If Congress ever stops obsessing about whether Vladimir Putin’s attire (or lack of) is an indicator of Russian foreign policy, maybe they can actually look into the running of the medical insurance companies. In the meantime, maybe this is what’s happening inside the boardroom:

Chairman: Gentlemen, we have invited you here for an explanation of why profit margins have plunged so dramatically.

Board Member A: The investors are very unhappy. Our largest shareholder had to use existing funds to make the payment on his ski lodge. Another had to postpone his trip to Fiji and Micronesia.

Chairman: Let’s start on the pharmaceutical side. What is going on, Mr. Hogg?

Lester Hogg (Pharm Guy): Well, you know that it’s hard to get companies to create new drugs because it’s so hard to get the government to approve anything. It’s all going generic.

Chairman: We’ve heard all that. Are there any new trends?

Hogg: A lot of people seems to be trying herbs and other supplements. We’ve even heard of psychiatrists prescribing them. That pulls people completely out of the pharm system.

Chairman: That makes no sense. Insurance doesn’t cover herbs. It has to be more expensive.

Hogg: Talk to the twits over there (points to the medical insurers). Copays for drugs keep going higher.

Julius Bones (Med Guy): You people can’t keep your costs down. We had to start charging them a percentage of the price instead of a flat fee. You said it was the only way to make a profit. The customers said the premiums were too high.

Hogg: And whose fault is that? You guys are letting patients get CT scans for a sprained ankle.

Chairman: We thought that forcing people into HMOs and such was supposed to keep costs down and profits up.

Bones: Well, it didn’t work out quite the way we expected. We thought that by forcing everyone to go through a primary doctor, a lot of the specialist fees would be eliminated.

Chairman: What happened?

Bones: Them. (Points to a team of attorneys)

Phineas Shark (Legal Guy): We have to make sure the doctors don’t get sued for malpractice.

Chairman: So you decide which tests are needed to protect the doctors?

Shark: In a manner of speaking. We make sure the doctors don’t make promises they can’t keep.

Hogg: So they try herbs instead of drugs.

Shark: There are fewer proven side effects. People don’t want to die from their treatment.

Bones (aside): That completely dries up the flow of money.

Shark: And we make sure enough tests are done to avoid missing a problem.

Chairman: So why aren’t we making money off all these extra tests?

Bones: Well, we made some reforms in the past that are cutting into those profits. We forced the providers to form groups for internal referrals and improved communication. And we made them switch to electronic communication.

Chairman: So??

Bones: So instead of taking the x-ray and sending the patient somewhere else for further diagnosis, the patient is referred internally and the x-ray is available for anyone in the system to see.

Chairman: What idiot thought that would be good for the insurance industry?

Shark: We never thought the medical world was organized enough to actually follow through. Our bad.

Chairman: This is totally unacceptable. It seems that every time we come up with something to protect our interests while still looking like the good guys, they figure out how to actually use it.

(He looks around the table.)

Chairman: I’m giving you insurance executives 90 days to come up with a way to exploit the holistic medicine industry or you’re gone.