Time Saving Pro Tip: Don’t Waste Your Time Reading About Health Care Reform

Here is a time saving pro tip. You have hundreds of better things to do than reading about health care reform. In fact, the stories you read are not even about health care reform, they are about politics. And they are just the same as all the stories you have read for the last 8 or 10 years.

The last go-round was a legacy builder that did you – personally — very little good and this go-round is mostly aimed at undoing whatever legacy was built the last time. It won’t do you – personally — any good either.

No need to favor or disfavor either party here. Neither one can accomplish the job because both are hog tied by their dependency on the bribes (political contributions) of the industries that create the problems in the first place.

A corollary pro tip could be: don’t pay any attention until you hear the word “affordable” taken seriously. Deciding who pays does nothing about the amount that is paid unless the one doing the paying has a personal interest in the bill.

The point of insurance is to pay something into a pot of money that will be available to pay you for a cost you can’t afford on your own. It began with insuring ocean voyages and relied on the idea that most ships didn’t sink. If all the ship owners threw a little money into the pot there would be enough there to pay the guy whose ship did sink.

Another key point with insurance is that you don’t insure against costs you can afford to pay on your own. Virtually everyone can afford a Band-Aid or an aspirin. The cost we can pay on our own differs from person to person: the less we can afford, the more we want to shift the costs to others and the more we have to pay as a premium to do so.

A caveat: there will always be people who are incapable of absorbing any cost or paying any premium. Humanity suggests that the rest of us look them after them.

The first signal that a serious attempt to fix the health care cost problem is afoot will be when someone asks, “What exactly is a right to health care?” The phrase sounds uplifting and very European, which has much appeal in certain quarters, but what does it mean?

A “right” is something that nobody, anywhere, any time can take away from you. Few have considered the uplifting phrase with that in mind. More importantly, what is health care? Is it a big blob of everything you can think of that makes you feel better or is it a bunch of separate components ranging from “take two aspirin and call me in the morning” to the latest clinical trial for an obscure orphan disease?

The European systems, which so many admire, do not provide the latter. They stop when a respectable level of care has been provided to most people with much weight given to public health considerations. Yup, it is rationed. In Europe, if you want more than that you buy it yourself. Many do.

A legitimate left right discussion could take place on the question of taking care of yourself when buying the level of care that you need or having someone else take care of that decision for you. The rubber meets the road on that question when somebody chooses to buy no health insurance but then needs it.

The second signal that seriousness is afoot is the idea that the largest pharmaceutical purchaser on earth (and on whatever other planets remain characterized as such) is going to negotiate drug prices.

That purchaser is none other than Uncle Sam whose interests are looked after by an executive branch and 535 elected officials, the vast majority of whom have received bribes in the form of political contributions to keep the negotiation of drug prices from ever happening.

No negotiation of drug prices, no meaningful change in health care as it applies to you.

Signal number three: end the silliness of having your employer provide health insurance. The idea began as a work around to wage controls in World War II and has hung around unneeded ever since. Best way to end that is to end the tax deductibility of the cost. Big seriousness signal there but again the group health insurers have figured out the return on investment for well placed political contributions.

Another great big ox in need of goring is hospitals. Notice all the advertising they are doing? Generally, that means they want more of us to like them and demand to go to this one or that. That suggests they make money off your choice (which is fine, they should or they’ll go do something else). Imagine the impact on the hospital bills (that you never see because all you did was hand in your insurance card), if patients were incented to ask, “what will this test cost and what will it do?” Steve Brill, the guy who upended the legal system by getting lawyers to tell his magazine how much money they made, knows all about this and it would be a great seriousness signal if he were named czar of the project.

Crummy things happen in operating rooms and we are all sad when they do but, on balance (that nasty cost benefit thing again), lawyers suing health care providers cost more than the value they add. We pay that cost. Do you think the trial lawyers understand the return on investment of political contributions? Feel free to take the extra time you might need to answer that one.

