Save Our Health Services From The Profiteers

---

 
The chief executive of a huge US health insurance company was assassinated in cold blood earlier this month. That’s big news. The bigger news though is the reactions of many Americans – ranging from lack of sympathy to downright gloating about the man’s death.
The context here is that healthcare costs in the US are too high, and insurance companies are seen as the culprits. Many people feel they’ve been treated badly by these companies, and for them the murder of the CEO seems like karma.
The US certainly has the best healthcare technologies and professionals. The country spends, as a percentage of GDP, twice as much on healthcare as other developed nations. In spite of this, the majority of Americans don’t feel they have a good system protecting their health.
Warren Buffett once called America’s healthcare costs the tapeworm that drains the economy – and that the tapeworm has won. Given healthcare expenses are the single biggest cause of bankruptcies in the US, the tapeworm is indeed winning.
We’ll let the Americans sort their healthcare issues themselves, if they can – and the wise money isn’t on them being able to do it. Let’s look at our own situation here in Malaysia instead.
Personal experiences
For years I was covered by my employer’s health benefits. But it’s easy to take that for granted. A colleague learned that when he survived a heart attack and was later declined private medical insurance because he had become a high risk.
Another friend sent his old father to a private hospital for treatment. Two hospitals later, he’s paid enough bills to buy a decent bungalow in a smaller town.
He could afford it. But even so, he quipped that private medical centres are in reality medical malls. The medical specialists there aren’t employees but business owners in a complex arrangement with the hospitals to share revenue and costs.
I read about a young doctor who used to work with the government whose father had cancer. The private specialist she consulted declared the father’s illness to be terminal and offered him hospice services – which he co-owned.
Many private specialists are loath to referring their patients to another specialist, as that’s tantamount to sending customers to a competitor. Here’s where the term “medical mall” is indeed a fitting description.
Doctors in public hospitals aren’t incentivised by profits and are willing to involve specialists from other disciplines to do what’s best for the patient. That sounds much more like what Hippocrates would’ve wanted.
A few years ago, I had a serious issue with my spine (yes, I actually do have one, thank you). Put off by the predatory doctor in a private hospital, and the delays in a government hospital, I had my surgery done at the private wing of a public university hospital.
I was very happy with the medical procedure, even if the “service” wasn’t quite five stars. But I’d rather have my insurance money go to a doctor who chose to stay in public service than pay another doctor waiting to buy his second Ferrari.
It’s a national crisis
We’re clearly facing a crisis in health services. Medical insurance premiums are rising faster than the inflation rate, and will surely overload the national health service, itself already close to breaking point.
Many who’ve used public medical services are surprised at the quality, and certainly the affordability. While the queues can be long, and getting a specialist appointment can be a pain in itself, you won’t go bankrupt because of it.
The high costs of private hospitals can’t be blamed on the insurance companies alone. The hospitals, and the specialists they have under their roof, even if not exactly under their employ, have a lot to do with it.
Many specialist doctors justify their high charges by citing the cost of getting qualified – first obtaining an expensive medical degree, and then the specialist qualifications and licenses that come later.
Fair enough. But many of our specialists were trained at the government’s expense, with the only “sacrifice” being the opportunity costs of being bonded to government service while enviously watching their private sector counterparts pile on the wealth.
But even if the specialists did spend a lot on getting qualified, after 3 or 4 decades of being in “business” they would have achieved payback years ago. Everything since then has been pure profit. They’ve recouped their costs, and then some.
Hospitals or hospitality
Private hospitals are increasingly becoming hospitality businesses, preferring to treat expensive illnesses and pursuing the lucrative medical tourism sector where foreigners come for elective medical treatments and have a holiday as well.
Comfort, service, luxury and such matters come to the fore. So, for many private hospitals, it’s all about the “business model” of how to enhance revenues (through high billings) and increase profits (by focusing on “lucrative” cases) while cutting costs, such as salaries of the non-doctor staff.
I have a family member pursuing nursing qualifications in the US, after which she’d probably be able to live a comfortable middle-class life there. But not in Malaysia – nurses here aren’t the ones who benefit from the high billings of private hospitals.
The European way
I certainly don’t want our health system to be like that of America, something almost Darwinian in its survival-of-the richest mindset. I believe health is a societal responsibility and not just a privilege for those with money.
We need to have something better.
The answer must be a well-run national health system, much along the lines of many European countries, together with strong rules on how private hospitals should operate. But such measures aren’t easy, either to afford or to control.
Technology, such as AI and robotics and biotech can help, but overall, I’m pessimistic as the bad (control of such technologies in the hands of the greedy) is likely to overcome the good – cheaper and more effective health services for all.
As it is, artificial intelligence is already extensively used by insurance companies to review and increasingly reject insurance claims. The murdered CEO’s insurance company actually rejects one out of every three claims, the highest rate in the US.
This particular company is a huge and powerful profit-driven bureaucracy that’s answerable to almost no one but their shareholders. Afraid as I am of bureaucracies in general, this type scares me the most.
What politicians must do
The increasing burden on the national health service may degrade it such that it cannot serve the rakyat properly any more.
The demographic picture – lower birth rate leading to a smaller tax base, people living longer and consuming more medical services etc – is not in our favour. Neither is the increasing profit-orientation of many aspects of the health system.
Politicians must pay more attention on how to keep fellow citizens healthy, by both offering resilient, efficient public health services, and by curbing some of the excesses of the private sector’s naked capitalism.
It’s scary that many Americans are applauding a vigilante killing of one of those they see as corporate pirates more interested in profit than in helping people deal with their health.
It shows how broken things have become over there. And if we don’t fix things, the same kind of descent towards anarchy can happen here too. - FMT
The views expressed are those of the writer and do not necessarily reflect those of MMKtT.

---