They Still Don’t Get It

In spite of facts like Tenet Healthcare rising 9.5%, making it the biggest riser among the S&P 500, or headlines like US Stocks halt global drop, the analysts and TV-approved fund managers continue to pretend that the weekend vote to give entrepreneurs and small businesses a break has nothing to do with our economic future.

While I still believe our health care payment system and its built-in incentives cost us roughly twice as much as they should, this legislation does put individuals and small businesses into a much larger actuarial pool.  That will keep those health insurance customers from being screwed by premiums two and three times as high as paid for the very same people when they are part of large corporate groups.

That’s huge.  It will finally free people at the peak of their professional lives to create new jobs, new companies, and even whole new industries.

Do you think Microsoft or Google could have happened if the founders were 40-somethings instead of 20-somethings?  Not bloody likely.  Family responsibility and the onset of normal aging pretty much guarantee that most middle-aged workers have to stay in their corporate squirrel cages, especially if they or their spouse or any of their children have one of those “expensive” conditions that insurance companies love to reject.

You can make your arguments about whether young people have a monopoly on creativity and business sense, but I know that when I see a doctor or lawyer or any other professional for the first time, I take some comfort when I see a little graying at the temples.

Is this the fix I would make?  Of course not.

I think the new law should have included a rapid increase in the number of spaces available at medical and nursing schools, giving those students the option to work in public clinics or hospitals or hospices to pay off student loans over time.

Would those places offer the best care at all times?  No.  Would they offer basic preventative care, urgent walk-in care, and extended aged care at really low cost?  Sure, if they had rules that said the only requirements for treatment were proof of citizenship, a small payment, and agreement to submit medical errors to binding arbitration panels.

A “safety net” like that would mean any legitimate citizen or legal visitor could get the help they need with no claim forms, ever, and that includes no forms filled out by the medical staff.

Private insurance and private care could go on as before or even better, as a premium available to those who paid for it, or those whose employer decided to pay.

That’s the kind of system that could cut our overall cost in half and give us the same or better health outcomes as a nation.

Just think how competitive we would be in the world market.

It seems that institutional investors have gotten the joke — that USA, Inc. may be starting to level the playing field with the rest of the world, and succeed in business far more than it would on the previous trajectory.

Don’t take my word for it.  Just listen to the market.



7 Responses to They Still Don’t Get It

  1. Bruce B says:

    I am not saying I have the answer, but does the fact that the government is going broke not have negative consequences for the economy and business development? I know you don’t believe the scoring on this bill. Nobody can. What government program ever costs what they say it will? Also, I don’t have an answer on the pre-existing conditions either, but is it reasonable for someone to wait until they are sick to buy insurance? That’s no longer insurance. That’s a subsidy. The cliche about waiting until your house is on fire to buy fire insurance looks like it will apply here in some cases (not all). There are apparently things you like in the bill. I think the unintended consequences (I’m not sure they’re unintended) will be brutal.

    • hhill51 says:

      I look at the whole system, and recognize that the for-profit monopolies have laid off all the expensive patients onto the taxpayer already through Medicare, pre-exiting conditions private insurance rescission (eventual Medicaid patients if they’re really sick) and Social Security Disability. They also set it up to maximize costs because they work on a percentage of what flows through the payment system. Part of the reason the government is going broke is the rate of inflation for Medicare, etc., running at 4x normal inflation. A big chunk of that is the multiple layers of “justified” overhead like claims processing, claims dispute, malpractice insurance, marketing costs, corporate perks, etc. From the top down view, we spend twice what other countries do, including some very capitalistic countries.

      As to the wait until you’re sick to buy insurance approach, to me, the lack of a mandate is giving a few selfish people the right to bankrupt the rest of us. Unless we have “do not treat” bracelets and let them lay their and die when they smash up their cars or have cardiac arrest.

      • hhill51 says:

        That’s why I look at a true, bottom-of-the-line network of public facilities as an alternative for the uninsured. Then you don’t need a mandate. Just make sure the VA gets better standards than the free clinics.

        If they don’t want to go to the quasi-free public clinic, then let them go private.

  2. Jon says:

    Amen, brother. This is about innovation and staying competitive. Don’t listen to the red herring pushers out there who claim to want something, “just not this.” they don’t have better ideas.

  3. Tom D says:

    “That’s huge. It will finally free people at the peak of their professional lives to create new jobs, new companies, and even whole new industries.”

    That’s called reaching for a bright spot. Surely people who have the energy and capital to start all those new businesses in their 40’s and 50’s would have enough capital to buy insurance without this enormous bureacratic boondoggle.

    Those who don’t understand hesalth care delivery cannot see that providers will increasingly exit the federally mandated system. Thirty percent already have completely opted out of Medicare (just one example). The feds can educate lower level clones (with forgiveness of education debt they willingly took on) to work in government clinics, but generations of skill and competence will be gone becaue of this farcical “plan”.

    Quality medical care will increasingly go off-shore like most other centers of quality in the U.S.

    The “dream of change” is totally out of synch with the reality of quality health care delivery.

  4. Tom D says:

    Any new insight on Anworth which seems pinned to the ground despite nearly daily Fed pledges to keep short term rates at zero forever, as in Japan?

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