Open your eyes to the vul­ture cul­ture of for-profit health in­sur­ance:

The Irish Times - Tuesday - Health - - Front Page - Des O’Neill

The Ir­ish ex­cel in all sorts of un­usual ways. For ex­am­ple, could we pos­si­bly win an award for the most naive health con­sumers in the world?

This thought oc­curred as a far­ci­cal story un­wound re­cently, gen­er­ated by the chief ex­ec­u­tive of Laya and the man­ag­ing di­rec­tor of Ir­ish Life Health. These cham­pi­ons of the op­pressed and down­trod­den went on Six-One News ex­press­ing con­cern that their cus­tomers were be­ing “bul­lied” into sign­ing away public-funded hos­pi­tal care.

Their looks of sin­cer­ity and worry were so earnest that the but­ter sub­sti­tutes (we are talk­ing about health in­sur­ers, after all) were in no dan­ger of melt­ing.

Yet these two pri­vate com­pa­nies are track­ing the tra­jec­tory of Bupa Ire­land, ag­gres­sively tar­get­ing low-risk younger in­sur­ers (re­mem­ber the ads about chil­dren go­ing free), col­lect­ing their pre­mi­ums, hol­low­ing out risk equalisation to within a mi­crom­e­ter of le­gal­ity, and avoid­ing re­cruit­ing older cus­tomers who ac­tu­ally need care.

Oh, and they will likely ei­ther even­tu­ally fold or sell on.

After Bupa Ire­land ran away with tens of mil­lions, it was clear that man­agers in the sec­tor had learned fast. Oliver Tat­tan, who jumped ship from the VHI, made ¤10 mil­lion from the sale of his start-up Vi­vas. A group that in­cludes the cur­rent man­ag­ing di­rec­tor of Ir­ish Life Health set up GloHealth, again ag­gres­sively court­ing younger low-risk con­sumers, and then sold to Ir­ish Life, gar­ner­ing 33 mil­lion Cana­dian dol­lars (¤22.3 mil­lion) for the founders. Where does this money come from?

Ob­vi­ously not from thin air, so pre­sum­ably it came ei­ther from present and fu­ture in­sur­ers, or else strate­gic struc­tur­ing of debt – in the fi­nal anal­y­sis, from us tax­pay­ers. Thirty-three mil­lion dol­lars could buy a lot of health ser­vices . . .

Slow learn­ers

Ir­ish health­care con­sumers are clearly slow learn­ers, re­quir­ing sev­eral it­er­a­tions of be­ing fooled be­fore ac­cept­ing their shame from the per­pe­tra­tor. The chutz­pah and cheek of these ex­ec­u­tives, bring­ing out their tiny vi­o­lins for what most viewed as con­cern over pres­sure on prof­its rather than a deep-rooted sen­si­bil­ity to the rights of their sub­scribers.

In ad­di­tion, public hos­pi­tals, while not per­fect, tend to have a bet­ter sense of the need to at­tend to the re­ha­bil­i­ta­tive el­e­ments of hos­pi­tal stay and may have a longer stay (and more pres­sure on prof­its) than the treat-and-street phi­los­o­phy of pri­vate hos­pi­tals.

I am ap­palled by what I have en­coun­tered in my rare res­cue con­sults in pri­vate hos­pi­tals, the nadir of which was a se­nior nurse telling an ill, vul­ner­a­ble pa­tient that the VHI was ring­ing daily to say the pa­tient’s in­sur­ance had run out.

Not-for-profit en­tity

In­sur­ance does not run out when you are sick, and un­like the post­man, the VHI does not ring even once. While the VHI is not per­fect, it re­mains a not-for-profit en­tity, with a mis­sion in the first in­stance of com­mu­nity rat­ing, ie, the same price for ev­ery­body re­gard­less of med­i­cal con­di­tions.

One of the tragedies of the US health sys­tem, from which we badly need to learn, is how the for-profit in­sur­ers de­stroyed the not-for-prof­its, with the no­ble-minded Blue Cross sadly be­com­ing for-profit in 1994.

As noted in a re­cent US re­view, in­sur­ance com­pa­nies such as Laya and Ir­ish Life mar­ket them­selves as care­givers, con­fus­ing the public, but they are not. The com­pa­nies are fun­da­men­tally in­vest­ment ve­hi­cles, max­imis­ing prof­its to boost share­holder value and man­age­ment pay­outs.

The naivete of the public is com­pounded by un­crit­i­cal re­port­ing of health cor­re­spon­dents of these dy­nam­ics, un­re­flec­tive col­lu­sion of many health pro­fes­sion­als (es­pe­cially nurs­ing and medicine) with for-profit health­care, and the sim­plis­tic think­ing of the politi­cians who de­vel­oped the re­cent Sláin­te­care re­port.

If a pri­vate sys­tem is to func­tion as these politi­cians imag­ine, we need a rad­i­cal re­think of how it is funded and op­er­ated. A re­cent re­fer­ral to our ser­vice from a pri­vate hos­pi­tal stated bluntly that it was not safe or fea­si­ble to carry out a pro­ce­dure in the pri­vate sys­tem when a pa­tient would re­quire pre- and post­op­er­a­tive re­ha­bil­i­ta­tion. The pri­vate hos­pi­tal re­quested that we fa­cil­i­tate through the public sys­tem!

We need to open our eyes to the vul­ture cul­ture of for-profit health in­sur­ance, and de­mand that our politi­cians en­gage with pro­fes­sional and con­sumer bod­ies to re­shape pri­vate health­care to be fit for pur­pose, em­brace its re­spon­si­bil­i­ties, and en­sure that money paid in is spent on health­care and not on mar­ket­ing, div­i­dends and large pay-outs to in­vestors and man­agers.

One of the tragedies of the US health sys­tem, from which we badly need to learn, is how the for-profit in­sur­ers de­stroyed the not-for-prof­its

PHO­TO­GRAPH: DARA MAC DÓNAILL

The 2017 Women’s Mini Marathon, spon­sored by the VHI: “While the VHI is not per­fect, it re­mains a not-for-profit en­tity.”

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