It has been almost a year since Michael Moore’s film, Sicko, came out, and it seems to have finally turned at least some people’s attention to what I have always seen as the source of the crisis in health care in the U.S. It is not doctors charging too much, hospitals overpaying their executives, or patients going to the doctor every time they stub their toes. The crisis is rooted in the insurance industry that controls the flow of money, and, of course, keeps some of the money as it rushes by.

Sicko does seem to have turned attention toward the insurance industry. But to me, there is still a missing piece. Moore demonstrates repeatedly that the reason why insurance companies are such a corrupting influence is that they are in business primarily to make a profit for their shareholders, not to care for the sick and dying. If caring for sick people conflicts with making a profit, the sick people lose.

While this is true and also despicable, it does not solve anything. It does no good to point a finger at people and say, “You’re just in this to make money and that’s evil.” It does no good, even though it could certainly be argued that, for instance, allowing the woman with whom I worked to die at 40 of a blood clot in her lungs, because you would not spend the money to diagnose her back pain, is evil incarnate. It is hard to think of a better definition of evil, when I think of how much she suffered in her last week. All of us know stories like hers. We did not need Michael Moore to tell us this.

But, if this were just evil, we would have no chance against it. Walk up to a business person tomorrow and say to him or her, “You are evil, because you make a profit at the expense of others.” That person will have a strong and passionate defense of his or her choices. Take that basic self-justification and inflate it with a revenue stream that is approaching ten percent of the U.S. economy. The insurance industry has a lot of muscle with which to shout back, “No, we’re not evil.” It can make lots of soft and fuzzy commercials full of smiling children and puppy dogs and lots of commercials with worried faces and threatening voices. “Government control!” “We care!” “Thrive!”

The problem is not just that insurance companies are in business to make money. The problem is the attempt to apply the insurance model itself to human health.  People have only been funding health care this way since the mid 1940s, or about sixty years, the lifespan of the oldest members of the baby boom. Things went along smoothly enough for a while as the U. S. economy basked in the relative ease of that great money machine. First the parents of those 70 million people made and spent money raising them. Then they entered the workforce and fuelled an unprecedented time of prosperity. They paid income taxes, Social Security taxes, and health insurance premiums far in excess of their use of services. But now they are getting old and they are getting sick. The level plains are past and a large mountain range has appeared on the horizon. The insurance industry would like to believe it can continue just as it has done, just as Meriwether Lewis did when he first saw the Rocky Mountains ahead of him. He wrote in his journal that night, “I will believe it a good comfortable road until I am compelled to believe differently.” Six months later he and his men were starving in the snow.