Sunday, August 16, 2009

Just Another Game

In the very early years of the current millennium, I had what I imagined to be an adequate health insurance plan. It was not a “healthcare” plan necessarily, but rather one designed to protect my ass(ets) in case of some sort of catastrophic illness or injury. The $1,500 yearly deductible virtually guaranteed that, baring such a catastrophe, all expenses would come out of my pocket, and indeed prior to late October 2000, my insurance provider rarely ever paid anything on my behalf. On the morning of October 17, 2000, all that changed in an instant. Catastrophe struck in a big way.
I have written about that transformative event on several occasions. It was much more than life altering; it completely tilted the axis upon which my life rotated. I woke up in a Reno hospital five weeks later not knowing much, but soon found out. It would be an educational experience that was heavy on experience. The various aspects of how that cool October morning touched my life are numerous and when multiplied by nuance, infinite. One of the tiny threads in this complex fabric, however, has current relevance; it has to do with a debate that has turned away from what it is all about to everything it’s not: healthcare reform.
I’ll not rehash here the need for some kind of healthcare reform. Conservatives and liberals alike largely accept the idea that our current system is seriously dysfunctional. Almost everyone agrees that we need to do something. I was lucky; I had insurance, but that $1,500 deductible is a myth – one that is well hidden in the techno-legal mumbo-jumbo that I could not decipher on my best day. And those in late 2000 and most of 2001 were not my best. In simple but decidedly accurate terms, there are three players in the game: The patient, the doctors (collectively, and the hospitals and the clinicians and the x-ray techs and the anesthesiologists, and, and, and) and the insurance company. Of those three players, two are seasoned professionals; they know the lingo and the bureaucracy… it is their game. The amateur is the patient, but only the patient can lose the game. Only the patient bears the legal responsibility for the cost of his or her care – a cost ultimately determined by the pros.
Suffice it to say that my cost far exceeded my deductible, and for reasons that have not yet, still, been adequately explained. I’m not even sure they know themselves and there is no one person accountable. Except me, by law. And if I can’t pay, we all do. But I cite this only to personify what healthcare (or lack thereof) has become in the greatest and most prosperous country in the world. What gives? Why can’t we fix it? We have identified many of the problems as well as possible solutions many, many times and over many, many years. What could possibly be standing in the way? This should be a rhetorical question, but it is becoming increasingly obvious that it is not, so I’ll answer it: Partisan politics.
And in today’s culture, that really means dirty politics. This is not about helping the people of this nation get covered or reforming what has been for far too long a broken system, it’s about winners and losers. Many of the arguments presented – and accepted – are so ridiculous that reasoned, valid and legitimate debate is no longer taking place. Although it is not at all surprising that the extreme right-wing demagogues would perpetuate these fallacies (death panels? Please…), it is somewhat surprising that so many otherwise rational Republicans (or conservatives) do. Their not so thinly veiled goal is to beat Obama and the Democrats and it has become so pronounced that the concept of reforming healthcare has fallen off the agenda entirely. It is just another game, but the losers remain the same.
If something isn’t done soon the opportunity will be gone. The Republicans are so bent on seeing the “other side” fail that serving this country and the best interests of all of her people comes secondarily, if at all. Can we afford to wait another 20 or more years for another window to open up? If this reform effort fails, what does the right have to offer other than the status quo? Our elected representatives have long forgotten for whom they work – this is not news, but when it comes to something that is so pivotal and fundamental, wouldn’t you think they could pull their collective heads out of their ass(ets) and put this pettiness aside?
Maybe I expect too much.


Tim said...

Mike, While I'm sorry for your experiences, and I'm no apologist for the health insurers, and we do need health care reform, what's happening in Washington, while very partisan, is much more complex than you represent. I could go on and on and on as to what is wrong with health care policy in America, and what the very significant hurdles and opportunity costs of reform are, but let me simply suggest there are principled objections, bolstered by practical realities, that, if ignored, will leave most people unhappier than they are now. It is too simple, and not accurate, to suggest Republican/conservative opposition to health care reform is some knee jerk need to beat Obama and the Democrats.

Otherwise, I'll leave you with this fact: the average net profit margin of all industries in the American health care sector is 10.65% (it's declined since the recession); the average net profit margin of the health insurers is 3.30%. If profit is the yardstick (and it certainly is the issue the proponents of reform are too happy to demagogue), health insurers are significantly under-performing the rest of the sector, including drug manufacturers, home health services, medical labs and bio-technology. In short, the money is being spent (and made) on medical goods and services, not insurance.

Mike Althouse said...


I'll grant there are a number of differences in approach to healthcare reform, and many could be categorized ideologically. These are legitimate areas for honest debate and compromise. My issue is not Republicans or conservatives per se, and not with the usual list of extremists (the Limbaughs, Palins, Bachmans, etc.), but rather with those otherwise measured and rational conservatives who more or less tacitly validate these outrageous claims. It serves no one - and any meaningful healthcare reform will be pushed out another 20 years or more.

Tim said...

