from other people. That is, on the right wing, the original sin.
Medical care has gotten more expensive over the years, and now millions of people, either by choice or circumstance, do not carry health insurance. An ethos of greed pervades our society today, and for-profit health insurance companies are as caught up in it as any Wall Street financial house. Where once their executives might have been gray and dour upper-middle class suburbanites, today they are overpaid millionaires leaching on our health care system. There will be no getting rid of them soon or easily, as they have stitched themselves to the butt of the political system as well.
From the left side of the spectrum, this is immoral. Health care, according to the Universal Declaration of Human Rights (to which the United States is a signator) is not a privilege. It is a right. The consequences of lack of care, denial of care and rescission of coverage is death. The sentence is carried out in silence, the perpetrators protected from any exposure to suffering. This is the nature of Arendts “banality” of evil, or desk murder.
Other countries developed differently in the wake of World War II. The idea of profit-seeking in the field of health care was defined from the outset as immoral, and systems were constructed to provide health care for citizens without private for-profit health insurance. The result was universal coverage, and, oddly (from a right wing perspective anyway), much lower costs.
I have thought for years now that the essence of right wing thought can be boiled down to Social Darwinism. The idea that someone is not entitled to health care, that economic performance should dictate level of care, has at its root survival of the fittest. This is the Post War era, and we don’t talk like that anymore. Eugenics is condemned, as are master races, but survival of the fittest, as defined by the marketplace, is still the ethos of the right wing. It is immoral.
From our moral perspective, health care is a right. Health insurance corporations interfere with this right – in fact – seek to profit from our need for it, and are therefore immoral organizations.
We on the left seek to eliminate not the health insurance corporations, but rather the underlying profit motive. We want to offer quality care to all who need it, using the entire population as the premium base and the tax system as the funding mechanism. We do this not as economic beings, but as caring and compassionate and moral beings. We will not be harmed by use of government force in this area any more than the hundreds of millions of people in other industrialized countries who have universal health care.
For-profit health insurance is an immoral undertaking that facilitates killing of people in our society for profit. The executives of these companies are desk murderers. They should be punished, and their activities ended.
Piece of Mindful 
Cash for clunkers imploded with 700,00 simple transactions.
What will happen when 80M people show up for GovtCare?
When a bureaucratic snafu takes out the diseased kidney instead of the healthy one, will that pencil pusher rise to the immoral level of the insurance companies?
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Cash for clunkers did not “implode”. The program had some problems as it was so popular, which have been solved. It achieved its objective. I’m not in favor of it, but it’s a bad example for you to use.
Other countries manage just fine with government-run systems, single payer systems, or heavily regulated non-profit private insurance. They offer care to everyone, and are therefore morally OK and in tune with the UDHR.
Our system is wildly expensive and laden with unnecessary private bureaucracy.
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Via Hot Air.
>>Transportation Secretary Ray LaHood says the government has approved $1.22 billion in reimbursements to car dealers for sales under the Cash for Clunkers program. …
The rebates led to more than 690,000 new car sales at a taxpayer cost of $2.88 billion.
The math on this isn’t exactly rocket science. The administration blew 58% of the C4C money on overhead, leaving only 42% for the dealers and the car buyers. It amounts to $1.36 of administrative cost for every dollar in subsidies granted, a terrible conversion price for even Obama’s idea of redistributionism.<<
More lies from Swede.
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Swede – if you have integrity, you’ll do further research here. Your pocket calculator math sounds wrong.
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Took your advice. From Lahood, Trans Sec.
http://news.yahoo.com/s/ap/20090910/ap_on_re_us/us_cash_for_clunkers
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Turns out only 40% of the money been given out with 60% remaining. Article was updated after I read it the first time. Here’s the update. Swede’s calc error and admission.
>>Whoops, I read the article below a little too fast. The $1.22 billion number is the amount of rebates paid back so far. The remaining isn’t entirely administrative costs but also the amount of rebates yet unpaid. According to this article, though, the administrative costs to date have been $144 per rebate. That’s a lot of money for a simple car rebate, and with 690,000 rebates to process we’re talking over $100 million to process rebates for a program that lasted weeks. Still not every efficient.<<
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No big deal, frankly. I doubt that the private companies who did the loans on the new cars that were sold did it for less than $144, likely much more.
