The Health Care Morass – Can We Handle the Truth?

Here’s an unpopular proposition – the health care industry as we know it can’t be “fixed” because it is based on a false premise, the premise of “free money.”

Truth — there can never be enough money in any insurance pool to provide extraordinary care for every participant; finite resources can never yield infinite benefits, any other expectation is free money, Ponzi math.   So, anyone, on whatever side, who tries to sell a pipe dream that somehow everybody’s going to be covered and we’re going to all have all the health care benefits to which we’ve become accustomed at “affordable” insurance rates is blowing smoke.

Yes, the current system is out of control:
– “greedy” insurers have dropped their pay-out rates, some to as low as 60%,
– Big Pharma’s insidious take-over of the industry for their burgeoning financial bottom lines is unconscionable,
– trial lawyers adding $3.6 billion in direct costs (2008 malpractice insurance expenses), and who knows how many billions more for CYA tests and such, is at best, not helpful
– non-contributors to the pool receiving, gratis, the most expensive health care delivery, at emergency rooms, is ludicrous…

…and on and on.  A snip here, a patch there will help — you can grow the financial pool by siphoning more out of people’s pocketbooks (through rates OR taxes), or you can attempt to wring more “benefits” out of the cost side, but, no matter how you parse it, there will still be a limited pool, and somebody is going to have to decide who and what gets covered – the argument is only about WHO does that rationing; the insurers, which, it can be argued, do a crappy job (yes, they do ration, through denial of coverage), or the government, which, it can be argued, does little well (or the states, but Massachusetts has done such a high-profile lousy job, you don’t hear many voices for that option.)

Here’s a different question to ask – why did we ever put our physical well-being into somebody else’s hands in the first place?  Of course there’s no free market mechanism to keep costs and benefits in equilibrium – you walk into the doctor’s office or show up at the hospital, and your expectation is, it’s all going to be taken care of by your insurance company, up to millions in coverage over your lifetime.  The doctor, the hospital, the pharmaceutical companies, the labs, the insurance company – they’ll make all the decisions amongst themselves, you just pay your premiums and your copays and trust them to deliver you from your ailment.

That’s the fantasy upon which we’ve built our expectation of health care, and that’s why it can never be “fixed” to meet our expectations.  Personal health care MUST become a personal responsibility, with the consumer making his/her own market decisions based on his/her own financial state and priorities.

A good step forward has been the rising popularity of Health Savings Accounts (HSA’s and the like), which require a high deductible before coverage kicks in.  It certainly encourages the consumer to invest in taking care of themselves, and even “shop” for non-life-threatening procedures and tests.  Problem is, just ask your provider what the costs of the tests, or the procedure will be – odds on you’ll get a blank stare and ‘we don’t have that information, why would you want to know that?’  Maybe I’m reading the wrong details, but I haven’t seen anybody advancing any “upfront pricing” requirement of providers, and without it, there can never be a “free market” connection between consumers and providers.

Things can’t stay the same – the question is, is socialism and rationing or the sometimes harsh personal responsibilities of a free market system your choice?

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