[Oe List ...] Fw: Re: some proposals for real health care reform

[R Williams]

Susan,
 
This is a response to what you have said here as well as to your response to something I said earlier regarding the role of profit.
 
First point, there really is no such thing as a "non profit" organization.  Every organization has to make a profit in order to continue to exist.  The real designation should be between "for profit" and "not for profit" since "non profit" organizations are those that did not survive.  The only difference between the two is what they do with the profits.  A "not for profit" by law must reinvest its profits and a "for profit" distributes a portion of its profits to its investors/owners.
 
As for the role of profit.   An earlier comment you made in response to something I said  seemed to suggest that you thought I said there is something wrong with profit.  Indeed all organizations must make a profit in order to survive.  Profit is vital, i.e. necessary for survival, but the essence of every organization is to serve.  So, profit is vital, but to serve is essential, of the essence.  This is not a new idea for "for profit" businesses and in fact goes back at least to Adam Smith.  One of the more common current analogies we often hear in business is, "Profit is no more the purpose of business than breathing is the purpose of life."  Again, vital but not of the essence.
 
The problem begins when a business decides that making a profit is its one and only--anything goes as long as it adds to the bottom line.  When that attitude is foremost customers are exploited, workers are manipulated and treated as instruments of production, and communities are rent asunder.
 
The purpose of business is to serve, period.  And it must serve it's entire stakeholder network, among whom the primary players at a minimum are customers, workers and the community.  Serving stakeholders and being profitable are not mutually exclusive, except when the emphasis is on short term returns.  For the long term, there is no other way to be consistently profitable that to effectively serve.  Peter Drucker said that if a business fails, after all the analyses as to "why" are done, what it invariably boils down to is, the business ceased to serve.
 
This wisdom from Willis Harman, co-founder of the World Business Academy, really says it best for me.
 
"Business has become...the most powerful institution on the planet.  The dominant institution in any society needs to take responsibility for the whole....  But business has not had such a tradition.  This is a new role, not yet well understood and accepted.  So business has to adopt a tradition it has never had throughout the entire history of capitalism: to take responsibility for the whole.  Every decision that is made, every action that is taken, must be viewed in light of that kind of responsibility."
 
Regarding our healthcare crisis, if hospitals, insurance companies, pharmaceuticals, etc.--for profit and not for profit--would voluntarily take up that up that kind of responsibility for the whole, then I would agree with you that the role of government should and indeed could be limited.  But the fact is, as Willis Harman said, that role is "not yet well understood and accepted."  Until it is, and business decides to promote and serve the common good, then the regulatory powers of government must protect the general population from the exploitative, manipulative greed that many health-related and other businesses, including those in my own industry (finance, insurance and real estate.)  For me, this is at the heart of the economic, health and many of the other crises we are facing at home and around the globe.  Gratefully, I can cite several cases in which businesses today are picking up that kind of responsibility.  This promises a
 healthier, more economically equitable future, but the work has just begun.
 
With respect,
Randy Williams

--- On Fri, 9/11/09, Susan Fertig <susan at gmdtech.com> wrote:


From: Susan Fertig <susan at gmdtech.com>
Subject: Re: [Oe List ...] some proposals for real health care reform
To: "'Order Ecumenical Community'" <oe at wedgeblade.net>, dialogue at wedgeblade..net
Date: Friday, September 11, 2009, 3:23 PM



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I like a lot of what you say in this message Marshall (I know - can't remember when I ever agreed with you about anything!!).  I am particularly interested in your first set re: Congress.  I worry a little about your second set, because the incentive for invention (i.e. new cures) is profit -- those pharmaceutical companies just need better oversight to break the link between doctors and pharmaceutical companies (why isn't it a conflict of interest for doctors to own pharna stock --and then prescribe from those companies' products?).  I'm curious about your comments on Medicare Part D -- I opted not to sign up for it, for instance, because I couldn't see how it would be better than what was available commercially.  And why 2E?  Again, I want those pharmaceutical companies doing research and finding new drugs and new cures. If there is no profit, who will do the research?  Taxpayer funds are not a bottomless resource or a tree that just grows
 money.
 
