(The next two blog entries I will be posting consist of a two-part series about the American Health Insurance crisis. In the first essay, I discuss the Health Care industry in the U.S. as a profit-driven corporation. In the second essay, I will be looking at privatized Health Insurance as a crap-shoot)

Before I begin this attempt at getting my mind around the issue of Health Care in America, let me preface my remarks by thanking Ann from Baltimore who has promised to intervene on my twitter messages when I become too obsessed and frantic about the state of private Health Insurance in America.

To those who have not heard of Ann from @annq, check her twitter venue out. She’s my steady force of calmness in the sometimes frenetic world of cyberspace. Love you, my dear.

Now, Let’s play ball.

When I recently watched a utube interview of ordinary Canadians on the topic of their Health Care system, I was struck by their hesitancy in responding to a question about co-pays. One person simply asked, “co-pays?” From this brief series of interviews, I had an instant epiphany about the Health Insurance conversation in America, a conversation steeped in business-model language that controls so many of our perceptions of Health Care (If you’re interested in watching the video, check it out.

I am not sure when Health Care in America became a big business. But I do know that the Health Insurance industry dominates the conversation about medical/hospital care. Deductibles, co-pays, life-time caps, premiums, overhead. These are all words that are from a business paradigm; they are part of a vocabulary of a profit-driven enterprise that has managed to make every other approach to Health Care seem like a naïve, Florence-Nightingale sentimental journey back to the days when doctors made house calls.

The language of the Health Care industry makes it almost impossible to perceive Health Care through any other lens. We are now forced to believe that the industry cannot function without a percentage of overhead; after all, it is in business to make a profit, and overhead is an investment needed to keep the business operating on a day-to-day basis.

And deductibles and co-pays? They are not just words. They have now become built-in, fixed necessities. They are the default realities of an industry that has forced us to accept them as the inevitabilities of doing business. “Deductible,” like “co-pay” is a contract word that sets up the monetary parameters of a formal economic relationship between a “customer-client” and a business. “The business of America is” indeed “business.” Health Care in the U.S. is no exception to this rule.

Unlike Apple and GM, however, the Health Care industry does not create anything; it simply manages. In that respect it is very much like the finance industry, a fat-cat middle-man out to perform an economic, third-party service to a patient and a doctor and/or hospital.

Health Insurance companies make every attempt to keep the “price” of services down. To use a crude analogy, it is in the business of bookkeeping but not just as a transcriber of costs; it actively intervenes into the Health Care system by placing cost limits on the system.

Then it has to make sure that individuals and groups aren’t out of control with their health-related expenditures. And it often works with business cycles (My prescriptions, for example, are allotted in 30-day cycles or an equivalent cycle, except for “vacation” allotments—ever wonder about the similarity between a 27-day credit-card business cycle and the cycle used to determine when you can have your next prescription filled?).

But when one asks, “who is watching the watcher?” Well, if a corporation is in business to make a profit, only an inside board of directors is going to determine how much a corporation’s CEO is going to make.

For the record, the profit aspect of the Health Insurance industry becomes sickingly transparent when one sees the 2008 salaries of some of its top CEOs: (1) Aetna CEO, Ronald A. Williams: 24 million (2) Cigna CEO, H. Edward Hanway: 12 million (3) Coventry CEO, Dale Wolf: 9 million (4) Health New CEO, Jay Gellert: 4 million (5) Humana CEO, Michael McCallister: 4 million (6) U Health Group CEO, Stephen J. Hemsley: 3 million and (7) Wellpoint CEO, Angela Braly: 9 million.

So there you have it folks. The American Health Insurance industry is in the business of monitoring and guiding the medical-expenditures/care world in order to boost its profits and to satisfy its shareholders; at the same time, it tries to make sure that its clients receive the contractually obligated medical procedures and care spelled out in the clients’ policies.

In this divided-loyalty world of clients and shareholders, the industry is forced to juxtapose the two in a kind of balancing act hoping that profits can rise steadily, while, at the same time knowing that medical care costs are increasing exponentially, a train-wreck ready to happen anytime there’s a recession or even the threat of one.

And what if a Health Insurance company has more than two or three quarters of being in the red. What happens if a Health Insurance company goes bankrupt? What about the people who have their Health Insurance covered by a company that goes bankrupt? It’s not as if anyone has his/her 1 million life-time Health Insurance cap protected by the FDIC?

Are clients supposed to wait and hope their medical bills will be paid during the bankruptcy period? How can any group covered by a bankrupt company ever be assured that if a new company buys out the bankrupted company that their premiums won’t skyrocket into the fourth dimension? And we all know what happens when a new company begins to restructure an old company. It’s not a pretty picture.

Aetna, for example, posted a 29% percent profit-loss in July of this year. Do Americans constantly have to worry about their Health Insurance policies defaulting if a company goes under?

Yeah, we know that business always has a “risk” factor. After all, the great entrepreneurial minds in America were the “great speculators.” Risk is what gives the profit-motive its adrenaline. We have our Rockefellers, our Fords, our Goodyears to prove it.

But do we really want Health Care to be forged out of a business-risk model? Should you have to sit in this risk maelstrom for thirty years hoping beyond hope that your health insurance company doesn’t go under?

I think you get my point. Hope you come back for Part II, “American Health Insurance, a Crap-Shoot.”

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