2009-08-14 / Columnists

The Rockaway Beat

Take The Profit Motive Out Of Health Care
Commentary By Howard Schwach

If you are older than 65-years-of-age, then you know very well that our health care system needs to be rebuilt from the ground up. As a city public school teacher for 33 years, I was generally well-protected by GHI, the company of choice for most city workers.

Then, I turned 65, and found that, for some reason, profit became more important to that semi-public company than my general health.

The raging debate over whether health insurance companies should be public or private became very personal to me and my family, and I believe that we are no different from the majority of seniors striving to live on Medicare and Social Security.

The first thing that happened was that GHI took my medication of choice away and replaced it with a generic that, according to my doctors, did not provide the same balm to my pre-cancerous esophagus.

For years, I had reflux problems, regurgitating almost every night. That caused my esophagus to become pitted and at-risk for Barrett's Syndrome.

Both my GP and my gastroenterologist prescribed Nexium, a relatively new drug at that time, which not only stopped the reflux, but helped to heal the esophagus. I took the Nexium for a few years and then turned 65.

The drug arm of GHI refused my prescription for Nexium, instead providing a generic form, Prisolic, a drug that stopped the reflux, but did not heal the esophagus. Both of my doctors wrote to the drug provider, which is also owned by GHI, to protest, but to no avail.

They were told that Nexium was not cost effective for people over 65 and that the generic would have to do.

So much for having a profit motive involved in health care. It's not the care, it's the profit.

It's all about the profit, and that's why the profit motive needs to be removed from health care.

I am not a socialist, and I do not believe necessarily that government is better at running a program than the private sector, but there are some areas where doing right is more important than doing well financially, and health care is one of those areas.

When Medicare got into the drug business with its Part D coverage, lobbyists for the drug companies and the large health maintenance organizations (HMOs) pushed a rule through Congress that the federal government could not negotiate lower drug costs with manufacturers, and would have to pay top dollar even though it had a huge bargaining chip of buying massive amounts of the drugs, even though the Department of Defense could bargain on behalf of its VA hospitals.

That kept drug costs high and higher and pushed many seniors who hit the notorious "Donut Hole" of health care to give up much-needed drugs in favor of buying food and shelter.

The drug companies and health insurance providers have been the villain of the piece for years, and the lobbyists and advocates in the media for those groups have continually pushed the mantra that we are much better off with them than we would be with a government run program - but clearly, we are not.

Not when some clerk in Omaha is deciding whether I am the proper age to get the medication that I need to keep healthy.

Not when some grunt in a cubicle in Des Moines can tell me that it is not cost-effective for me to have an MRI of my shoulder even though I can't seem to move my arm over my head.

Not when my family is in the Donut Hole and has to pay $365 for a onemonth prescription of a drug that cost only $62 the previous month, when we weren't yet in the Donut Hole.

Right now, the health insurance providers, the American Medical Association and the drug companies are fighting what was once called a rearguard action - a fight to the death not to lose any territory to the marauding Democrats.

It is do or die, and, for them, the question at hand is not better health care or even health care for all Americans. It is a question of profit and they are not going to give up any profit until they are at the edge of the cliff and ready to be pushed over.

Karen Ignagni is the chief lobbyist for the health insurance industry. The New York Times said that she earned $1.6 million in 2007.

They don't pay that much money for surrendering profit to altruism.

"Attacking our community will not help anyone get covered," she said angrily the other day when a politician said that her community was "taking windfall profits."

She says that her hope is that her industry will accept changes it can live with while fending off too much government interference.

Neither health care coverage for all Americans nor quality health care has anything to do with her strategy.

It's all about the profit.

And, there are lots of profits, even in a time when many industries are failing, health care remains stronger than ever.

The ten largest insurers earned more than $13 billion in 2007, the latest year for which the figures are available.

As it stands today, medical bills cause half of the personal bankruptcies in the United States each year — even for people who have health care insurance.

The politicians in Congress don't have that problem, because they have their own well-funded insurance program.

The fear on the part of the "Blue Dogs" - the conservative Democrats - of providing insurance to others may well be fueled by the $508,000 their political action committees got from the health care sector last year, up 90 percent from what they got the previous year.

Even President Obama, so determined to get a health care bill this year, agreed to stop Congress from extracting cost savings from drug companies beyond the agreed-upon $80 billion, an agreement that was made by the White House in secret and behind closed doors even to Congress.

That is because drug company lobbyists reacted with terror to a House of Representatives plan that would allow the government to negotiate drug prices and demand additional rebates from the drug industry.

It's all about the money, honey, and all about profit.

It's time to take the profit motive out of health care.

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