Some health
insurance numbers came out this week. Health care premiums went up 4% so far
this year. Health care premiums went up 9% last year. Wages for the average Joe
and Jane went down 7% over the last two years. See a problem here?
The Census
numbers out this week show a 2 1/2% decline in average household income. The
poverty rate did not follow previous patterns and remained flat. Analysis of the
census data indicated greater economic inequality currently that at any time
the Census has been reported (middle to top, middle to bottom, top to bottom,
etc.). Such economic inequality continues to increase. Americans without health
insurance coverage fell to 48 million. Analysts attribute this decline to
increased enrollment in Medicaid and the initial effects of the Affordable Care
Act.
So them’s
the numbers. This blog is on healthcare and the vital importance of reforming
provision for this basic human need. The political debate is framed around the
doctor and the patient. Additional government bureaucracy should not get
between the doctor and the patient. We don't want the government calling the
shots on how we’re cared for, when we’re care for, and where we’re cared for.
Keep your government hands off my medical care, and off my Medicare.
I agree
that unqualified government bureaucrats should not get between a doctor and a
patient. Apparently, that is the job of health insurance bureaucrats. The
health care debate should be seen not in terms of who provides the care, but
rather who pays the bills.
Most
Americans receive their health coverage from their job, albeit somewhat
tarnished and diminished compared with the health plans of the good old days
(insert your good old days here). When insurance companies actually cover and
pay for continues to shrink while premiums continue to rise. Hey, but we need
some kind of health coverage, and we don't want no stinkin’ socialist
government health coverage. So, just keep it the way it is. But can we..... just
keep it the way it is?
Why are
your wages shrinking? Like most of the world, and unlike most television “news”
programming, the answer is complex. I point out that the Facebook status of
your shrinking wages are “It’s complicated”. A few reasons for the non-two-per-center’s
now-you-see-it-now-you-don't magic show are: (a) Many businesses have little
social conscience or responsibility. If you take a hit, it's just business. (b)
There are a lot more stupid regulations these days which makes running a
business more expensive. (c) Commercial credit and thus cash flow is tougher to
obtain. (d) Business get stuck paying for your healthcare.
The numbers
this week indicate that average annual per capita premiums are over $16,000.
That's just premiums, just so you can have peace of mind in case you might get sick. Three quarters of these
premiums are paid by your job. So if you think that you're paying more and more
for your health coverage, imagine what your employer is thinking.
Joe Blow
didn't start the company you work for in order to provide health coverage for you
and your kids. Oddly enough, Joe Blow started the company you work for in order
to make money. If insurance companies continue to raise their rates, how long
will Joe Blow be inclined to provide health coverage for you and your kids?
That's called a waterfall.
We might
blithely drift downstream as the waters grow more turbulent, only to eventually
encounter the waterfall we've been ignoring. For gentle readers unsure of the
definition of a waterfall, it is a big cliff with water pouring over it in
order to clean up the mess at the bottom. I recommend taking a different river.
Why is
healthcare a political football? Why is healthcare political at all? Because
there's Big Money in healthcare. That's called a trough. This trough is too
high off the ground to be of much benefit to the average person. The trough is
created by the system (providers, insurance companies, politicians, etc.) and
the system reaps the benefits. The system makes the rules of how the game is
played. But all the average person wants is healthcare when they're sick.
The average
person can't afford the rates the system charges. So the average person pays
protection money and get a little protection in the Big-Money shell game known
as healthcare. Like in Defense, our technology is the best on the planet, and
our costs are the highest on the planet. If we pay a bijillion times more for
Defense or healthcare, it's a very hard case to make that we’re a bijillion
times safer or healthier. The numbers show that we are not either of those things.
Like the
business you work for, the healthcare system was not created to provide health
coverage for you and your family. The irony is.... Oddly enough, like the
business you work for, the healthcare system was created to make money.
Elements of the healthcare system, such as providers and drug companies, have
dual agendas. They want to help people, but they also have to make money. In
recent years, the making-money part of that equation is winning out. Other
elements, like insurance companies, simply are in business to make money. Most
people don't stop and consider that the mission and purpose of insurance
companies, like all corporations, is to make profits for shareholders. This is
a similar to lawyers working for auto insurance companies. When you’re in an
accident, the lawyer’s job is not to protect your interests. That’s the job of
your lawyer. What, you can’t afford a lawyer? Don’t you have lawyer insurance
with your job? Another racket...but I regress. The insurance company lawyer's
job is to protect the interest of the auto insurance company. The purpose of
the auto insurance company is to make profits for shareholders. Just some
musings to pass the time on our trip down the river.
So one
reason government is involved in healthcare is that it benefits from the
Big-Money at the trough. It helps politicians keep their jobs. Another reason
is that the healthcare industry (providers, insurance companies, drug
companies, etc.) are highly regulated. The healthcare industry was not visited
by the regulation fairy. Government helped create the system and the trough.
Government
has the influence to be a solution. But government is not thinking clearly.
