Dr. Locke, I'd love to see people start to hold corporations accountable. Instead, we get the kind of corporate hero-worship/brand loyalty displayed upon the death of Steve Jobs. This video is profane, but George Carlin comes pretty close to hitting the nail on the head-
http://www.youtube.com/watch?v=d5Ujn2UxTcY&feature;=youtube_gdata_player

I completely agree with this writer. His piece illuminates one part of the bigger problem I see, which is that because of the exaltation of "the market" and "market forces" American life has now become an adversarial process. Everyday people are constantly burdened by the necessity of parsing every offer the market makes in attempts to divine where the catch is for us. This is because we've all learned the bitter lesson that no offer is what it appears; there's always that catch.

We have to fight mostly losing battles to learn what's in our foodstuffs in order to choose healthful foods and avoid those we prefer not to consume, for example foods that are wholly or partly genetically engineered.

We have to practically get law degrees to read insurance contracts, only to learn that insurance rarely covers anything remotely likely to occur. The peace of mind that insurers used to tout as a reason to buy their products has become nothing more than an advertising slogan.

We are incessantly, especially in elections seasons (which are now constant) bombarded in every form of media and in our mailboxes with meaningless "messages" that are either wholly bogus or so far from straightforward that we cannot tell what is being said, and hence cannot make good decisions. Our Supreme Court has blessed this kind of American life by deciding Citizens United in favor of unlimited corporate spending on elections.

Politicians are more concerned about reelection that the common good. Not one has the character to speak truth to power or to stand on anything remotely related to a real priniciple that doesn't serve a monied interest.

Corporations of all types resist any regulation on their behavior, ignoring the costs in human suffering and environmental degradation. Banks, bankers, stockbrokers and hedge funds invent specious "products" that are nothing more than imaginative ways to strip us of any wealth we may have accumulated.

Business cooperates by moving jobs offshore and local governments collude by insisting on more and more tax money to educate people for the service economy that has evolved. Students leave college with financial burdens that they won't pay off before retirement only to find that the "service economy" means flipping burgers or retail jobs at minimum wage.

Government talks about "access" to health care, "access" to broadband, "access" to whatever while ignoring the fact that "access" means only that these things are available only to those with a boatload of money to hand over. "Access" to these things is an empty promise when one is unemployed or underemployed.

What will we have as a society if we continue in this direction? It seems to me that we can look forward to a future in which our "opportunities" will lie in providing services to the wealthy few. Are we returning to America's roots in servant classes who left England for "the land of opportunity?"

...the obscene idea arise that providing health care for humans ought to be a profit-making enterprise?" and food? how about clothing? most people still pay for shelter out of their own pockets. If I smoke, drink, use illicit drugs should I be cared for in the commons? the arrangements we have with the state are partly tradition, partly rational choices. Their are plenty of things wrong with health care in the United States but if the answer is to make health care free, brace yourself for medicare squared. And BTW, have you read about any profitable hospitals lately?

Hey, Dean... Did you see that many of the 99%-ers are complaining about the burden of student loans? Michael Moore - and his acolytes - were recently chanting, "no taxes, no fees, education should be free". I wonder how we are to do that with faculty expecting $200,000/year salaries?

Excellent article. Medicare is a non-profit entity with extraordinarily low administrative overhead of only 5%. One way to defang the health insurance industry is to replace it with Medicare for all. A single payer option would have been a huge step toward this goal but our elected officials sold us out and took it off the table during the run-up to national health care reform legislation a couple of years ago.

Washington Regence Blue Cross/Blue Shield is a leading health insurance industry bad boy in our state. State Insurance Commissioner recently chewed Regence out for a set of serious, longstanding abuses of customers and medical providers including:

Improperly withdrawing money from customer bank accounts in more than 6,000 transactions due to a mistake in its automatic premium payment system. In 200 cases, it withdrew from accounts of nonmembers, exposing names and account numbers.

Failing to pay some retirees' claims for several months.

Denying claims for services that had been preapproved.

Delaying claims payments because the company misplaced records.

Using a voice mail greeting to instruct callers to its underwriting customer service department to call an office that was open only on Thursdays, but there was no answer at that number on Thursdays.

This fiasco is described in more detail here:

http://www.ama-assn.org/amednews/2011/09/26/bise0928.htm

Either insurance industry regulations Washington are so lame that it is impossible to punish Regence and other industry malfactors with civil or criminal sanctions even in cases where one of these corporations has pulled these shenanigans thousands of times over a period of YEARS. Alternatively, Kreidler is so cowed by the industry that his idea of sanctions is to order them to get their act together and let it go at that.

