Sunday, November 10, 2013

Get the profit motive out of health care

by Richard Mellor
Afscme Local 444, retired

The capitalist class likes to boast about the efficiency of the market. How there is no other way of organizing production in society. They have a very pessimistic view of humanity really; they think we’re all like them, that without the profit motive we will not produce, we’ll all just sit on our asses.* They employ a whole sector of non-productive workers whose job it is to watch us and ensure we produce. I remember my boss coming in to the lunch room one day and the first thing he does when he sees a couple of us sitting there is look at his watch. He’s conditioned to do that; he gets rewarded for it like Pavlov’s dog. Human Labor power is measured in time, so time is in money.

It’s not always so black and white. He wasn’t always in that position and sometimes his loyalties were divided. This is not a good quality form the point of view of those who control the labor process in society.

All this is in the interest of efficiency.  The private sector is efficient, the public sector wasteful, overpaid and unproductive.  But efficiency for the capitalist class is one thing, for the worker and our communities it’s something entirely different. The US Post Office for example is an extremely efficient service. No matter where you live in the US you will get your mail, you are guaranteed it.  This is crucial in rural communities and communities with large senior populations.

For the capitalist class it’s inefficient as the money they allot to it doesn’t cover expenses. This is their excuse anyway although it is much more than that as I have explained in pervious commentaries.  They want to privatize it and eliminate 4000 post offices. How is that efficient for the recipients of the service? They see it as a business, we see it, or should see it, as a service returned to us from the collective wealth our labor produces. It is how we allocate society’s resources, human indlcuded.

I was reading the other day about San Jose State University.  The campus administration is demanding immediate cuts, up to 20 classes.  The administration is, “Merely asking its academic programs to live within their budgets”,the Oakland Tribune reported.  But who determines the budget limitations? Who sets the parameters?

 “That is an absolutely ridiculous way of running a business” says one department head. But there’s the problem right there; it should not be a business, it is an institution of education. Another department head; “We’ve gone from, I think, outrage and shock last week, when we first found out about this, to ‘how do we make this work?’ We want to help make this work, but we’re trying to figure out how not to hurt the students,”

And yet another problem; business is a ruthless venture, it is a permanent state of war, economic war. The answer to this assault on public education by the warriors of capital cannot be fought by “trying to make it work”, within the limits they set for us. The aim of their activity is to hurt the students; they are aware of this. Our only response to it is to reject it is a business, get it clear in our own minds what we need to live a decent, healthy and secure life and then determine the strategy and tactics necessary to obtain it in the face of fierce resistance from capital and its political representatives.

All this boasting about how great US society is based on Donald Trump and Warren Buffet’s view of the world. These people have nothing in common with the vast majority of Americans.  

The US health care system is not only barbaric; it is inefficient. It’s not inefficient if you’re the CEO of a pharmaceutical company or a hedge fund manager of a CEO in the hospital industry or any other coupon clipper, especially the insurance company heads.  But if you need to get medical care it’s mediocre at best.

Just last week, there appears to be a slight success in requiring insurance companies to cover care for mental health and addiction in the same way they do for physical illnesses (which is not so hot either.)  “According to administration officials, the rule would ensure that health plans’ co-payments, deductibles and limits on visits to health care providers are not more restrictive or less generous for mental health benefits than for medical and surgical benefits.” The New York Times reported last week.

The rules will apply to most other forms of insurance the Times says.  And that is another absurd process, having an insurance company, a private for profit corporation determine society’s access to health care.  Still, the Obama Administration is ecstatic and under the Affordable Care Act (Obamacare) treatment for mental health and substance abuse in included among “10 categories of benefits considered essential and thus mandatory” in the Act’s plans, says the NYT.

Just ponder for a second about this so-called democracy when an insurance corporation determines “In mental health, uncertainty kills,” says one sympathetic politician, “If an individual poses a threat to himself or others, he cannot be told he will get the care he needs as soon as his insurance company decides what parity means.”, parity being the same options as physical illness. Yes he can, that’s freedom free market style.
whether or not you can receive medical care; this is not a civilized society by any stretch of the imagination.

The insurance companies are not actually in the health care business other than administrating it.  They are in the profit making business. As Marx described the activity: “a schoolmaster is a productive labourer when, in addition to belabouring the heads of his scholars, he works like a horse to enrich the school proprietor. That the latter has laid out his capital in a teaching factory, instead of in a sausage factory, does not alter the relation.”

We live in a dictatorship of capital and capital always puts profits first.  Insurance companies already provide some mental health coverage but , “…, some have found ways to get around existing rules and to deny payment for treatment, or to otherwise limit the benefits.”  That is standard procedure and should be unacceptable in any civilized society; it is criminal activity. They will always put up road-blocks to any procedures that curb profits. People die form this activity in their hundreds of thousands but it’s part of doing business for them, its efficiency.

The present rules change intends to eliminate the practice of restricting doctor’s visits or hospital stays for the mentally ill. Insurers have actually required patients to get “authorization” before seeing a psychotherapist. One doctor hopes these rules will end, “’the uniquely discriminatory form of prior authorization and utilization review’ applied to emergency care for patients with mental illness.”  

The consequences of such a practice meaning:
 “A person who has a heart attack or pneumonia and goes to a hospital will routinely be admitted, with electronic notice sent to the insurer on the next business day……By contrast, if a person who is profoundly depressed and tried to commit suicide goes to a hospital, an emergency room doctor must call a toll-free telephone number, ‘present the case in voluminous detail and get prior authorization.’”

This situation will not change though until money and the profit motive is eliminated from such social necessities as health care and education. The coupon clippers that control these vital services will always try to “get around” rules and regulations that curb profits. Insurance regulators are considered to be “too close” to the industry the Times adds but we know this to be true. The regulators for the deep water drilling industry handed over the writing of regulations for that industry to the industry itself; the catastrophic BP spill is one result of that.

These vital industries must be public services as opposed to private for profit businesses, even in a capitalist economy, where publicly elected boards are still limited to control by one of the two wall Street parties that have a monopoly in the political arena.

But we must strive to replace this control with genuine democratic control and management by the workers, consumers and communities that use these services. A transit board for example, or water board, or county health board should be composed of elected members of the workers in that industry, from specialists to custodians as well as elected members from the communities they serve something along these lines. I also would include representatives of the trade unions representing the workers’ in the industry as well although given the rightward shift of the trade union leaders and their ideological marriage with the bosses, my tendency is to only include non paid rank and file members.

The medical industry in total, including big pharma and research and development must be nationalized and run along the same lines..  These are just some thoughts and changes like these can only be developed through public debate and discussion and will only take place when working people have our own political party.  The most important thing is big business and the profit motive kept is kept out.

The idea that an insurance company determines access to health care in society is something we have to drive from our consciousness, it is not the way to manage society and allocate society’s resources.

* Profit off of capital and wages paid for work (the price of labor power) are two very different animals

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