Mike, O.k., I see that point (amongst your several others), and think it a fair one, on balance (and it is behavior I try to avoid, as I try to focus on the positive rather than the normative debate [although I can play there as well]).

But part of the problem you highlight is known bad faith from the proponents. For example, the oft-discussed "public option," does set the table for a national single-payer system in which one won't be free to keep, let alone choose, one's current insurance (which, ironically, is another false debate, as most are insured in large groups, and accept one of one to three choices offered by one's employer), it cannot help but do that, for all kinds of economic reasons (shorthand: admin. costs migrate to the taxpayer, and the enterprise does not have to make money to balance its books - it can sustain losses in perpetuity, thereby allowing it to under cut insurers that have to balance their books - which it would, thereby gaining market share as the privates would not be able to compete). The only real reason for a public option is to kill off private insurance, which it surely would.

Yet the president and Congressional Democrats will not admit (other than on a a few youtube videos capturing candid moments) that to the American people. Nor will they admit: 1) they cannot cut costs without limiting/rationing care; 2) there is a permanent shortage of providers and hospital beds, and plans to increase coverage by 15% will increase demand by 20% (all studies on this show that subsidized care, which is what the uninsured will receive, is over-utilized compared to non-subsidized care), thereby imposing greater demand on fixed supply, thereby increasing costs; 3) the primary cost drivers are technology (the new neat stuff that saves/improves lives that 15 years ago would have gone unsaved/unimproved) and utilization (the population is aging; 70% of health care services are used by those 55 or older, ergo...); and 4) profits (which they are too happy to demagogue) fund innovation and advancements in health care (public funding in the U.S. for medical research is only 28% of total R&D, the privates do 72% of all research in the cancers, heart diseases, Alzheimer's, Multiple-Sclerosis, Lupus, etc., etc., we all want cured or treated). All of these matters (and others) are why the "non-partisan" CBO (they actually work for Reid and Pelosi, which makes their fiscal and actuarial criticisms even more heroic) has scored the health care proposals as huge budget busters that will fail on their own terms.

So, given the proponents' lies (and they are lying - they know this stuff as well as I do, probably better), I'm not feeling particularly reproachful toward those who make up their own lies (for those who do know - many, if not most, don't) against the proposals. And, given the Democrats vast majority in the House, and the filibuster-proof majority in the Senate, and that Obama sits in the White House, in the end, if this fails, it will be because a majority of Democrats in either chamber could not muster the will to vote in support.

The political calculus of that is this: 85% have health insurance; the vast majority of those are happy (or happy enough) with their insurance; 15% do not have insurance, approx. 40% of those by choice (what we call the "young immortals"), another 25% are illegal immigrants and the remaining 25% want coverage but cannot get it due to unemployment, pre-existing conditions, or cost (most of the uninsured would get coverage in the individual, rather than group, market), and about 10% are, unbelievably, qualified for Medicaid or Healthy Families (SCHIP) but will not enroll, for whatever reason). So, how many Blue Dogs, who want to be in Congress more than they want universal coverage, vote to increase costs, taxes, deficits/debt and wait times for the 85% who are covered to extend coverage to the 15% who are not? My own guess is, not enough will vote to do so, but I've been wrong before.

Kim Williams said...

i have just had a brief time 'between health care." i had one simple (so I thought) need for medical help with an infection. i just needed some antibiotics for an infection - i've had the infection before...

i clearly told the receptionist, the PA and the doctor that i was paying for this our of pocket and didn't want anything done or tested that wasn't absolutely necessary. i left the office with a prescription after seeing the doctor, peeing in a cup and paying $195.00 for a visit and lab test.

not bad, until i started getting bills from the doctors office, and Lab Service companies for over $540.00. WTF!? Then my previous insurance carrier notified me that these same bills had been submitted and denied by them

yes. we have a problem...

here from NetChick tonight...

Mike Althouse said...


Your points are duly noted and although I do not necessarily agree on all counts, I'll go this far: Either the government should go all in (i.e. single payer) or stay out of the business directly. At my core, I like less government, but in this case I don't believe the current system is capable of competent self-regulation, as my personal experience shows. And whether or not single-payer is feasible is a moot point - it will never fly. I do not necessarily accept the premise that a "public option" will force private insurers out of business, however, it would definitely have an effect - probably a negative one.

What I do want to see is this kind of discussion occurring in Washington. It's not and there is plenty of blame to go around, not the least of which belongs to the news media. I think there are ways to get the uninsured insured (and I do think that is important) and to reign in the complexity designed by the insurance companies to baffle the consumer. I am talking about reform and I don't want to see what is another opportunity to secure meaningful change squandered once again because the two sides can't play nice.

It speaks to the extreme polarization that has brought government to a grinding halt in so many areas. Just look at the tax codes - another area where what should be a simple process has grown so complex only an expert can understand it. And that is a creation of our government - with the help, of course, of special interests. Something needs to be done and dwelling on the hyperbolic and the fallacious is only going to keep the current system in place - a victory for some to be sure.

Unfortunately there are far too many of "them" and, apparently too few of "us."