Maine AllCare has received many responses to the Dec. 5 Maine Voices column, “Trump’s health care policy appears heavy on complexity, light on mercy.” One respondent correctly observed that not every industrialized country has a “single-payer” system.

This observation misses the forest for the trees. Indeed, many countries employ private insurance companies. But they are overwhelmingly nonprofit, heavily regulated public utilities.

Insurance companies process Medicare claims, but most of the time Medicare, not the insurance companies, underwrites the costs of care. There is a reason for this. Having a for-profit health insurance system sets the tone for behavior throughout the system.

The United States is the only country in the world where for-profit insurance and other products and service companies are central to its health care system. It is also the only society where profiteering and wealth extraction from sick, frightened and essentially powerless patients by insurance, pharmaceutical, medical device and other corporate providers of health care products and services (some of them nominally nonprofit) are not only tolerated and permitted, but also often celebrated.

In other countries, the mission of the health care system is facilitating the delivery of health care. Instead, our for-profit system often erects financial and other barriers to care (insurance companies), or prices their products out of reach of most Americans (pharmaceutical, medical device companies and corporate service providers), all in the cause of maximizing profitability.

We offer access to the most profitable services to those able to pay for them, often without regard to their clinical necessity or merit, leading to well-documented over-treatment, sometimes with disastrous results.

In other wealthy countries, health care is a right, not a privilege to be purchased by those with the means to do so, and is considered a public service, not a way to get rich quick. This was the column’s central point, and one worth repeating over and over again.

Philip Caper, M.D. Julie Pease, M.D.

board of directors, Maine AllCare


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