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Features Health & Wellness Healthcare advocate says problem is still profit

George SixHealthcare in the United States has been a problem for decades, and George Six knows it.

A retired Episcopal priest and volunteer with the advocacy group, Healthcare For All North Carolina (HFANC), Six says that what started out as a good idea, even a noble idea – nonprofit, collective protection for consumers and providers – was quickly overrun with a focus on profit. According to Six, who was employed by MetLife Insurance for a time after graduating from college in the 1950s, the failure to control healthcare is due to the “cost plus” foundation that private health insurance companies established in those early days.

“The market place has had 30 years to fix all of this,” said Six, who was the featured speaker last Thursday at the League of Women Voters monthly Lunch with the League. Citing statistics from the Department of Health and Human Services, Six says that before passage of the 2010 Affordable Healthcare Act, there were as many as 165,000 uninsured people without access to healthcare in North Carolina's 11th Congressional District alone. Equivalent to over 23 percent of the population, this was one of the highest uninsured rates in the country.

During his remarks, Six traced the history of health insurance in the country, starting with the non-profit cooperatives and provider plans which became Blue Cross and Blue Shield, respectively. These plans operated on a “loss ratio” basis which simply covered the risk of the insurer and allowed it to break even. While policies did not generally offer catastrophic coverage, basic healthcare needs were more than adequately covered.

The first private insurers and unions had to be able to compete with the non-profits in terms of the quality and breadth of care provided. Eventually, however, a shift toward privatization changed the whole approach of insurance. As profits were based on percentage of premiums, and as there seemed to be no end to the demand for insurance products, there was no economic reason for either insurers or providers to discourage rising healthcare costs – and there was every reason to move to a “cost plus” approach whereby providers and insurers were guaranteed profits above whatever costs they incurred.

“It's not good for the business world to have cost containment,” Six explained. “What started out as a very practical approach to people's needs by people who were providing the care, basically got swamped in a world of corporate net profits.”

According to Six, healthcare is really not a partisan issue. From Truman to Eisenhower, Johnson to Nixon, controlling healthcare costs has been a perennial concern. Similarly, what is now called “Obamacare” (with derision by some) was essentially modeled on Massachusetts' “Romney-care.”

However, while the Affordable Healthcare Act represented a great opportunity for the country, and while it is increasing accessibility and guarantees insurability, it has failed miserably to control costs, says Six. The insurance industry made sure of it. While Six does not believe the act is endangered by lawsuits that challenge the constitutionality of forcing people to buy healthcare coverage, he says the same interests that are attacking it now are the ones that made it vulnerable in the first place. And some who may have bowed under the pressure of the debate may now be seeing that single-payer coverage “wasn't such a bad idea after all.”

For Six, though the march toward a sane healthcare system for America continues, he admits it won't be easy. He sees some hope in the experiments with single-payer systems in states like Massachusetts, which has managed to reach a 98 percent coverage rate, but these experiments also face great challenges.

“If you really want to talk about reform in America, it's going to be tough, because the people who control everything are holding the cards very close to their chest,” Six said. What will it take to bring change? “What will it take to get people back into the streets?” he answered rhetorically.





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