Englisch Abschlusstext: Health Care – People, not Profit

Unser gesamter Englischkurs handelte über das kritische Schreiben auf der Basis von Aussagen anderer. Politikwissenschaftler A sagt dies und das, Prostituierte B behauptet etwas anderes. Obwohl ich mit A’s Logik mehr anfangen kann, überzeugt mich das prickelnde, erfahrungsbasierende Argument von B – so in etwa.

Mein Abschlusstext handelt über das von mir gewählte Thema Gesundheitssystem. Ich wollte das amerikanische System verstehen und endlich dahinterkommen, warum ein Staat nur so doof sein kann, kein soziales Auffangnetz für seine Bewohner bereitzustellen. In meinem “Research Paper” ziehe ich Vergleiche zwischen den Briten, Franzosen, Deutschen, Japanern und Amerikanern – und stelle fest, dass auch das deutsche/österreichische System seine Macken hat – nämlich auf der Ärzte-, nicht auf der Patientenseite. Deutsche Ärzte werden unterbezahlt, zumindest am Vergleich anderer Staaten gemessen.

Die Thesis meines langen Aufsatzes kann mit diesem Zitat von “Frontline” zusamengefasst werden:

“When it comes to treating veterans, we’re Britain or Cuba. For Americans over the age of 65 on Medicare, we’re Canada. For working Americans who get insurance on the job, we’re Germany. For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India.”

Um den Blog nicht in die Luft zu sprengen, verstecke ich meinen Text Health Care – People, not Profit” hinter dem folgenden Link…:

Tobias Deml

Research Paper Final Draft

English 1

2-2-2010

Health Care – People, not Profit
Or: Why the US Health Care Business is More Than Obsolete

In my private life – which means when I am not writing homework or long research papers – I am a big fan of self education. The things I am most skillful in are those that I taught myself; I also learn in a very different way than when I study something for school. Don’t get me wrong that early in my research paper; I love having the opportunity of learning about the entire world for two more years after high school in a formal setting – but the learning process in college and in my private life is a very different one. Soon after I started studying in California, I met all kinds of politically engaged people. Through discourse with them I developed a big interest in the health care system of the United States and its relation to other countries.
When I was asked to write a research paper in English, I figured that it would be a clever thing to combine this assignment with my private interest. In the following pages I will try to give you an overview over the health care systems around the world, focusing on the United States and European countries. If you are a supporter of the current, corporate health care model in the US I hope to give you new insights that might inspire you to learn from the positive and negative aspects of foreign systems.
Let me start this journey with an overview of the different schools of thought that result in common health care models worldwide. To get deeper into the issue, I chose to explore the journalistic work of PBS.

The Public Broadcast Service (PBS.org) produces a documentary-/investigative journalism type of documentary series that can be watched online; their name for this series is FRONTLINE. One of the documentaries produced under PBS’ flag is “Sick Around the World”, a closer look on the health care systems of five capitalist democracies – and their fiscal as well as social impact on these nation’s people. Roughly, these systems can be categorized in four different health care concepts.

First, the Bismarckian Model; it was the first health care system worldwide. Developed after the historical union of the scattered German dukedoms, the Bismarckian model employs a mixture between insurance and government control. The results are “Sickness Funds” which are government-regulated and not profit-oriented. They are funded by a combination between employee taxes and employer deductions; people who do not work are covered for free. One problem with the Bismarckian model is that doctors are paid under international standards and hospitals have financial problems. Countries that provide health care through systems based on this model include Germany, France and Japan.
The second type of health care concept is the British Beveridge Model. This health care system is purely managed by the government, financed with tax revenue. Doctor’s wages and rates are controlled by the government (which employs a majority of physicians directly); most hospitals are owned by the government as well. As a downside, there are longer waiting times for complex procedures like hip replacements. First established in Great Britain, it was adapted by other wealthy countries – its purest form exists in Cuba, introduced by the revolutionary and military dictator Fidel Castro.
Thirdly, quite similar to the Bismarckian model, there is the National Health Insurance Model. In this concept, healthcare is provided by many private-sector funds – that are financed directly by the government, which in return uses tax revenue for the funding of its program. Medicine pricing is largely controlled and subsidized by the government and limits people’s cost for drug purchases to a minimum. This subsidization can trigger more government spending and therefore lead to more national debt.
The NHI is mainly used by Canada, later joined by South Korea and Taiwan. Asked about the American health care system, the former Taiwanese President of the Bureau of Health Insurance, Hongjen Chang, answers: “Well, [the American health care model] is not really a system […] – it’s a market.”
With this statement, we close the circle and come back to the United States and the fourth model – the Private Insurance Model (FRONTLINE calls it the “Out-of-Pocket Model”). The Health care is paid for by the individual through insurance premiums – those who cannot afford insurance stay without health care. This model is largely used in third world countries that are too undeveloped and poor to uphold a government-controlled health care system. The United States employs an adapted version of the out-of-pocket model in which soldiers, veterans, people over the age of 65 and under the poverty line as well as disabled people receive governmentally-funded health care. The rest of the population has to finance their own health care or seek coverage with a private, for-profit health care corporation (Health Maintenance Organization – HMO). The government’s programs are funded by tax revenue, while the health care providers are operating with the premiums their members pay.

