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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