Sunday 12/22 Musings: Health Care Needs Serious Debate

Among other things.

Today is the shortest day of the year for sunlight in the Northern Hemisphere;  and for anyone whose personality swings around with the amount of sunlight in a day like my wife, the world is a better place for the next 270 days.

NY Sports teams are all hung up on the strategy of paying big bucks to older stars in the hope they all have near career years and bring a championship.  It's not working.  These basketball teams are unwatchable and boring.

In the Who Knew Category:  Only the Northeast calls sneakers, sneakers,  they are Tennis shows everywhere else.  And it is mainly the Northeast and mid-atlantic that call Tractor-trailers, tractor-trailers.  They are Semi's or 18 Wheelers elsewhere.  And garage sales are Yard Sales or tag sales in a lot of places.

RedStateVT commented yesterday that a family of 4 in New Hampshire, who make $100,000 a year, and will buy health insurance for $12,000 a year (plus co-pays/deductibles) were suffering because of Obamacare and would somehow have been better off under the old system.  I know RedStateVT's preferred management of this is to buy a $25,000 deductible for a relatively small amount of monthly premium.  And I also know RedStateVT has a family of 4 and the 1st or 2nd year on that plan, he met the $25,000 deductible.  How would that family in New Hampshire come up with that $25,000 plus other payments when they are complaining about $12,000. The answer in both cases is only with a great deal of pain and cutting back in the rest of their budget.

The real issue that all the hysterics about "Repeal" Obamacare obfuscate is that the old Fee for Service System generated a system where Healthcare represents 20% of GDP.  The European Single Payer plans are in the low teens.  But unless Republicans agree that a single payer plan is the solution it isn't going to happen.  Why, because the Health Care industry spends $500 million every year lobbying Congress to preserve the private sector involvement in the Heath Care industry.  I agree there are real reasons why that should be the case in many aspects of health care, but it also means we are not making progress on controlling this 20% of GDP, which some forecast will be 25% of GDP over the next 25 years as the Baby Boomers exit this world.

The GOP didn't even allow Medicare to negotiate bulk purchases of drugs when Pharmaceuticals were added to Medicare in Part D during the Bush II years.  That is the penultimate example of following the money.

For the system to work financially, the average person needs to pay 20% of their income for Health Insurance today or be subsidized by everyone else.  In addition, the cost of annual healthcare use/insurance for a couple over 50 is about $10,000 to $15,000 (without anything extraordinary).  You need to budget for that and, if you make too little, you need help.

Why can't we go back to the old system?  The old system created the problem.  Fee for Service and a belief that the government should not be involved created 50 mm uninsured using the system only too late and in too expensive a manner that the system passes on to the insured.  It also resulted in people who lose their jobs and have pre-existing conditions being unable to get insurance.  It also resulted in people who got sick losing their insurance upon renewal because they hit a lifetime cap or couldn't afford the repricing.  It resulted in a system where by a 77 year old Medicare patient gets surgery on both ankles for arthritis and the system pays $200,000 in NY and $40,000 in NH.

So, let's not pretend that repealing Obamacare is a good long term solution to the issue of controlling health care costs.  Obamacare contains incentives to pay for care, to bundle pay for fixing problems, and to try and undo the creativity in using fee for service to compensate hospitals enough to cover the uninsured.  In 1986, Ronald Reagan signed the COBRA legislation that passed in a bi-partisan manner, and included "Emergency Medical Treatment and Active Labor Act:  Wikipedia notes:  "Congress passed EMTALA to combat the practice of "patient dumping," i.e., refusal to treat people because of inability to pay or insufficient insurance, or transferring or discharging emergency patients on the basis of high anticipated diagnosis and treatment costs."

The law has been criticized as an unfunded mandate, but the hospitals found a way to get the insurance system to cover the costs which raises the costs to the insured.  And undoing the requirement either leaves people dying in gutters (which is what was happening before) and violating nearly 2400 years of Western morality.  Hippocrates wrote the Hippocratic oath late in the 5th Century BC.  Do the GOP really want to undo that in the United States?  I don't think so as there is not an ounce of compassion in advocating that.

The Hippocratic Oath essentially makes the providing of healthcare a national utility that needs to be paid for.  Everyone uses health care almost every year and multiple times over a lifetime.  You cannot predict when you will need care.  I nearly died in 1993 (age 40) and would have without health insurance because being that cheap I wouldn't have gone to the Dr's with the regularity I did and would certainly have waited longer to go to the hospital then happened because of the Dr's orders.

Despite the example of Heritage Foundation/Romney/Obamacare working well in Massachusetts, on a national level implementation is a much rockier path but it is difficult to discern who is upset for valid reasons of fairness and who is simply upset because they were being subsidized by the old system and that subsidy is now going elsewhere.  (Follow the money)  I am assuming the website issues will be fixed, although I note as a full payer shopper for an individual policy, both Aetna and Anthem told me to apply directly and not through the NY website, which is supposedly working well.

I have gone on too long.  I wish the GOP would focus on getting things into law that would help control healthcare costs, such as:  Medical Malpractice Reform (or even General Tort Reform), allowing Medicare to negotiate bulk purchases of drugs, and separate access to health insurance from employment.  I admit I cannot imagine how we would transition from Private Sector Health Insurance to a single payer plan when (a) it would create a labor transition for tens of thousands of people, and (b) Medicare through the Advantage Plans (which my wife selected) is using the Private Sector Health Insurance so how does undoing that work.  This could all be done, but politicians would have to be serious about negotiation and compromise instead of "Repeal Obamacare."