What a surprise. We’re offered two choices by government,(1) governments
wastefully and inefficiently pays for your healthcare, and (2) you pay for your
own damn healthcare. Are these the only two alternatives you guys could come up
with, seriously? We’ll feed your family. You have the choice of a Bic Mac or a
bucket of lard. One is on sale. Choose wisely.
You might
say the Republican approach is to provide vouchers and let market competition
make healthcare more efficient. I stopped typing until the laughter subsided.
Think about it. You charge $20 for your healthcare service. The average sucker,
I mean citizen, receives $20 from the government to cover your fees. What will
you do? You'll raise your fees to $40. The sucker, I mean citizen, pays the
difference out of their pocket. You keep your profit margin. You can always
raise rates next year. You make up the rules.
This is a
bit like education. Everybody needs healthcare, whether you get it from the
witchy-woman or the Mayo Clinic. Government, in it’s infinite wisdom, has
decreed that everyone must plant their butts into seats for so many years to
get an education. It's tough seeing tweens doing hard time. So the public
schools are babysitting factories. We’ll send our kids to shiny new
market-competitive schools. But Joe Blow starts a market-competitive school to
make money. If the Joe
Blow Academy
Not so good
to be in the public schools. Government has to shell out for vouchers, so money
is cut for the public schools. But every kid has to go to school. The public school is not allowed to turn away
kids. They have to take in all the little Mansons-in-training. Your little
monster who so cute when they're sleeping has
to go to school. It's the law. Joe Blow knows that your little monster who looks
so cute when they're sleeping will blow his numbers and profit margin. Your kid
is trouble right here in River
City Joe Blow
Academy
So if the
system makes the rules, how can healthcare get fixed? Left on its own, it will
not fix itself. The guys making the rules will not give themselves less money,
oddly enough. Faget about it!
There are
three parts to the fixing healthcare solution: market competition, incentives,
and regulation. For most folks, regulation is a wash-your-mouth-out dirty word.
What is regulation? At one level, it's how the game is played. It establishes
the boundaries of the playing field. Republicans want market forces and
competition to change healthcare. Market forces are creating the current rules.
They cannot/will not change healthcare. The market is not the place to start.
Regulation is the place to start. Our current river still leads to a waterfall.
I recommend a different river.
We
currently have a sick care system based on fees-for=services. The system treats
the average person when they're sick and charges them for drugs, tests and
procedures. That's what the market does. That's the way the game is played.
With the Republican, market-driven approach, that's the way the game is played.
Medicare is a sick-care fees-for-services system. For government paid health
care, that's the way the game is played. Under the Democrats, that's how the
game will be played.
So I'd like
you to see two things: (1) healthcare is about who pays the bills, and (2) the power
lies in who defines what healthcare is. If healthcare is defined as sick-care
fees-for-services, it doesn't matter which captain is at the helm when we get to
the waterfall. I recommend reframing the definition of healthcare in creating a
new regulatory framework to send us down a different river. Who has the power
to do that..... squabbling politicians, faceless bureaucrats, big-money
think-tank policy wonks? I remind our gentle readers that the power is in their
hands, the whole We the People thing. Government power, regulation, and policy
is ultimately in our hands.
The new
definition of healthcare should be centered on the concepts of wellness and improving
quality of life. Rewards and incentives within healthcare should be based on
getting you well and keeping you well. It should also incorporate personal
incentives and disincentives for keeping ourselves well. That is a different
river.
Healthcare
is currently paid by the government and by insurance companies. Under the new
definition of healthcare and new regulatory framework, government should for
the most part get out of direct pay for healthcare business. Government can
partner with industries to provide scalable incentives. There should also be a
national pool to distribute cost and risk for catastrophic and end of life
care. Actual payment for healthcare should come from private sector insurance
companies. Insurance companies should be told that if they want to keep playing
the healthcare game, they will make their money by completing for patient
wellness, quality of life, and quality of care. Obviously, the insurance
company most effective in organizing providers for these outcomes will be the
most popular and received the most profit. So the People, not the system, would
make the rules of how the game is played. Free-market forces could do what they
do best.....innovate, compete, reduce costs and gain market share while
increasing our national wellness and quality of life.
While all
this is an extreme oversimplification, the fact is, as I see it, we have to
reframe the fundamental definition of health care to get fundamentally
different results. A regulatory approach, although driven by popular
sentiments, is essentially top-down. Healthcare can also be reformed from the
bottom up. This also requires a reframing of the definition of healthcare and commitment
to economically support that direction. By spending your healthcare dollars on
the insurance companies and providers which best promote wellness and quality
of life, you more stably establish these concepts is a viable market drivers.
More and more companies will organize and compete around these principles and
may eventually shift how the game is played.
A bottom-up
approach to health care reform involves your actually caring, considering what
you would like to experience from providers, having conversations with
providers and neighbors, investigating market alternatives, making your voice
heard in organizing locally or at work to advocate a particular provider
choice, and making an economic commitment to support the providers moving in
the new direction. These actions are what is needed for healthcare reform.
They're also what is needed for good government. We need to understand that we
are personally responsible for the quality of the health care we receive, as we
are personally responsible for the quality of the government we share. There’s
a waterfall ahead. Choose wisely.
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