FRONTLINE interprets the various levels of government involvement in the American health care system on their website:

“When it comes to treating veterans, we’re Britain or Cuba. For Americans over the age of 65 on Medicare, we’re Canada. For working Americans who get insurance on the job, we’re Germany. For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India.”

The mentioned 15% of the US-population whose health is not protected by their government equal roughly 43 million people – uninsured people whose often tragic cases made filmmaker Michael Moore alert. In his documentary “Sicko”, Moore travels to countries that employ all sorts of different health care systems and interviews average people on their experiences with the health care systems in their country. Contrasting to “Sick Around the World”, which does analyze the downside of different health care approaches, Moore doesn’t try hard to find real evils in the health care models of Canada, Great Britain or France; his criticisms are so simple and intentionally weak that average people are able to convincingly argue against them. It is apparent that Moore’s film has a strong slant against the American system and is biased in its choice of interviewees. In my opinion tough, he is absolutely right to employ the technique of selective information – the cause of making people aware of the broken American health care system justifies these means. Stories of eyewitnesses like a nurse whose husband was repeatedly denied necessary check-ups and operations to fight his cancer by his insurance provider up to the point where the untreated cancer killed him (Moore, 00:24:10) or a mother who tells the story of her small daughter’s sudden illness that remained untreated because the insurance company wanted to treat her in a different hospital, which ultimately lead to the young girl’s death (Moore, 01:10:00) are a gloomy memorial to a failed system that prioritizes profits over human lives. No other health care system in a developed country reports medical debt or even bankruptcy of individuals – these tragedies only happen within U.S. borders.

Personal portraits of health care industry professionals are one of the issues that “Sicko” covers to explain wrongdoing inside the American health care industry. These individuals admit getting raises or promotions if they manage to deny more individuals their operations and health services. Through their denial of funding and therefore denial of care, the company saves money – in case of complicated operations like cancers or tumors, they save hundreds of thousands of dollars – in exchange for the life of an untreated patient who could not afford the operation by himself. Some supporters of private insurances might suggest that since all these American HMOs are operating on an efficiency-oriented manner, they should be wasting less money on “expensive patients” and administrative costs. But is this corporate system really helping people to save money? Let’s look closer at statistical evidence for claims about governmental and per-capita cost.

CodeBlueNow!, an US-based non-profit health reform advocate organization published data derived from the World Health Organization that brings average life expectancy in correlation with average health care expenses:

Country Life Expectancy Per capita expenditure on health (USD) % of government revenue spent on health
Germany 80 3,521$ 17.3%
France 79.5 3,464$ 15.4%
United Kingdom 79.5 2,900$ 15.9 %
Canada 80.5 3,037$ 17.1%
United States 77.5 6,096$ 18.9%

World Health Organization, 2007.

Interestingly enough, spending on health care in the United States is higher in absolute as well as in relative numbers, compared to other countries. The life expectancy in the U.S. is lower though. How can health care be more expensive but at the same time less effective? The answer is: profit maximization. If going to the doctor is expensive and financially dangerous, many people will stay away from getting regular check-ups that could reveal long-term illnesses in their beginning stages. While other countries largely invest in preventative care in order to minimize the number of fully developed, complex diseases, the United States is indirectly provoking the development of diseases from slightly harmful to life-threatening by keeping people in fear of going to the doctor. In countries like France or the UK, doctors get actual monetary bonuses if their patients’ health increases or if their illnesses are cured – compared with the US where insurance representatives get bonuses for denying insurance coverage. This stark contrast between illness prevention and illness provocation is one of many signs that there is something wrong with the philosophy behind profit-oriented health care – and its resulting social impact.

Similar to American doctors, hospitals and health insurance providers, the pharmaceutical industry of the United States operates with a profit-driven market competition and nearly no governmental intervention or price control. The authors of “Ethics and the Pharmaceutical Industry” warn about a distortion of drug production because of market-based dynamics: The pharmaceutical industry creates products based on customer demand rather than human medical needs.

“On purely medical grounds, the needs of a poor child suffering malaria in sub-Saharan Africa should have priority over a middle-aged American man suffering from hair loss. Through the prism of capitalism, however, the balding man is a valued, potential customer and the African child barely exists. Malaria research attracts 20 cents in research dollars for each infection, whereas ailments that are prevalent in developed countries attract hundreds of dollars per case.“

Although the Food and Drug Administration of the US government steps in to study side effects and accept or deny a medicine for the general market, there is largely no capping for prescription drugs and medicine prices. Pills that are supposed to heal complex illnesses often cost thousands of dollars, allegedly to finance research. While most developed countries have an annual price negotiation between health care providers and the pharmaceutical industry combined with governmentally subsidized price caps and additional funding for drug affordability, US citizens often have to pay the full, profitable price for prescription drugs. In some cases of American cancer patients, spending on these special drugs exceeds 100.000$ per year. With the knowledge of international health care systems and medical market dynamics, some might ask: What stops the U.S. from a health care reform that learns from foreign health care models? Some critics claim that health care should not be controlled by the government; it would become a socialist system that threatens democracy and capitalism.