Every single elected official in Washington knows perfectly well that there is no group more ill suited to solving this problem than them.

The political point could be made simply by changing the name of the existing law to “nyah, nyah, Obama is a Kenyan” or something like that.

The existing law is unresponsive to the factors that will fix the problem. The new one (if there is one) will be too, so why bother?

To answer that question, go back and count the number of references to political contributions.

 

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Haven Pell

At the conclusion of the Constitutional Convention of 1787, a woman asked Benjamin Franklin, “Well, Doctor, what have we got, a republic or a monarchy?” Without hesitation, Franklin replied, “A republic, if you can keep it.”

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16 comments

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  • Good points. As you know I lived in Brazil for 30 years. Every day sitting in traffic when I looked at the damn buses and saw painted on them: “Transporte Público. Direito do cidadão, dever do estado,” it made me want to puke. I think you can translate, but to simplify: Pubic Transportation. A “right” of the citizen, a duty of the state.” This is almost as lucicrous as the “Ordem e Progresso” emblazoned on their flag, but it seems we choose to emulate this kind of fodder for the foolish who continue to believe that the state can and will do more good than it does harm when it comes to “helping the poor.” Meanwhile, the money flows… Funny how it always seems to flow in the direction of the Capital city of whatever country you find yourself in.

  • If I understand, you argue for:

    1. A limited right to basic heath care like the Euro system;
    2. The right to negotiate with the drug companies for quantity pricing;
    3. Transferring the cost of health care from employers to some other entity;
    4. Transparency in hospital costs to promote cost control;
    5. Limiting malpractice awards;
    6. Reversing Citizens United.

    Sounds very much like a solid, progressive position on health care.

    • Rob, you added # 6 not me.

      Worthy topic: which is worse the person who solicits and accepts the bribe or the person who gives it. Good idea for another story.

      If you had added one that was not clearly there as the others are, it would have been an open market to choose among a wide range of easily understood coverages.

      #1 could either be a base level for all or a “public health standard for those least able to provide for themselves.

      If this is a solid, progressive position I’d be for getting it done and moving along to other problems.

      But, of course, putting a check mark next to it means no more political contributions to fight about it.

      • Thought #1. The one thing I thought you surely meant to say both here and in many other posts was that: (a) political contributions = bribery; and (b) nothing will be solved until we solve that problem. My understanding of the Citizens United decision was that it protected political bribery as a first amendment right. So I don’t know how you get to removing or limiting political contributions without first dealing with Citizens United. Am I wrong?

        Thought #2. Part of me hopes that the Freedom Caucus wins and Obama Care is removed. Then we can devote the ’18 and ’20 election to a clean single payer debate similar to your 5 points.

        • a) political contributions = bribery (at least as a starting place) — agree
          b) solving that problem definitely eases the path to problem solving

          does one regulate the bribe giver? In Citizens United the court says no. it is free speech (though actually C.U. dealt with showing an anti Hillary film too close to election day)

          or does one regulate the bribe taker? the 535 elected officials plus presidential candidates. Ds and Rs have created a complete sham called the Federal Election Commission (according to three people I know personally who have run it).

          With that in mind, I would be inclined to start with a focus on the bribe takers, perhaps with a vigorous program of public shaming since they are not willing to regulate themselves.

          I don’t think my 5 points leads inevitably to single payer except perhaps for those who are completely unable to take care of themselves.

          • sorry this “b) solving that problem definitely eases the path to problem solving” has to be one of the stupidest statements ever.

            I meant dealing with political contributions / bribes makes resolving policy problems easier.

