The Contradiction of Profit and Service

The conflict between the profit motive and the desire to serve others is something many of us live with every day.  Like most therapists, I struggle to make a living while also accommodating patients who suddenly find themselves unable to pay my usual fee.  I don’t know if I always get it right, but I take the struggle seriously.

So I think we often miss out on the fact that it is very different for businesses.  With responsibilities distributed in a business, there is room for different points of view.  But, then, in our system, there is a bottom line.  In the end, profit will trump all other considerations.

A new book by Wendell Potter, former director of media relations at CIGNA, makes clear that it is not reasonable to expect reliable and effective health care coverage from insurance companies that are driven to make profits.  He notes the following:  between 2000 and 2008, as private insurers raised premiums by over 90 percent, payments to care providers grew by only 72 percent.  Moreover, even in the recession, profits for the five biggest insurers totaled a staggering $12.2 billion last year, up 56 percent from 2008.  (Deadly Spin, recently reviewed in The Boston Globe, “An insider dissects the health insurance industry.

The top executives did well, according to Potter, but it is their job to manage profitable companies that give good returns to investors.  They did well because they performed well.  But despite claims to the contrary, their primary job is not to serve the public.

Potter points out that they manage the contradiction in two ways:  they engage in sleezy practices like purging their roles of less profitable customers, like small businesses when their claims go up and individuals with “pre-existing conditions” (now illegal under the new health care law);  then they engage in massive public relations campaigns to discredit critics.  They begin with slogans like “Socialized medicine” and “government takeover,” but go on to talk about “death panels” and provide horror stories about insurance coverage in other countries.

Potter’s book is immensely useful because he was on the inside for 20 years, crafting PR campaigns and writing slogans for politicians (mostly Republicans) to use against efforts at reform.  He supplies facts and stories.  But I don’t think he is telling us something that we don’t already know.

Those who are profiting from the current system simply cannot support reform.  Just like Wall Street cannot welcome regulation, and industries cannot support oversight into safety that cuts into profits.  To expect otherwise is to deny an awkward and unwanted truth – at least, in our system — and allow oneself to be manipulated.