End of story. See what following through got you?
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B.S.,
If it’s functions like Medicare? All 80 million will pay taxes, and some percentage of the cost based upon the collective risk, minus the advertising, overhead, executive salaries and profit taken out by corporate monopolies. It will cost less per person, and less per GDP.
That bureaucrat will work for the hospital, the one you choose freely today. If it happens often, amoral, perhaps. If the hospital is making it a practice for profit, immoral.
But if Medicare is as bad as you say it is, everybody will pick corporate insurance because it is superior in every way. When I want Fed Ex, I pay a little extra. So, what’s the real problem here?
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That whole Cash for Clunkers comparison really is ludicrous. It was a short term project with a set beginning and, essentially, end, with really no baseline of expectations concerning how many people would choose to take advantage of it. Health care is an entirely different undertaking.
Besides, “bureaucratic snafus” are already doing plenty of damage in private health care. To assume it will get worse is asinine.
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What was I thinking, you’re right, it won;t get worse.
http://www.dailymail.co.uk/news/article-1208970/Man-collapses-ruptured-appendix–weeks-NHS-doctors-took-out.html
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Swede – it gets really, really old. Goddammit – that’s an anecdote. Go it it? A-N-E-C-D-O-T-E!
You want anecdotes?
http://www.guardian.co.uk/commentisfree/michaeltomasky/2009/aug/24/healthcare-horror-stories
That’s just the beginning. If you have integrity, you’ll do further research into our own system.
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Wait a minute, don’t you refer to other countries health care, satisfaction, cost of care…etc.
Last time I looked this wasn’t an anecdotical free site.
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From our moral perspective, health care is a right.
You may have a right to seek all the health care you want, but what is your moral justification for having others pay for it? Your right to freely swing your fist ends at someone’s nose. Your right to health care ends when your hand starts into someone’s pocket. The desk murder of a paycheck, so to speak.
Yea, yes, we have a social contract to help each other, but what are the limits? Must we give an illegal alien four liver transplants? Must we indulge the street alcoholic who’s only skill is aspirating his vomit and chronically spending weeks in intensive care?
You rail against health insurance companies, but isn’t that just shooting the messenger? I once mentioned that if you think health insurance companies were ripping people off so royally, why don’t you start your own? Gather some like minded souls as yourself, figure out a rate that would cover all current and future conditions, and charge away at a happily lower rate, since you wouldn’t spend such a big chunk of the premiums on hookers and blow as you seem to think current providers do. Your response indicated that premiums would be too high to garner any customers. I think this is the essence of it: how much is our obligation to the health care service, and how far off are current charges by the industry? In a lower post you indicated you were paying $700 a month for some coverage. What do you think you should be paying? You’ve advocated general taxes to support health care, but this transfers money from the wealthy and healthy, which is one way to do it but not the best way.
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In still later posts, I indicated that I am now paying $0.00 in health care premiums.
In 1993, the average payout of premiums to claims was about 95%. Today it is closer to 80% and edging downward. The reason is that Wall Street demands performance, and economic performance for a health insurance company is to minimize payment of claims.
They do this by avoiding people who might get sick, avoiding people who can’t afford premiums, denying claims and shifting costs to other insurance companies, hospitals, government, etc., and by rescinding policies when the holder gets seriously ill.
I mentioned that if insurance companies behaved in a humane manner, they would go out of business. This is due to adverse selection. I didn’t say this to make the point you are making, but rather this: That the business model is incompatible with universal care. Health insurance properly is a role of government. Health care is a right, and not a privilege.
As to who pays, if it is true, as I believe, that the wealthiest sectors are overpaid and workers underpaid, then your whole conceptual structure of our existence is topsy-turvy.
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I mentioned that if insurance companies behaved in a humane manner, they would go out of business
Not necessarily so.
In 1993, the average payout of premiums to claims was about 95%. Today it is closer to 80% and edging downward.
So 15% of your previous premium was diverted to hookers and blow. So at 15% less, would you have been happy with that? Do you feel that would have been a fair premium? Would that have been your fair share?
