The Issue of Profit in Health Care – Part One

I cannot even begin to count the number of times I have read comments and posts from people on social media, or in response to articles, where someone says that health care should not be for profit. Yes, on its surface, it sounds like a very noble sentiment. But that is just the surface.

We must start by digging beneath the surface of such platitudes, and consider what place health care has in everybody’s lives.

Those who advocate for single payer health coverage insist that “health care” is a basic human right.

In an article on the Medinnovation and Health Reform blog, Richard L. Reece, M.D. provided an excellent line of demarcation between medical care and health care. I will quote it for you verbatim:

“Medical care is what doctors can do for you. Health care includes what you do for yourself – such as diet, exercise, and lifestyle.”

As Shakespeare once said, “Ay, there’s the rub.”

With these two very common-sense definitions, which have been conflated as if they are really synonymous, we can discern the separate purposes of each term. I would conclude that the correct meaning of the term “health care” is how we, as individuals care for ourselves. Unless we are severely disabled in some way, we are all personally responsible for own own health care. If we maintain a sensible diet, level of physical activity, and avoid such unhealthy habits as smoking or inappropriate drug use, we can expect to remain relatively healthy. We can also take the responsibility to see a primary care physician for some basic preventive procedures, but that is our prerogative. Because it is our prerogative, we should have our own choices in which practitioners we see and how we pay for those procedures such as cholesterol testing, mammograms, etc.

For those of us who are physically and mentally capable of managing our own lives, I should add that common sense should guide us to budget some money for medical expenses that will help us to stay healthy or catch a problem soon enough to do something about it. I know that some people have had a problem with politicians making this statement, but it is really common sense – it might be a good idea to forgo the latest smart phone or video game system in favor of stashing away money for some basic medical services. One great freedom-loving way to do this free of too much government interference is to either maintain a Health Savings Account or get a low-cost membership to a Direct Primary Care practice if there is one available. Both routes are affordable even to lower income people, and anyone with an average intelligence should be able to manage such responsibility for their own health.

By the way, on the physical activity front, it takes little to no money to exercise – just personal discipline that anyone has the capability of developing. One does not have to belong to a gym; they can regularly walk, run, or buy some very inexpensive home exercise equipment and/or workout videos. Walmart and Target have very inexpensive exercise aids; I should know because I have bought them.

However, life happens, and there are illnesses and accidents that we cannot control. Let’s say that someone has a serious car accident that is not even their fault (it  happens) and they are injured. Then that person will clearly need medical care with the hope of healing and becoming healthy again. However, in that case, they are clearly not receiving “health” care; they are receiving the medical services of a doctor who must assess the extent of their injuries and recommend treatment. Of course, there are illnesses or conditions that can happen to a person no matter how they manage their health. I don’t think I have ever heard of a way to prevent multiple sclerosis. Once again, they would be receiving medical care that will hopefully take them back to a condition of general health or at least be able to maintain a relative degree of health and well-being.

I go back to the original definition of health care then. As long as we are not incapacitated in some way, we are capable of managing our own health care. Those who are incapacitated in some way will clearly need a personal caregiver and someone to provide the medical care they need to maintain life as well as possible. I do not object to some public provision to make sure the health and medical needs of the most vulnerable people are met. However, all of society should not be lumped into that system; instead such a system should be tailored to meeting the special needs of the most vulnerable people. In fact, I would argue that single payer systems such as Canada’s have been moving toward enabling physician-assisted suicide, so those who are considered to be a “burden” to society could be encouraged to exit the world, which is hardly my idea of care.

Let’s get back to the issue of doctors “profiting” from caring for people. Should not a physician who has very specific skills in treating illnesses and injuries have  same livelihood the rest of us expect? Remember these physicians have sacrificed personal lives, a decent post-college income, often a sizable portion of future earnings to pay off debts for their training, and most often sleep, to take people from a state of illness or injury to health again whenever possible. And yes, those who practice general medicine can encourage their patients to do what it takes to get or stay healthy.

I would like to add to that, most of us expect to “profit” to some degree from our work, and many of us are not as skilled as a physician and have not undergone what a  physician does to be trained in their work. Yet we expect that OUR livelihoods should provide us with more money than it takes to feed, shelter, and clothe us as well as maintain our health. We want our dinners out, movie nights, vacations,  top-of-the-line smart phones, etc. Those should all be funded by profit, not basic living costs. Ditto for doctors.

I have barely warmed up on this subject, and it’s already about as long as the last one, so I will simply leave you here … for now. I will take up the subject again in my next post.

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At this time, the purpose of my emails is to inform you of my latest blog post so you don’t miss out on anything I write. I am also planning on providing you with some interesting educational information in the near future regarding how the United States got to the crazy place we are in right now with the dual goals of general health of the public (I hate the term “population health”) and making sure people with medical and surgical needs receive the care they need. I personally find it fascinating.





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