Common Confusions
Anne Gauthier is lead author in a Commonwealth Fund publication that provides an excellent overview of issues facing US healthcare. This is particularly valuable when paired with her chartbook on the same site from Mar 2005. She does share several misconceptions with most other current authors, and these impede any real progress toward goals of greater value or lower costs. For example, on page one, she states that the “goal of any health care system should be to help all citizens live long, healthy, and productive lives....” Hard to argue with apple pie, but, well, no, and if that is the goal, the system is doomed to failure. Healthcare has almost no effect on any of these parameters. The great gains in longevity have come from public health, not healthcare (sanitation, immunizations, air and water quality). The health of the population is related more to personal habits (smoking, obesity) and is probably inversely related to healthcare. (More or better healthcare preserves sick individuals within the population, thus detracting from its overall health.) The improved productivity of recent years was brought on by technology and education--not by healthcare. So, there is this common confusion between health, healthcare, and health insurance. It’s important to link the goals with the levers. Raising the tax on tobacco or gasoline will do nothing for healthcare, but either would likely improve health.
The second common confusion is over for-profit vs not-for-profit status. There are insinuations in Gauthier’s work and others that for-profit institutions are somehow evil and sap resources that should be given to the poor. Wrong! For/not-for is an accounting trick. ALL HEALTHCARE INSTITUTIONS MAKE MONEY. The difference is how the profits are reported to the IRS. More on this, if there’s interest.
Comments
Bob, you make really good point regarding health, healthcare, etc. Right on!
One item I would disagree with is the difference between for profit and not-for-profit. Yes, it is basically a tax status and yes both for profit and not-for-profit have to make a profit. No money = no salaries, supplies, etc = no staff or operational funding. My disagreement is that not-for-profit must utilize all profits in furtherance of the mission of the organization and not in the lining of shareholders or owners of the organization. If they do not do this, they lose their non-profit status with the IRS and have to start paying taxes.
Posted by: John Harrison, RN, MHSA | May 17, 2006 02:35 PM