Monday, July 31, 2017

Slowing our Roll on Healthcare Reform

Last week, three Republican Senators joined the 48 Senate Democrats and struck down a horrific bill that would have kicked 22 million Americans off of healthcare.  After six months of assault, this was a huge relief to members of the resistance who, literally worked day and night to lobby members of Congress to put a halt to it.  It was a good day.

It's only natural in the aftermath to start talking about a path forward.  Where do we go from here?  For those who would say "single payer now," I say: slow your roll.  Here's why:

If you've ever had a child come to you with gum stuck in her hair, that's a pretty good analogy for the American healthcare system.  It's sticky, it's messy, and it's sort of worked into all sorts of things.  Also similar, everyone's got their home remedies, all of which work to varying degrees, but nothing is a perfect solution.  And just yanking at it only makes things worse.

One oft-cited statistic about healthcare is that it represents 1/6th of the American economy.  That should be enough to give anyone pause.  While you may not feel any particular sympathy for the 'big bad insurance companies,' that number represents hundreds of billions of dollars, millions of jobs, and - oh yes - a bunch of publicly traded companies that find themselves comfortably nestled in our retirement accounts.  You simply can't turn an entire enormous industry on its head overnight without some serious consequences rippling across broad sectors of our nation.

So let's just put single payer back in the box for a while.  So, what's left?

It's important to think just a moment about what health insurance as a product does.  Because it's not actually for the patient.  Health insurance actually protects hospitals, ensuring they will get paid for services, ensuring they have the cash flow needed to continue operating.  Health insurers don't really provide the patient anything today.  They are an administrative layer, complete with the added costs of overhead and executive compensation, all conveniently added to the expense that the hospital already charges for care.  What's more, they charge you based on what they "guess" your eventual medical costs will be, whether or not they ever materialize.  This may sound like an indictment, but it's really the beginning of root causes.  If we break it down, we see problems that need to be solved.

  • How do we ensure hospitals are protected from going out of business?
  • How do we ensure health insurance companies profit from improved health, a benefit to the patient and reduced load on the system?
  • How do we ensure people are really paying their 'fair share'?
And, most importantly:

  • How do we ensure everyone gets the care they need without fear of going bankrupt?
There are a LOT of potential answers to each of these questions.  Do we declare hospitals "critical infrastructure" and provide them direct government subsidies (the way we do farms) to offset their shortfalls?  Maybe.  Do we transform the health insurance industry into a health management industry, where people pay for the access to non-medical and screening services that help improve the customer's health profile and limit doctor visits?  Possibly.  Do we transform "insurance" into "membership," where your actual accrued balance is what is used to pay directly for medical services when needed?  Who knows?  The point is, now you've got new, tangible problems to solve.  

And yes, would single payer address those things?  Of course.  But, again, we'd tank an entire industry overnight, throw a bunch of people out of work, sink your retirement account, and probably a mini-recession to go with it.  So let's move forward, but tread lightly.  

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