  • Here is a response I gave to something somewhat similar but I have to say up front while the cynicism towards the lawmakers/parties/”bribes” have merit, they don’t takeaway from the actual issues surrounding 20% of the ecomony and the many collective yet disparate constituents who participate as vendors, services, insurers, patientes etc.
    It seems to me that amongst other things some form of means testing is necessary. Aren’t there 3 main parts to this:
    1/. Paying – Insurance etc
    2/. Services – all the different types of medical care available
    3/. Big Pharma and medical costs
    On the paying side:
    A/. Make insurance available across State boundaries
    B/. Set up minimum requirements that all policies must include
    C/. Make it deductible up to some reasonable annual number
    D/. Create tax credits for those who have income under a certain number
    E/. Provide a tax discount for all persons who voluntarily have health insurance. Those who don’t will pay higher income tax and the diference will go into a high risk pool for the uninsured for when they need services.
    F/. Once an uninsured person uses services – They have two choices – either pay for the services out of pocket or mandatorily join an insurance program.
    =====
    On then Services side –
    Élective versus Medical needs
    Préventive versus “emergency”
    Systemic disease requiring regular maintanance
    All of these have different requirements and costs which begs the question of who is to pay for it and suppose the diagnosis (not quite malpractice) are wrong.
    Big Pharma
    And its desire to get the entire world hooked on drugs for life.
    To say nothing of the polluting (unspoken) effects of drugs constantly flushed down the proverbial drain via elimination.
    ====
    Obamacare may not have worked but it was and is a step in the right direction and the baby should not be thrown out with the bath water.
    Considering that Healthcare is 20% of the economy with a baby boom needing ever more service for anther 25 years, the need to review what worked and what didn’t by competent people would make sense. The idea of a single payer will not provide in the end room for new players to easily enter the market – But Like the breakup of ATT – we will, if we make insurance market open beyond state borders, wind up have a similar consolidation over time. Although my solution might be to allow the states to make deals with other states. Rather than the federal government opening it up nationwide. A State like RI with basically 2 insurers might make a deal with Indiana which has 9 insurers.

    • Tim, your thinking is more detailed and the idea of using tax treatment to incentivize participation is of interest. I was beginning with trying to move the few areas that have bought their way off the firing line back into consideration. Thanks for the thoughtful and detailed contribution to the discussion

  • “Obamacare” is far from perfect, but, unlike Haven, I am convinced that it’s doing A LOT of good, and it will be improvable if it can withstand attack over the next 4 years–especially the next few weeks. And much of its funding is coming from a, generally-speaking, appropriate sector of our population. (I would be in favor of a one-payer system, but, at least, in the past it has proven to be unattainable.)

    If the new health bill or some revision of it (more funding for women’s health whether via Planned Parenthood or otherwise to secure approval by the Senate?) passes, I fear that Trump will go on a “roll” and do immense additional damage to our country and the world. Apparently, again unlike you Haven, I think a tremendous amount is at stake. I encourage others to support the efforts of Bernie Sanders and other effective spokespeople in their opposition to the health bill and to Trump, in general.

    • Like you, I am now on Medicare as is my child bride wife. We had one year when she was on Obamacare and that was a nightmare. As is the case now, Obamacare was rolled out in a haphazard way. I doubt there will be any contribution to affordability unless the costs described in the story can be reduced without political intervention.

      As to Planned Parenthood, it has always seemed to me that the organization has two major sources of funding: government $ and contributions. Why not split the organization in half and have the part supported by contributions perform the abortions. The government could then support other women’s health issues provided by the other part of PP.

  • “You have hundreds of better things to do than reading about health care reform. ”

    Your quality of life will be much better if you follow Haven’s advice– the best advice given this year!

    Bob

    • Thank you Bob,

      I can think of few greater joys that helping you save some time rather than wasting it on political foolishness

  • “Rights” cannot be taken away but can’t the obligate (health workers) others.
    Single Payer systems assume rationing determined by societal value/advanced age/costs.
    Taxpayer supported insurance should be Catastrophic (preclude bankruptcy).
    Market forces could be invoked by patients paying (up front) for medical expenses before submitting to a Carrier.
    FDA processing must be accelerated to reduce pharma development costs foreign production certified by same standards.
    Compete compete compete!
    Make ALL contributions to elected types subject to daily internet posting showing the details of the receipts to include the id of the signer/originator (not corps/pacs).