The Perception of Greed Applies to Nonprofit Health Care Too
There is some real crazy stuff going on in this world. A guy with what looks like a charming smile laid in wait and then assassinated the CEO of UnitedHealthcare, a large for-profit health insurer. It’s all on camera, even the assassin’s momentary flirtation with a receptionist. Our vanity is our greatest weakness and the thing that will always get us caught. Both the assassin and the government’s surveillance ability is downright scary, if you really think about it. Not only are our momentary flirtations — or even our nose picking — all on camera everywhere, but we can actually watch assassins with silencers assassinate somebody. I am glad for it in this case. But I don’t know whether incessant surveillance isn’t far from murder. I’m just saying.
Watching the assassination and its investigatory aftermath is like watching the first 30 minutes of Law & Order, excerpt somebody’s husband, father, brother, and son is really not coming back. The speculation is that the killer was mad enough about “greedy insurance” companies that he decided to kill somebody.
Health care, and therefore health insurance, is invariably associated with greed because health care is dispensed primarily according to market forces. Slate labels as an “uncomfortable truth” the amorality of the American health care system. The market’s lubricant — or its gasoline if you like — is a greed we call “profit.” Not even nonprofit health care is dispensed in a manner immune from market forces. People don’t sell to or work for nonprofit health care on a nonprofit basis. Nonprofits have to pay market rates even if they sometimes charge less than market prices. So neither nonprofit healthcare nor health insurance is held in particularly high regard. That doesn’t justify killing someone.
In fact, the whole nonprofit health care complex suffers from a distorting sort of “what have you done for me lately” perception fueled by reports of “eye-popping” salaries. Opponents of nonprofit healthcare tax exemption increasingly insist that we tax nonprofit healthcare just like for-profit healthcare. We just don’t often make distinctions in our perception of greed in health care, whether nonprofit or for-profit. The failure to make those distinctions fuels inefficient policies towards nonprofit healthcare. I imagine, for example, that the cost of requiring nonprofit hospitals to perform “community needs assessments” every few years is relatively miniscule. But even miniscule costs add up. They inevitably direct assets away from the charitable goal but we insist on them because we think nonprofit health care is just as infected with greed as for profit health care.
Misdirected rage effects nonprofit health care just as much as for-profit health care. That’s probably why Medica, a 501(c)(4) health insurer, decided to close its offices for a week:
As authorities in New York continued their manhunt for a person of interest in the killing of UnitedHealthcare CEO Brian Thompson, Minnetonka-based Medica has temporarily closed its headquarters as anger at health insurers has swelled online this week. A Medica spokesman said safety concerns following Wednesday’s shooting in New York City prompted the health plan to close its offices through Dec. 13, as insurers and other industries across the country take steps to reduce the visibility of top executives.
. . .
Medica was founded in 1991 when Physicians Health Plan — the original HMO customer in the 1970s and 1980s for UnitedHealthcare’s management services — merged with another health plan. It’s an independent nonprofit insurer, but for many years it continued to hire United for back-office services.
And then the very next day, UCare, one of the few 501(c)(3) HMOs in the country, announced that it too is temporarily closing after receiving a “concerning phone call.” UCare and Medica know that the rage at perceived greed motivating the assassin applies to nonprofit health care too. I am not sure people even make economic distinctions anymore between nonprofit and for-profit health care. They think nonprofit health care is greedy too, perhaps to an insignificantly lesser extent. In less tragic circumstances, that perception increasingly influences nonprofit health care tax policy. The phenomenon is most often apparent regarding property tax exemption, where taxing authorities point to CEO salaries as prima facie evidence that tax exemption is unjustifiable. In either case, but in the nonprofit world more than the for-profit world, we should first accurately determine whether the perception is correct and only then adjust our tax laws accordingly.
darryll k. jones