Regence (which operates in Washington and Oregon) claims to be non-profit, but its president, Mark Ganz, earned $897,671 the company's Washington branch in 2008, including a bonus of $550,548. In Oregon, his compensation package totaled $872,665. In both states, Ganz brought home $1,770,336. The other high ranking Regence officials with six-figure salaries included Mohandas Nair, executive vice president and chief marketing executive, who earned $356,681 from Washington, and $295,140 from Oregon for a total of $651,821. Regence’s treasurer, Steve Hooker, treasurer, who’s announced his retirement, earned $337,543 from Washington and $304,641 in Oregon for a total of $642,184. William Barr, executive vice president of operations, took home $430,926 from Washington, and $377,119 from Oregon for a total of $808,045. And, Kerry Barnett, executive vice president of Regence’s corporate division, earned $312,482 from Washington and $302,990 in Oregon for a total of $615,472. [info source: Wikipedia]

According to its website, Regence used 86.3 cents of each premium dollar in 2010 to pay medical claims, a far cry from Medicare, which uses 95 cents of each dollar to fund payment of claims.

In spite of Regence's wretched track record, one of the Seattle area's largest employers, King County, recently awarded Blue Cross/Blue Shield a five year contract to administer its self-funded employee health insurance program. It looks like contracting with a company with a track record of nickeling and diming sick people and their medical providers is a key element in King County's game plan for driving down employee health care costs.

The world has become a Rorschach Test. Like rats on a ship, everyone senses that the boat is sinking. And we each project onto the screen the causes and culprits that appeal to us most. It's quite interesting, really. There is a fair amount of consensus, for example, about the general dimensions of (at least) the overall economic problem, but almost no agreement about the solutions to it or anything else.

Maybe there really are no rationally discernible solutions, and we will end up ripping one another part in our rage and frustration at not being able to figure it out.

There are at least a couple of good reasons why there should be profit in the health care industry. We want people to spend a lot of time and their own money to develop and invent cures for what ails us. That we should also use government research funds for other cures/vaccines is also reasonable. And if government funds are used, then profits should be limited to the patent lifetime after which we all benefit from the discovery. I find nothing wrong with this. While many people would work endless hours for the glory of the discovery many more people will also work those hours for personal enrichment.

On the insurance side of the equation, its pretty clear to me that only if we all self insure does it really work out. One can claim personal responsibility for some choices, ie smoking, lack of exercise, but as far as I know, birth defects, MS, most cancers are not caused by a lack of upstanding moral character. And children have no way to pay, neither do poor old people, which means we might as well lump everybody into one giant pool of insured, and use some sort of tax collection to pay for it all. Not that everyone gets a new hip, liver transplant etc, but that we agree to prioritize which treatments work, which only give a few more months of life and spend accordingly.

There are a lot of things wrong with the provision of health care in the US, but the profit motive isn't one of them. Why should you, as a patient, give more of your trust to a provider who is treating you under government coercion, or "from the goodness of his heart"? If someone comes up with a drug or performs a procedure that saves my life, you're damned right I want her to make a profit at it! That profit is earned, and earning things is a concept frequently alien to the bureaucrats in government.

Dr. Locke -- Thank you for your article. It might be most instructive to separate products and services into two categories: Those things that are improved by the profit motive and those that are degraded by it. A good example is police and fire services. We wouldn't think of privatizing those services (well, some might). Conversely, we wouldn't want the government in charge of making sure everyone had a TV -- the market provides for that. I would put healthcare in the public category and get insurance compainies out of the business entirely. They do not actually supply a service. There was a time when insurance compainies had no role in providing healthcare.

Jordan

Thank you, thank you, thank you for writing this, Dr. Locke. I almost sense that the tide is turning...

I'm sure there was a time when driving a car did not entail insurance either and my parents just paid the doctors when they could but if you have an investment of $trillions
in staff, facilities and machinery there has to be a reliable stream of revenue (not my parents). The US government is, of course, reliable but as to their efficiency I would question that. Medicare if efficient in the sense that, with fees established by fiat and no limit on cash available it is (and should be) fairly easy to mail checks to service providers. In the first ten years of Medicare costs exceeded estimates by about 800%. I don't know the figures since that time but I have read that twenty years from now, given recent rates of increase, Medicare, as it exists now, and Social Security will consume the entire discretionary portion of the federal budget. It may only spend 5% of that on administration but that it will be scant comfort.

