Why for-profit health care makes no sense

By James Fieseher, M.D.
Portsmouth (N.H.) Herald, February 09, 2011

One of the major reasons that America is the only industrialized nation with a privatized for-profit health-care system is the fact that most Americans don't understand how it works. Most of us believe it's too complicated and doesn't seem to make sense, even though it's the only health care that we have ever known. Perhaps the best way to understand how private (non-government) health care works is to apply the concept to a government run service. Try to imagine your local municipality privatizing your police protection:


"Yes, I need help. Someone's downstairs breaking into my house trying to rob me. Please send somebody right away."

"Can I have your insurance number, sir?"

"My WHAT?"

"Your police insurance number. If you want us to send a policeman over, we'll have to have your insurance number."

"But there's someone in my house now."

"I'm sorry sir, but without your insurance number I am unable to authorize a patrolman."

"Okay, let me see if I can find it. I have the lights out and the robber doesn't know we're up here."

"I can wait a short time sir, but I do have other calls."

"I think I found it. The number is YGG73552W."

"I'm sorry, sir, but that was last year's number. You would have been issued a new card for this year. You should have a new card with the last letter Q."

"Oh here it is. The number is YGG73511Q."

"Very good, sir. Let me check your number through our system. Please hold just a moment."

"Please hurry. I think I hear him moving up the stairs."

"I see from our records sir that your policy doesn't cover robberies."


"Your policy doesn't cover robberies, sir. I'm sorry. I won't be able to send anyone out right now."

"Look, I'm being robbed. This is the only police policy my employer signed up for. I didn't even have an option for robbery coverage."

"I'm sorry sir. You know, you could have purchased an individual coverage policy outside of your employer's insurance."

"I can't afford that. That policy costs over $600 a month!"

"I'm sorry sir. Is there anything else I can help you with this evening?"

"You mean that's it? That's all you can do for me?"

"Yes sir."

"Look, lady. This guy has just broken into my home, he's now up the stairs and I think he's about to attack my wife."

"Oh, that's good, sir. Your policy covers assault."

"It does?"

"Of course, sir. That's part of our personnel protection policy. I also see that you also paid for family coverage, which means that not only are you covered for assault, but your wife and children are covered as well."

"Thank God! Now, please, send someone over right away!"

"Yes, sir. Would you like us to send a criminal law student, a rookie policeman or a veteran police officer?"

"What kind of ridiculous question is that? Of course I want a veteran police officer. My wife is being attacked!"

"It's just a matter of co-pay, sir. The generic criminal law student is a $10 co-pay. The rookie will cost you $25 and the veteran police officer is $75."

"Why so much?"

"That's what you pay when you want a brand name — our finest."

"Forget it. I've got a handgun somewhere around here. I'm just going to shoot the bastard myself."

"I wouldn't do that if I were you, sir."

"Why not, he's assaulting my wife."

"Yes, but shooting him would be an unauthorized, out-of-network referral not to mention our non-compete agreement you signed. We would have to arrest you for that."

This sounds outlandish, but that's exactly how private, for-profit health care works. The reason we don't understand it is exactly because it doesn't make sense. As a doctor, I've spent literally hours on the phone with health insurance representatives in an effort to get needed services for patients with life-endangering illnesses, only to be denied because it wasn't covered under the patient's policy.

Of course, there's the cost factor. Changing from a private health care system to a nonprofit or even a public or single-payer system costs money, quite a bit of money. Take New York City as an example. According to the 2010 budget, New York City spends $4.195 million for "New York's finest" in police protection, arguably the best police force in the world. That comes to about $500 per person per year for police protection. Not bad. If you or your employer spent that much on health care, it would be quite a bargain for arguably the world's finest health care. Further, if the police versus medical analogy is continued, we see that privatizing the New York City Police Department would save the taxpayers of New York City $4.195 billion, but it would cost the citizens of New York City a total of between $8 billion and $12 billion for private police protection — based on 2003 world health statistics showing Americans paying two to three times the amount of dollars for health care compared to other industrialized nations. So New York City would save money, but New Yorkers would spend two or three times as much for police protection.

But wait, you say. "We don't want the government running our health care system." We don't? Is there some other government you trust more? You don't like the way your municipality runs your fire and police departments? Do you really believe that your health insurance company does a better job than your local fire or police department?

The fact is, the better we understand health insurance, the less sense it makes to operate a health care system using a for-profit model. The idea of keeping the government away from health care through privatization or deregulation is akin to keeping the government away from fire or police protection.

America was founded upon principles of capitalism and independence. Changing to a non-profit health care system won't change that. It will merely make it cheaper for our businesses to run with a healthier population.

The writer is a Portsmouth resident.