Health Don’t Care Anymore

I have five drafts of healthcare blogs written over the past several months. I decided instead of making researched arguments which were all but impossible to make accessible, I’d just do a quick blog on my thoughts and conclusions.

My Context

I have health insurance. Because of my usual state of self-employment peppered with occasional stints of outside employment, I’ve had to select and pay for my own insurance for much of my adult life. Only once was a plan ever offered to me by an employer…which was a lower-benefit package than I had for more of my out-of-pocket money (boy…did they get rooked on that).

So, I get the insurance I can afford. As the years go by, the coverage is pared away while the premiums increase. My lifetime benefit hasn’t increased even though medical costs have skyrocketed. As a result, I’ve reserved using medical services only for very routine visits and vaccines. The rest is held in the event of something catastrophic.

My experience has been that I end up paying a lot of money, above and beyond my premiums and co-pays, only to obtain laughably irrelevant results. For example, physical therapy for a neck/shoulder injury could have been covered by one 50¢ handout and an elastic band instead of a couple of thousand of dollars of visits to bored “professionals” watching me lift weights.

Is it no wonder, when I popped an ACL a few years ago, that I decided not to have it repaired? My physical training coursework in college taught me that you can get on quite well without this ligament if you’re mindful of it. So…I limped for a year. Sure, my foot will turn in sometimes, now; but I still have insurance money banked in the event I get T-boned in my car at some intersection.

It’s for that cushion that I’ve paid tens of thousands of dollars in premiums over the years…for insurance that has offered me only a fraction of that in benefits.

You can imagine my amazement when I saw the full force of Medicare. A few years ago, my father was declining from what is considered one of the nastiest of dementias. We were looking at bills, under his regular (non-Medicare) insurance, of thousands of dollars per month. When he entered hospice care…poof…we didn’t see another medical bill.

We were spared having to rent a bed, a wheelchair, the large pharmacoepia of drugs, oxygen, the hospital stays, the aides and nurses…all of it was covered. Even with Medicare, what wasn’t covered was continuous care. We couldn’t afford that ruinous out-of-pocket expense. So, until he died, I spent 18 hours every day tending my could-never-be-left-alone father.

So…I see the insurance/healthcare problem from a practical first-person perspective.

The Problem

The problem is simple: it makes no sense that healthcare is a for-profit enterprise. I remember back in the early 70s when they started trying to sell this bucket of tripe. Sure, medical bills and hospital stays could be a major financial hit, but they weren’t often ruinous. Not like today.

In the 80s, when HMOs became all the rage–well, that always seemed stupid. My family and I stayed away from it as long as we could. Eventually every insurer was basically an HMO/PPO/pick-your-letter provider. Why? Because there was profit to be made in shifting medical policy from doctors to bean-counters.

It just gets worse every year.

So…when people say they are “happy” with their insurance, I’m amazed. Either they are rich or someone is paying their premiums, because I can tell you that the kind of care they say they are happy with is not at all cheap. I’ve priced it out.

When politicians propose “solutions” whereby I “get” to keep my insurance…I say thanks but no thanks. What I have is the pits. I get what I can afford because I can’t afford not to. Even so, I really don’t have any options. I’m an organ transplant, cancer treatment, or major trauma away from being wiped out. (Actually, just the major trauma. The “treament” for the other two is already bought and paid for. Yes…it’s come to that.) I’m fine as long as I stay healthy, but I’ll soon be flirting with the conclusion of my fifth decade. We all know that it’s all downhill from here.

The Solution

Since early in the 2008 presidential campaign, I’ve been researching healthcare and crunching the numbers. What prompted this was candidate Hillary Clinton’s healthcare proposal (since echoed by President Obama) that would require everyone to have health insurance…bought from the same damaged system we currently have. Since that was obviously asinine, I looked at all the various proposals. Also, me having to create systems like this for the fictional worlds I write, I tried coming up with some creative solutions on my own.

My litmus test for success or failure was always the same: how can you corrupt the system? You have to assume that some schmuck was going to want to exploit and profit, so I took that as the measure of a plan’s worth and not how it would work in a theoretical perfect world.

Going through plan after plan, it become ever clearer that the numbers just don’t add up. Money is moving around that isn’t being accounted for (in the hundred of billions). Every for-profit scheme breaks because laws and regulations concerning business and commerce are too easy to change and too many in the executive offices are easily seduced.

The only…THE ONLY…process that had any hope was a tax-funded not-for-profit monopoly provider for all.

It’s really just that simple. In this country, with our demonstrated high-level of corruptibility in business and politics, this is the only way to have any hope of managing the industry. Sure, we can talk about high-minded ideals…but I’m not eager to bet my life on it.

How to pay for it? A health tax on all income. Apply it to all earned and unearned income above a certain poverty/low-income minimum. Make it a flat tax. And since the corporations like being treated like “people”, they have to pay, too. A flat tax on gross income. This is a GDP tax. It isn’t a business tax or a personal tax. We are taxing the money. No sliding scale. It’s equal to all except those just barely surviving, who get a free ride.

The Finish

Of course this solution isn’t likely to happen in my lifetime–certainly not without some sort of civil upheaval that seems necessary to spark any major policy reset.

What I fear is that at the end of a protracted policy struggle, the end result will be more-firmly-entrenched health insurers secure in the knowledge that Congress has grown so addicted to its bribes that it will never raise a hand against them. I think people who can’t afford insurance will be forced to buy insurance. If they don’t they will have to pay a fine which (amazingly enough) will be close to what it would cost to buy insurance in the first place.

Of course this country isn’t without compassion for the indigent. They can stand in line and fill out forms and beg to have government-paid relief for the evil insurance yoke that they are now forced to wear. When you simplify this, it means that the insurance companies will get more money because the government will be paying for most of the new recipients.

It’s likely you won’t be refused for a pre-existing condition…provided you pay a higher premium. You can’t be dropped from your policy…though the insurer can unilaterally reduce what you are covered for…and charge whatever rate it thinks you’ll be willing to pay. No way are the insurers going to lose money.

Some say that I’m cynical. Perhaps so. The fact is that it’s far cheaper for the insurers to bribe the politicians with re-election money (and other perks) than it is for them to have to accomodate any comparable, not-for-profit competition (“the public option”). Even if they gave $1 million to every member of Congress up for re-election, that $468 million would be cheap (and passed on to policy holders) compared to the losses they face with any fair-to-the-public option.

In the end, we’ll just have less coverage, higher premiums, and more paperwork. And that’s likely the best outcome we’re likely to see.

It just makes me sick. Unfortunately, I can’t go to a doctor for this particular illness.