Roles of professional participants in the system

Doctors and other healthcare providers

For personal reasons, as well as for the sake of the U.S. Economy, we care about ourselves and others as employees. Workers must earn a living, and we all have friends or loved ones who work in healthcare. We realize some health workers are paid too little and are required to work too many work hours at a stretch. In doctor's offices, we see the results of expensive malpractice insurance reflected in shortened office hours, increased service costs, and endless paperwork – for them and for us. We observe the discouragement of persons who entered medicine as a means of helping others but who feel flattened by exhaustion or disillusionment.

We patients also want the opportunity to select our doctors. When it comes to divulging personal information and intimate physical details, each of us wants to work with someone we believe is competent and has at heart our best interest. Some personality combinations simply prove unworkable. If we were assigned by the healthcare system to a required physician, we might feel little confidence that a satisfactory relationship could be attained.

Private healthcare insurance businesses

As in direct health care, we all have friends or relations who work in the insurance industry. They may sell policies or assess claims, but they, too, need to make a living.

A few people pay individual premiums to private insurance companies for healthcare coverage, but most health insurance is tied to groups – either employers, such as the government, or particular businesses. Since more than 46 million people in the U.S. lack healthcare coverage, neither category applies to everyone. Those whose insurance is tied to their work know that rates have been rising rapidly for several years. According to the Kaiser Family Foundation, the average cost of family coverage premiums in the U.S. has risen since 1999 by nearly four times the rate of workers' earnings (Star, 8/20/09, p.A4). In 2009, it is not unusual for a family to spend one quarter of its total income for health care (“What is Driving the Rapid Rise in U.S. Health Care Costs?” (http://www.lwv.org/SocialPolicy).

Government-sponsored health insurance programs

In government, too, we all have friends and relatives who are system employees – town or city, county, state, federal – in one of the multitudes of departments, courts, agencies, or bureaus that execute public business. We also want these people to be able to participate in the economy and to keep their homes.

Although citizens often talk as if money paid to government is just sloshed into a feeding trough, Medicare and the Veterans Health Administration have exceptionally good records for providing excellent patient care while maintaining low administrative costs. Year after year, Medicare's administrative average (3%) beats that of the private insurance industry (15-20%) by a wide margin (http://www.lwv.org/SocialPolicy).

Pharmaceutical industry

In Indianapolis, the word pharmaceutial brings to mind Lilly. Everyone knows someone who works for Eli Lilly Co. We also want those employees to be financially sufficient. Besides the welfare of individual workers, we wish their company success. Lilly has a reputation for being an excellent employer, and the company provides huge philanthropic boosts to the city-county, to museums and arts groups, to schools and teachers, etc.

Yet everyone realizes that development of new drug possibilites, testing of prototypes, approval of substances by the Federal Drug Administration, and loss of exclusive rights to a product can be game-stoppers from the standpoint of either the company or of patients. For the company, philosophy and cost analysis guide decision-making. For the patient, the dollar cost of the product (after insurance, if the patient should have insurance) determines whether a product will be used. For example, if the child of a family slightly above the poverty line needs a monthly injection that costs two thousand dollars per shot, what is to be done?

Medical supplies and devices industries

Many of us also may have friends or relations who work to invent, make, or sell medical apparatus. This category is immense, ranging from implants, such as butterfly valves or pacemakers, to bionic parts, such as prosthetic legs, or to assistive devices, such as glasses, hearing aids, crutches, walkers, or scooters.

Again, what is included in healthcare coverage affects patients as well as industry. We desire a living wage for all the workers, even as we hope for patients needing such wonders to be able to have and use them. Should healthcare coverage help furnish an immobilized 40-year-old multiple sclerosis patient with an electric wheel chair or scooter, with a manually operated wheelchair, or with no apparatus? Should the patient who has lost the sight in one eye get a false eyeball, a patch, or nothing? Decisions must be made.

Investment industry (mutual funds, etc.)

Most of us have friends and acquaintances who work in investments, or we did before the recent financial collapse. For those who still have jobs, we hope employees can continue to earn a living wage, just as we hope that our own investments will swell our IRAs, nest eggs, or travel/holiday funds.

Many of us fail to track carefully where our money is invested, though. When asked, we designated something to our stockbroker, 401K agent, or financial advisor, yet we do not read with understanding every prospectus and report arriving in our mailboxes. If medical insurance businesses, medical supplies or devices companies, pharmaceutical companies, or healthcare practitioner businesses are part of what we “own,” we may not even know it.

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Structure of the healthcare system
Effect on the U.S. economy