As to who pays, if it is true, as I believe, that the wealthiest sectors are overpaid and workers underpaid,…
Well, okay. I can agree to some extent. But this is a separate issue from health care. It seems to me you still are required to pay your share even under an unfair regime. You can’t just throw up your hands and say, “since our economic system is unfair, I shouldn’t have to pay anything”.
Health care is a right
Still problematic. How much? There are limits to rights. Yelling “fire” in a movie theater and all that. You have a right to speech, assembly, and voting, but that doesn’t mean others have to support an infrastructure for you.
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Not necessarily so.
Oh yes, necessarily. Health insurance by its very nature attracts people who need it while people who don’t need it avoid it. (Hence, insurers choose the workplace to sell it in) This has been a prolonged subject at this site, and I won’t go through it again. Simply read up on adverse selection. That is the internal contradiction that causes failure of the business model.
So 15% of your previous premium was diverted to hookers and blow. So at 15% less, would you have been happy with that? Do you feel that would have been a fair premium? Would that have been your fair share?
You’re really doing a whoosh!here. The reason that the medical loss percentage has been creeping downwards is the entry of for-profit insurance companies into the picture. Wall Street looks at EPS and EBITA and all of that, but they also look at medical loss and demand that public companies reduce it, minimize it. In the not-for-profit world, that problem does not exist. That’s why 5% became 20% – for-profit companies took over most of the market.
Well, okay. I can agree to some extent. But this is a separate issue from health care. It seems to me you still are required to pay your share even under an unfair regime. You can’t just throw up your hands and say, “since our economic system is unfair, I shouldn’t have to pay anything”.
I have my reasons. I am only eligible for high-risk programs, but I am not high risk. I spend less than a thousand per year on medical costs, but only qualify for very high risk groups that eat up premiums with heart conditions and cancers. So I avoid them. I’ve applied for a new policy, and am hoping I have a better chance of getting it in Colorado than Montana, where there are really only two companies operating.
The basic concept behind public insurance (or direct care, which also works, but not as well), is that the entire population is the community, and taxes are the funding mechanism. If you read above, and are aware of the experience of other countries, then you know that it works so well that costs are slashed, care is universal, and outcomes are better.
And beyond that, getting away from health care, wide disparities in wealth are anti-democratic, as wealth naturally collects in small segments of society, and that segment naturally takes over government (as it has right now), and we live under rules by wealth.
Does that small segment “earn” what it takes out of society? Of course not. They harvest wealth, they allocate it to useful functions (a useful activity) but do not create wealth.
How much [is health care a right]?
In total.
There are limits to rights.
The experience of all other countries is that universal quality care is not only doable, but much more affordable than what we do.
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Health insurance by its very nature attracts people who need it while people who don’t need it avoid it.
Your complaint here is that many current health insurance policies are a bad deal. I’m asking you that if it were a better deal, would you buy it? I suspect you really don’t want to pay for health insurance. You want the body politic via progressive taxation to fund health care, thus you can harvest the wealthy.
Wall Street looks at EPS and EBITA and all of that, but they also look at medical loss and demand that public companies reduce it, minimize it.
A lot of companies operate away from Wall Street, a lot of companies have slim profit margins. If it is a widely held notion that excess profits are being had in health insurance, like minded individuals could band together and capture some of this.
I saw an article about a school district in
Florida that many years ago thought their health insurance premiums were too high. So they went the self insurance route. Seemed okay for a while, but now they are up against the reality of the situation, including 1.4% of the workers generating 43% of the medical costs. Now they think they haven’t saved much over conventional insurance, and the thinking is they could do better with a company (via a larger pool to spread costs.)
In the not-for-profit world, that problem does not exist.
They have other problems.
If you read above, and are aware of the experience of other countries, then you know that it works so well that costs are slashed, care is universal, and outcomes are better.
Well, yes, we could do better, but the examples cited are usually European or Asian countries with a smaller, more homogeneous high IQ population. I’m not sure how transferable it is. There is a “conservation of social momentum” to these things: public levee building projects in Japan gets some nice levees; public levee building projects in America gets some awesome parties.
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