Apart from Cuba, none of the so far stated countries call themselves anything close to a communist or socialist political system. The argument that regulated health care would mold American democracy into socialism is a cheap, populist trick to distract from the actual discussion. The word “socialism”, a taboo since the cold war against communism, awakes feelings of powerlessness in the American mind. A socialized health care system curiously finds much resistance from certain political camps while socialized police, military, fire fighters and water supply are blatantly accepted.
In FRONTLINE’s “Sick Around the World” it becomes clear that the keyword “socialist” is used on purpose to weaken the discussion; Frontline does the opposite that such critics would do and sets the phrase “Five Capitalist Countries & How They Do It” as their documentary subtitle in order to exclude the socialism debate from the discussion right away. Despite the socialism argument, there seems to be a concern about the quality of a health care system that is not developing based on customer demand.

Many countries around the world manage to have quality control in health care based on competition instead of profit; hospitals compete for patients and want to grow their customer base, even if they are not allowed to make any profit. It is a fact that in some countries like Germany or Japan, hospitals face financial problems and a lack of funding due to low insurance premiums. This is an indicator that the Bismarckian model might not be perfect – but neither are profit-oriented US hospitals who experience similar troubles, especially now, in a time of recession. An article in the hfm (Healthcare Financial Management) journal reports, based on a survey conducted by the Healthcare Financial Management Association, that “[In 2009,] 43 percent of the hospitals said they had a negative total margin, up from 26 percent for the first quarter of 2008.” The profit-based competition between hospitals doesn’t seem to result better equipment or more stable funding for hospitals. Compared to the market-based rivalry of American HMOs, German Sickness Funds compete against each other for the sake of growth; if they produce a “profit” through the insurance premiums, this surplus is being carried on to the following year and used to fund lower premiums.
Nearly all health care systems around the world have the characteristic of scalable premiums in common; a person who earns a lot monthly pays a quite high premium while a person with low or no income is partly or fully financially supported by the government in order to afford health insurance. Many of these countries make it mandatory to have health insurance and penalize people who try to “escape” (with an exception of Germany, where high earners can opt out of the system and obtain private insurance). Due to this concept of scaled premiums it is guaranteed that every citizen is covered, without exceptions. In systems other than the American one, private insurers are forbidden to deny coverage to anyone, no matter what preexisting conditions these customers might have. I agree with Dr. Jaques Milliez in “Sicko” who, when asked if a universal healthcare were possible in the United States, answers with a bitten lip “No”. The idea of freedom and anti-parentalism towards the government is so deeply engrained in the American value set that it will take revolution-like political circumstances to establish an universal health care in the US.
The more research I conduct about US health care, the angrier I get. It is an atrocity what happens to the poor and seriously ill in this country. What some HMOs try to camouflage as “business practice” – namely denying someone funding for the treatment of a life-threatening issue – is not an unethical little accounting trick but conscious refusal of help and, in some cases, ice cold murder.

Works Cited

hfm (Healthcare Financial Management). “Hospitals Taking Strong Measures to Cope with Continuing Financial Losses.”

hfm (Healthcare Financial Management) 63.6 (2009): 14. MasterFILE Premier. EBSCO. Web. 11 Feb. 2010.

CodeBlueNow!. “Health Comparison by Country Chart.”

CodeBlueNow!. May 2008. Web. 27 Jan 2010.

www.neiu.edu/~sociolgy/soc_club_files/healthcareinus/
CodeBlueNowhealthsystemcomparison.pdf

This statistic is produced by CodeBlueNow!, a non-profit organization that calls itself “America’s voice for health care”. Although the sponsor is clearly biased towards the topic, their statistic is factual and derived from numbers provided by the World Health Organization. The comparisons give clear insight to functionality of health care systems and will enrich my paper with numerical support.

Santoro, Michael A. and Thomas M. Gorrie. Ethics and the Pharmaceutical Industry.

Cambridge: Cambridge University Press, 2005. Print.

Moore, Michael. Sicko.

The Weinstein Company, 2007. Film.

Michael Moore’s documentary about the broken American health care system interviews and displays numerous people who all have one thing in common: Their lives experienced a serious damage because of the health care system. This film adds another layer to my argumentation, namely a very personal and case-by-case one.

Palfreman, John. Sick Around the World.

Palfreman Film Group and WGBH Educational Foundation, 2008. Film.

The subtitle of this documentary implies a clever marketing strategy towards skeptics: “Five Capitalist Democracies & How They Do It”. Clearly, the words “Capitalist” and “Democracy” are there to compensate fear of communism and socialism in the health care debate. The film compares health care systems – exactly what I want to do in my research paper – and will give a good starting point to argue against fear-driven statements that support profit-based health care.

About the Author

Tobias Deml is an Austrian Filmmaker and Visual Artist. 2012 Cinematography Reel: http://vimeo.com/53973421 Tobias Deml ist ein österreichischer Filmstudent und Möchtegernregisseur in Los Angeles. Er arbeitet derzeit als Kameramann in Los Angeles und popelt in seiner Nase.