On your third point: I recently found out that Blue Cross Blue Shield is a non-profit.  I was quite surprised, because they compete with Aetna and all the others.  (Actually, BCBS is my carrier). Why do you want to force everyone to use a non-profit, though?  Oh well, I guess we'll never agree on socialism vs. capitalism. (And i don't mean that having non-profits vs. commercial companies = socialism, just that requiring everybody to be non-profit = socialism).
 
And finally, on your fourth section, what is excessive?  Who defines that? 
 
Susan
 



From: oe-bounces at wedgeblade.net [mailto:oe-bounces at wedgeblade.net] On Behalf Of W. J.
Sent: Thursday, September 10, 2009 12:39 AM
To: oe at wedgeblade.net; dialogue at wedgeblade.net
Subject: [Oe List ...] some proposals for real health care reform




OK, so I waited to hear Obama's speech. Not much new there. So now's my turn.


Here are some fairly radical proposals for bringing the cost of health care down from one sixth of GNP to maybe as little as one tenth, while moving toward universal coverage (excepting, of course, those pesky undocumented workers).


1. Start with Congress itself, which is captive to 'special interests' who provide generous campaign and lobbying issues funding.


a. Cap corporate contributions to Congress @ $1,000 total per year per candidate/officeholder for all corporations and their executives. Ban all corporate perks such as free flights on corporate jets, etc.
b. Drastically reduce the cost of political campaigns by banning paid television advertising on commercial networks. Unpaid news coverage and public affairs television exposure would be encouraged.
c. Substitute extensive free political issues exposure on the PBS system for all candidates/officeholders with massive coverage of debates, town meetings, speeches, position papers, books, articles, proposals, etc.


2. Squeeze both marketing costs and profits out of the major pharmaceutical companies.


a. Ban all commercial television advertising of medical devices and prescription drugs ("Ask your doctor about . . . ").
b. Change Medicare Part D to mandate federally negotiated drug pricing (the Republicans won't stand for this, 'cause they're protecting these special interests with a massive give-away program).
c. Require pharmaceuticals to offer the Medicare negotiated drug pricing through all insurance companies.
d. Encourage all prescription drug users to seek the lowest cost options outside the USA, for example from Canadian sources.
e. Require Medicare and all other payers of prescription drugs to use the lowest cost approved suppliers of generic drugs in the global marketplace.
f. Require FDA oversight of all approved foreign drug manufacturers.


3. Take the health insurance companies out of the 'for profit' insurance business and place them in competitive positions to lower the costs of health insurance.


a. Place all health insurance in not-for-profit spin-offs, breaking the hold of consolidation in the insurance industry.
b. Force competition among insurers by making insurance available across state lines.
c. Place private insurance companies under federal, as opposed to state, regulation.
d. Set up federally sponsored alternative insurance programs.
e. Give federations of small businesses the same negotiating leverage to drive down group insurance rates enjoyed by large corporations.
f. Require licensed insurance companies to offer individual health insurance at a rate that is the average of all their group health plans.
g. Make health insurance a right, not a privilege that can be denied to the 'undesirable.'
h. Lower all monthly Medicare payments to Medicare Advantage plan insurers to an annually negotiated rate (the Republicans won't stand for this, 'cause they're protecting these special interests with a massive give-away program).
i. Require Medicare Advantage plans to offer dental insurance in their benefits package @ zero premium to the policyholder.


4. Wring excessive costs and huge profits out of for-profit medical practices and hospitals.


a. Set up alternative medical practices like the Cleveland Clinic model based on salaried personnel, rather than fee for service payments, and give preference to these providers based on lower costs and higher quality of services.
b. Set up alternative specialty hospitals, clinics, and medical services companies with lower operating costs to compete with outdated and underperforming institutions.
c. Set up an alternative form of liability insurance with federal panels of physicians to sift real malpractice from spurious/inflated claims, and severely punish those who violate medical norms.
d. Put an end to defensive medicine, duplicative testing, and the 'anything goes' mindset by making physicians annually accountable to review boards for substantially inappropriate, wasteful 'overtreatment' of patients, with significant penalties for patterns of abuse.
e. Study systemic regional differences in cost and practice patterns with control mechanisms to rectify exaggerated distortions in the costs of medical care.
f. Offer standard fee-for-service procedures at Medicare approved rates throughout the nation through all insurers. 


That's just a few of the things you probably won't get in Obamacare.


Marshall
  

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