Friday, June 12, 2009

Health and Wealth - capital mistake?

Capital (letter)
an upper-case letter in a writing system.
Capital (financial)
any form of wealth capable of being employed in the production of more wealth.
a state of complete physical, mental, and social well-being
and not merely the absence of disease or infirmity.
an abundance of valuable material possessions or resources.

Health Care reform is a dear subject to me. Each day I am confronted with it's effects and I realise the intricacies that compose it and it's many facets. Unfortunately, my wife's medical bills often reach 5 digits. Coming from Europe, where not only Health Care but Health Care rights are, for now, granted as social benefits, backed by private insurance when so desired, I landed in a very strange place. A place where people without health insurance are driven out of hospitals and left to their own fortune in the middle of the street. Literally. A place where being sick is not just a health condition, it is a social stigma. Of course I had knowledge of this sad reality in the United States, but having knowledge of it from 4000 miles away is one thing, being in the eye of the storm is another. To me, Health Care is one of the cornerstones of a civilized society and one of it's fundamental indicators. The more advanced the society, the more quality Health Care it provides. In Europe, still very far from a real Union in the sense of Federation, the quality of Health Care is variable from country to country, but within the EU the common perception is Health is a common good and should therefore be every one's responsibility. As there is no quantifiable value attributed to human life, Health Care is not viewed as a profit driven activity. So far. There have been - and still are - attempts to privatize Health Care in several EU countries (namely in Portugal, my country), but they are invariably met with understandable concern and rejection from the people. In fact, even when the public Health Care system is not working at it's best it still provides millions of people the help they would never get otherwise. Otherwise, of course, being Wealth Care.

Health Care, from the business point of view, is a disaster. On the pure entrepreneurial side, no one in their right mind would expect to profit largely from an activity that can be so costly and unpredictable. On the pure moral side, no one with a basic set of moral values would seek profit as the ultimate goal of providing health assistance to other human beings. These are the core values, then come the nuances. Is Health insurance a bad deal? No. Should Health Care professionals work for free? No. Like in many other aspects of life, one must have the freedom and the right to obtain better conditions even when it comes to basic common needs. It is accepted that we all have the need to have a roof over our heads, but the fact that some of us can afford a million dollar roof does not mean everyone should. However, everyone should have basic fundamental housing, and that is an aim for civilized societies. It is one of the aspects of what is known as the fight against poverty. Basic global Health Care is much more complex than global housing, and more expensive, but it is a goal much easily achieved for the simple reason that we all need basic houses to live in but not all of us need the same basic Health Care. The basic expensive Health Care that we all should have access to will never be used by everyone for the simple fact that we are not all unhealthy. If you couple this reality with another indisputable one, that global Health Care equals global preventive medicine, then the number of people that will ever need serious and expensive basic Health Care drops dramatically. And here is the catch: so do costs. Catch, you wonder? Well, it's a very big catch if you have a Wealth Care system. You see, reducing costs by diminishing the number of payers/clients is a very bad thing if you have a profit based system. Very bad. One would think that healthier clients would bring much profit to health insurance companies, the only problem is healthy people don't really need health insurance - not the expensive kind that is so common today in the United States, anyway. A general costs breakdown in Health Care would also steal away the health insurance companies excuse for the outrageous premiums they charge. So even if health insurance can survive and has indeed a market within a public Health Care system the profit margins would be substantially smaller, as in billions of dollars smaller. Why would a company, any company, wish for a system in which it's activity profit is reduced so significantly? None would and none does. The word "health" in health insurance is not misplaced but it is seriously mistaken for something it is not: a state of complete physical, mental and social well-being. The main concern of a profitable enterprise is how to make profit while providing the best possible service, that is why Health Care can never achieve significant return since the better the service, the less profit and this does mean what you are thinking. The ideal Health Care system - the one we will never achieve but must live trying to - is the one that pays for itself, which simply means it's cost would be neutralized by it's revenue, the definition of non-profitable. Do you know any businessman in his right mind that would aim for such a thing? That is a Social aim. It's a society's aspiration, not a business goal.

Health Care should not be a business. It concerns us all and affects us all, no matter how healthy or wealthy we are. Saying any different is excusing the fact that wealth, not health, is really what we are talking about.

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