What will healthcare look like when Medicare-like reimbursement rates are all that medical professionals will be allowed to collect for performing services? As private pay alternative channels emerge, will the government shut them down?

I hate to sound hyperbolic, but I truly question the sanity of anyone who thinks a profit motive is properly situated in the relationship between a human being and an insurance provider. Indeed, among all the industrialized countries of the world, the United States is the only society where the idea that profit motive should have any role to play in the insurance coverage of medical care for human beings. And, not surprisingly, nearly every other industrialized country also spends a lower if not far-lower percentage of GDP on medical care while simultaneously achieving universal or near-universal coverage, longer life expectancies, lower infant morality rates, etc. ad nauseam.

Perhaps it is not insanity but ignorance: I wish more Americans could get past the "oh my God, no, socialism!" talking points and could have the opportunity to gain real first-hand experience with the medical systems in Canada, the UK, Germany, Finland, France, and see how poorly our system stacks up. For-profit insuranc ecompanies is a huge part of our problem.

If it is going to be all rainbows and unicorns under the new system, why do you have to force people into it and fine them if they do not pay?

Insanely brilliant.

Thank you for shining
Light rather than casting Blue
Light shadows on us.

Whatever color the light, even more would be better!

" the pervasive influence of health care lobbyists on CONGRESS, WHICH INSURES that the market functions in the health care industry’s favor no matter what the facts are. When the CEO of the largest private for-profit health care company in the United States — who was forced to resign amid a scandal over Medicare billing practices in which his company admitted to 14 felonies and agreed to pay the federal government over $600 million — can be elected as governor of Florida, what hope have we?

Do not read this article as an attack on the medical profession and its practitioners.... The object of our wrath ought to be the fat cats with the bulging wallets who have decided that our ills and ailments are a lucrative way for them to make even bigger bucks...They ought to go to the top of the list of America’s Least Wanted."

Nice Try Professor Locke, but the top of your list should be reserved for those less than forthcoming careerists that we elect to office and allow to do just about whatever they want. And the reason is as you state at the emphasis I added above. As many a libertarian will remind us, only the government has the power to initiate force and I don't know of a politician who does not exclaim a few years in about how much they love their job. Power corrupts, but not all of them. The few it does not are the ones worth studying and then placing at the top of a new list—America's Most Wanted.

Amen brother. Picture it, Medical Insurance Companies Incorporated,an entire industry happily extracting vast sums from the American Public and adding NO VALUE WHATSOEVER to medical services. Is it curious? Is it obscene? In fact, the industry serves only to diminish the value of medical services since our medical providers are diverted from providing medical care, spending much of their time complying with the innumerable layers of corporate bureaucracy. America spends roughly double what any other Western Nation spends on health care with most of the difference landing in the pockets of that same Insurance Industry that provides no useful service to justify it's existence. When do we wake up and cast off this abomination?
DOliver

I am hoping that President Obama's health care plan passes the Supreme Court rulings just to piss off the insurance companies. Insurance companies always complain that their profit margin is 3% or just above that. While this may or may not be true, one should ask them what their CEO's and executive compensation is. I have said it before and will say it again, bonuses and/or fees, are the driving force behind many corporations, including mortgage messes, remember Washington Mutual, and other major problems currently affecting our society today including health care and insurance. Corporations, in this country, do NOT want to pay for employee medical plans. DO NOT KID yourselves. Corporations also despise any kind of health care reform. Many insurance companies are in it to make a profit, they will do what is best for the corporation, NOT necessarily for the patient. We are all aware of members being put into higher risk health plans therefore higher premium plans and deductibles along with pre existing condition clauses.
The BIG question is how we, as a nation, plan to treat our citizens healthcare, without bankrupting the government or individual families. Health care works well in Europe because you have to be a citizen of that nation state you are residing in, married to someone who is or, in some cases, are a citizen of a former colonial empire that the nation state once occupied. But more then that, Europeans take the attitude that if a member of their society is sick let's treat them and get them well. Let's also practice preventative medicine as well. This is not always perfect and many European countries have issues they must deal with, regarding their health care, but their systems do work. We, in the land of the fee, yes I mean fee not free, seem to believe that the private sector is best, even when we know that in its current stage, the private sector does not always do what is in the best interests of the American citizen. Because of this we have not figured out a way to get rid of the corporate drag but still ensure sufficient research and developement as well as medical care to all citizens, is implemented without going broke. So we muddle through and hope we don't get seriously injured or ill.