Sooner or later, opponents of government-run health care are going to confront people like Edith Kenna.

Just as critics of private insurance must reckon with people like Jay Gilbert.

Contrary to the caricatures and stereotypes that too often cloud the debate, both are intelligent, dedicated, persuasive people who seem to sincerely want what is best for America – which is precisely why change has been so elusive.

Kenna, a social worker and therapist active in Hoosiers for a Commonsense Health Plan, made headlines earlier this month when she told a town-hall meeting organized by U.S. Rep. Mark Souder (R-3rd) that, “As long as there's a profit motive, you can't control (health) costs.” After I responded with a column defending the free-market system, she asked for equal time – and made a powerful, emotional and very personal defense of her position.

Exhibit A is her 34-year-old daughter, Jean-Gabrielle, who was a healthy, active athletic kindergarten teacher when she was diagnosed with a severe case of rheumatoid arthritis eight years ago. Eventually she could no longer teach, but was able to work as a full-time case manager, until her job was cut to part-time status last year and she lost her health insurance.

Jean-Gabrielle later developed an auto-immune disease and a lung infection and, with her health deteriorating, the family scraped enough money together to provide continued insurance under the Consolidated Omnibus Budget Reconciliation Act (COBRA). But that will expire early next year, leaving the family to wonder how it will pay her $3,000-a-month prescription bill. Her condition makes it difficult to find full-time employment with benefits, and Social Security disability is unlikely or, at best, years away.

So Edith Kenna wonders: Should her family have to go bankrupt so Jean-Gabrielle can qualify for Medicaid benefits, especially when private insurance companies – such as the one that has denied some of Jean-Gabrielle's claims – are making millions of dollars while paying their top executives more in a year than many people earn in a lifetime?

But Gilbert, president of Fort Wayne-based Physicians Health Plan, hardly feels like a villain – nor should he.

For one thing, PHP employs about 100 people earning more than $8 million annually who do exactly what would have to be done under a government-run plan: answer questions, process claims, decide which procedures are covered and which are not.

PHP – technically a nonprofit enterprise – generated more than $142 million in revenue last year and reported assets of nearly $60 million. With people like Jean-Gabrielle Kenna lacking adequate coverage, isn't that kind of wealth, well, immoral?

“The (profit) numbers are big, but the health insurance industry's profit margin is 2 or 3 percent. That's about 83rd (among American industries),” Gilbert said, noting that PHP lost about $5.3 million last year – a loss that was covered by those reserves, not through higher taxes or more debt, as might be the case under a single-payer program. And because PHP must compete with other private companies, its employees are motivated to promote wellness and to provide efficient, reliable, customer-friendly service in ways a government monopoly would not be.

Kenna and other single-payer advocates praise Medicare, but Gilbert said the federal program forces the private health sector to subsidize the program by reimbursing doctors and hospitals less than it costs to provide the service – a kind of “cost-shifting” common throughout the system.

But don't the uninsured deserve medical care, too? Yes, Gilbert said, and they're getting it: in emergency rooms, free clinics like Matthew 25 and other places subsidized by – you guessed it – health care profits that also pay for and encourage the expensive-to-develop innovations that save lives. This “safety net” may not always provide the level of coverage possible with insurance, of course, which is why many in the industry support regulatory changes providing portability and coverage of catastrophic illness and pre-existing conditions.


Kenna, for obvious reasons, focuses on the shortcomings of the current system. Gilbert sees its strengths and wonders, if health insurance profits are immoral, “Where does it stop? Is the house that doctor living in too big? You either believe in the free-market system or you don't.”

I do, and if the choice is between bankrupting individual families or further bankrupting the nation, making it unable to help anybody, including Kenna, I'll choose the former. But surely capitalism, coupled with compassion and a little ingenuity, can do better than that.