Not-For-Profit in the Arena of Needs and Single Payer Health Care

Not-For-Profit in the Arena of Needs

Who should profit from a person’s need for medical care or disability maintenance? Should anyone profit? Why should the gross-charge for medical care include a profit above and beyond the actual cost of production-distribution-administration and prorated training, design, and development and be a part of the economic model for the provision of our essential needs? Are food, water, energy, shelter, provisions for health/safety, and transportation essential need? Are these rights or privileges? Is survival of the fittest the our operating paradigm, or is compassion?

Specifically – health, medical, pharmaceutical, and prevention - businesses and services which comprise a 15 percent of our present GDP are essential to each individual’s life. Is the idea of profit for these services exploitive, if not a form of extortion? The brokers and middlemen that are now interjected between the consuming individual and the service provider/product should become unnecessary, with the improved levels of - communication, automation, and education – available today. Could an enlightened, educated, and responsible citizenry be self responsible for maintaining accountability for the efficacy of the administration of these services, and the acceptance of risk? Do we now have a model on the internet, AngiesList, that attempts to accomplish this? Is this not the place for litigation, but instead a place for the ‘free marketplace’ to weed-out, or entrust, where individuals’ actions to purchase and use are the judge and jury? If we and our educational institutions work correctly, we can dramatically improve our own oversight of medical care, and if we are individually conscientious, we can exercise higher levels of preventative medicine as well as preliminary diagnostics and even treatment prescription. If we individually fail to assume responsibility that fault lies individually with us. What defines a non-profit business? Who or what agencies monitor those not-for-profit businesses, define the policies appropriate of non-profits, and enforce those policies? Why would anyone want to establish and run a non-profit business? Could true not-for-profit health care related products and service significantly reduce the cost of health care? Or, on the other hand, are health care and the insurance management/access industries currently mainly operating as not-for-profit, thus making this argument moot? Is this truly and issue of individual responsibility, and if so how do we foster greater individual responsibility?

Another take of the problem of health care costs was developed by the CATO institute in 1994, in which the primary premise is the over-use of medical services because of ‘ease-of-access’ to the system. You can follow the link here to the article Cato Policy Analysis No. 211. In addition, Cato argues that ‘third-party’ payments (government/medicare/medicade, and insurance companies) are paying the bills, enabling the patient, and thus encouraging higher costs. Is it a combination of these observations? Are we trying to provide for the delivery of too much health care? What is too much? Too much for whom?

Last, how do these arguments relate to the other essential needs of food, water, energy, and shelter?

Who Profits Now in the Attendant Home Health Care Industry?

An overlooked area of health care is that supporting the aging population facing normal gerontological deteriorative processes. This is not so much preventative medicine, but supportive care. My wife and I have now directly participated witnessing the deteriorative aging process in 4 immediate relatives, both mothers, and two uncles all in their late 80s and early 90s. We experienced extended hospitalizations with the accompanying disorientation, the vegetative state fostered by most 'convalescent/nursing homes', the extreme cost of in-home 24 hour attendant care, and the hurdles of dealing with administrative paperwork, legalities/liabilities of health care workers transporting selves to acquire groceries and medications, etc. I was shocked to learn of the excessive margins (owners' profits) in the operation of home health care, and home attendant care businesses, where the ratio of owner operating costs to care worker salary 3:1, the care worker earning less than 30% of the charges, and in some cases, many making even less than this. The need for these services to the aged is great now and growing rapidly with a huge amount of exploitation of both the client/patients and the health care workers.

Care is being provided by individual workers with good intent, but with (poor/if no training) in the areas of meal preparation, first aide, basic medical symptom recognition and appropriate action, and psychosocial interactive techniques. Most of the workers are first generation Filipino, or other Pacific Islanders here in California. The wages they receive are substandard and sometimes exploitive, with often no job security.

Some form of subsidized training, needs to be a part of the healthcare mix, as these individuals are living at the subsistence level already. As many of these individuals may work 24/7, some accommodation needs to be provided for training that allows the care worker to attend training without losing their current job assignments. Better yet, a subsidized training program prior to working seems more reasonable with a living wage/stipend provided during the training period, followed with a license/certification. This could be a state or Federal program. In addition, as many of these individual care workers COULD be self contractors, the state could ease the process of running a soul proprietor contracting business by providing the counseling resources to locate liability insurance and complete the necessary forms and procedures to establish the ‘business’, as well as have a central site to advertise services as well as assess those services, much like AngiesList.

Individual care worker contractors would reduce the overhead to nearly “0”, while improving the salary compensation of the worker and reducing the cost to the patient/client. The overhead would be minimized by the municipality, state, or federal agency overseeing this contracting/licensing/certification/training/advertising. Accountability of care workers could fall on 2 sources, family members, or in the event of no available family, a municipal/state/federal caseworker, much like those used for foster care. Family members would also require training on what to observe/assess and how to assist through training once again provided through municipal/state/federal resources. How about if all of this became a part of the K-12 public education curriculum, right from the start? What a novel idea, teaching real life skills in school!

For the instances that large scale business provide for these services, some form of oversight and monitoring of the businesses that provide these workers is needed, as they should surely be NOT FOR PROFIT businesses. If profits are hidden in owner salaries and administration, as I suspect is currently the case, then there needs to be some way of creating a transparency here so that excesses are not being taken.

The need is huge and a profit based industry will not support the need of individual elderly who need these services, and who are mostly on minimal incomes themselves.