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Donna Smith

Donna Smith, American SiCKO, is executive director of the Health Care for All Colorado Foundation

July 27th, 2013 2:50 PM

Why Don't Our Laws Apply to the US Health Care Industry?

Patients or Consumers, Medicare for all, Single-payer, Donna SiCKO

It is a shame that the laws that apply to many other areas of life and business in America are just not applicable to the US health care industry.

Insurance companies, pharmaceutical companies, and health providers can and do demand payment up front for services not yet rendered, not yet fully disclosed, and definitely not guaranteed to be effective or even marginally helpful. Patients and their caregivers must prove their own value in advance of the potential provider actually providing anything at all. Then, if the service rendered or the service denied is unsatisfactory for any number of reasons, the patient still has to pay and may even be driven into bankruptcy paying for the substandard service.

Patients or Consumers? Either way, the laws fail us.

That's just because giving medical care is such an individual thing, eh? Medical care is something one person may benefit from and another with a similar condition may not. So many variables and so little that is constant from one patient to the next is part of the excuse offered for an inability to guarantee outcomes. Also, patients may or may not fully comply with all portions of treatment plans and thereby play their own roles in making care less effective. That's all true, but it still does not explain fully the reasons why so many of the services and goods offered through the for-profit US health care system are exempt from the laws that would apply to nearly all other consumer activities. It seems the health care industry wants to be seen subjectively with regard to results but definitely wants revenue to be very objective indeed.

Insurance may be marketed as protective of health and wealth and in reality for-profit, private health insurance has failed in many case to actually deliver on those advertised assertions. Many insured Americans struggle with out-of-pocket costs for care and many struggle with claims denials and delays. Health insurance is not health care, but you wouldn't know it from listening to how it is promoted. Sue them for something? Good luck with that. Many laws protect insurance companies from much legal liability at all and many states' insurance regulatory bodies don't do much to really help patients. There's nowhere for someone wronged by an insurance giant to get relief. Death is just a part of the business for them.

And the drug industry? Come one. That industry's ability to turn almost anything into the opportunity to make massive profits is legendary. And we all see and hear the advertising for the newest drugs with all the warnings aimed at protecting the company from any legal liability should patients get sick or die from the advertised product. Fact is that the drug industry just builds in a certain amount of money to pay out legal claims for defective or dangerous drugs as a cost of doing business. Death is pretty routine for them.

How about providers? Well, this gets a bit more difficult to wade into as some providers would prefer to see best outcomes for patients -- dead people really don't make good repeat customers. But there are also many for-profit providers that skirt the laws followed in other industries in how they handle financial transactions and guarantees to pay and even the release of patient records. Also, asking anyne in the patient safety movement how ill-protected we are at the hands of most providers, and you'll get an earful about the lack of effective legal protections in that arena as well.

We need to be able to see the US health care industry for what it is and in the full light of public disclosure. We need to discuss how and why having an improved and expanded Medicare for all for life system would make many of these issues so much easier and humane to track and address.

We need answers about why patients do not have even modest consumer protections within the US health care system that represent a huge portion of the nation's total business and economic activity. It's like we're in the Dark Ages in terms of regulating an industry that kills 123 people every day for profit. And it makes me angry. How about you?


Today's count of the health care dead and broke for profit in the U.S.:


The 2013, to date, U.S. medical-financial-
industrial -complex system dead: 25,471

The 2013, to date, U.S. health care system
bankrupt: 408,456


** These figures are calculated based on the Harvard University studies on excess deaths in the U.S. due to lack of insurance coverage or the ability to pay for needed health care, and the Harvard University study that calculated the high percentage of personal bankruptcies attributable to medical crisis and debt in the U.S. 123 people die daily due to lack of coverage or cash to pay for care; 1,978 go bankrupt every day due to medical crisis and debt though the majority had insurance at the time their illness or injury occurred. This statistic is also based on the 1.2 million bankruptcies in the U.S. in 2012, according to the U.S. Bankruptcy Court, and calculating those medically-related bankruptcies from that number.http://www.healthcareforallcolorado.org/endorse_right_to_health_care

Follow Donna "American SiCKO" Smith's blog: http://donnasicko.blogspot.com/ 

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