American Manifesto Part Three: Health Care Section One

American Manifesto Part Three: Health Care Section One

"If you judge people, you have no time to love them." Mother Teresa. 

America is one of the only democratic members of the western world without a predominant form of universal healthcare.  How often have Americans trumpeted the benefits of our quasi-free market healthcare system over the tax-burdened non-choice engrained images of England, Canada, France or the Netherlands?  Do we really still believe that or is that what certain disproportional benefactors from the current system want us to believe? 

America viewing health as a consumer product perpetuates decisions based on monetary consequences rather than collective benefits to humanity regardless of individual economic input to the system.  Doctors have swapped the paradigm of what does a patient need for what will I get compensated.  This is often done with no concept of what the doctors are actually charging.  Insured patients often have no concern for what their insurance company is actually paying.  This trade creates class warfare between tax brackets masking true solutions with misplaced jealousy.  

The number one reason our health system fails financially is that there is no linkage to knowledge of cost with the doctor or patient for a pill, test, operation, or procedure.  If our insurance deductible and co-pay is covered, we are indifferent.  We are clueless, yet every cog could be digitally tracked, assigned and valued and communicated in a universal digital paradigm using Big Data.  Some patient-elections are possible.  Others must be in the hands of doctors, but there has to be a better balance based on organized-digital data. 

Ironically universal healthcare in America may possibly be the best conduit for laissez-faire capitalism to provide healthcare from a consumer’s point of view. 

The current “free market” system taxes the working and supplements “free” sub-systems for the indigent, poor, and retired.  The “free market” system restricts people from what services they can acquire and from whom they can acquire them and shrouds their costs.  The current system takes away the pricing decision from the consumer.  This mutates the traditional supply and demand relationships of capitalism.  The “free” sub-systems stigmatize people and politicize access to healthcare perpetuating class warfare.  This is exploited during election cycles.

“Rich” people are excluded from “free” systems.  “Poor” people are stigmatizing for utilizing them.  This creates politically-divided delivery systems, which tear away at our interconnection as humans.  This perpetuates a conceptual reality of “brand name” medicine being superior to generic or governmental medicine as a magnified disparity, as if divergent biology is created once one ascends a tax bracket. 

Nobody is incentivized to conserve health costs, except the uninsured or those with considerable deductibles. 

The reality is Medicaid already drains the federal system in a disorganized manner due to the massive administrative costs of qualifying.  We each pay 1.45 percent of our pre-tax income to the federal government to fund Medicare for people over 65.  Working adults lucky enough to purchase healthcare hope to not get really sick because the insurance company will fight paying for what might really help us get healthy.  The saddest part is much of middle class America is left uninsured, while the majority of government employees are insulated to indifference with taxpayer-subsidized healthcare based on retire at fifty-five healthcare promises funded partially by the uninsured.

We are all human beings.  Cancer could give a fuck about a tax bracket.  The best healthcare solutions reside in preventative medicine facilitated through a healthcare system focused on wellness not cost-prohibitive not-deemed-necessary bypass of preventative procedures.  Our system is based around reducing up-front dollar costs to private insurers and healthcare providers by externalizing the costs to another third party rather than focusing on the patient to achieve the universal goal of a healthier population to reduce overall costs.  We operate myopically to manufacture profits for components of the system. 

The greatest fallacy of the current system is that people argue, “Why should I pay for somebody else’s healthcare when I pay my own premiums, shouldn’t they?”  The reality is our premium is already higher to pay for other people’s shitty healthcare or high-cost end of life procedures paid through Medicare.  Taxpayers are already paying for the majority of the costs for non-contributors by the nature of the healthcare providers’ covert pricing system.  The health costs of non-contributors defaulting to Medicaid are also higher because our food distribution system funnels the poor towards cheap empty high-caloric foods and beverages. 

Which is cheaper to treat childhood obesity or adult type-two diabetes?  Which is more profitable for the drug and healthcare private companies?  These questions encapsulate the definition of the non-severable nature of collective health of humans as a super-organism.  The determents of health one incurs can not be confined while maintaining the benefits of democratic society prospering from our mutuality.

Wouldn’t it be better for sick people to go to the doctor and do what the doctor said we need to do to get better and prevent greater long-term costs, rather than having to check if the “procedure” is cost effective by our insurance company first?  What is cheaper a recreational program for children or an obese adult?  What is cheaper subsidizing healthy product or fast food companies; soybeans or blueberries?  If we have to edge on one side of conservative and rationale judgment shouldn’t we go with the doctor instead of the accountant or the lawyer?

Healthcare is not a consumer-based product.  People do not optionally choose to buy substantially more healthcare when we do not need it.  The logic is basically, if we gave a one hundred percent healthy man free healthcare for life, how much more often would he go to the doctor over his lifetime than if he had to pay for it directly?  What about a universal system with a fluctuating deductible and co-pay based on IRS tax filings?  Wouldn’t it be better for us to funnel our tax dollars on the front end in part to reduce the number of high-cost anomaly patients in the system?  The cost is there.  We are already paying most of the cost.  We are just siphoning funds to insurance and pharmaceutical companies and the AMA for a broken system.

We have government run hospitals now with good doctors.  A doctor does not practice a governmental medical method in one hospital to clear an artery and then practice a whole set of secret private-practice procedures if the doctor is being paid through a private sector insurer.  Humans are the same biological organism regardless of job, education, race or country of origin.

The fact is the largest cost-shifting culprit of medical costs in the United States in the federal government through Medicaid.  A doctor may get paid less than fifty cents on the dollar for what the doctor billed for a service and have to fight to get that, but the math is an incestuous relationship with the private health insurers, for the lack of funds in Medicaid are an expression of the higher prices throughout the system to compensate for this un-paid gap and the profits retained by components of the private system (i.e. health insurance companies, lawyers, and pharmaceutical companies.)

Private insurers are set up to deny and delay treatment costs to protect bottom lines.  The game forces some other entity, usually the patient, to absorb the “correct” healthcare cost or not to incur the cost in the first place.  At the same time the insurer milks out as much profit as possible hidden in administrative and employee compensation costs. 

This shell game creates a Wizard of Oz-type wall for a healthcare system where no one actually knows what we will be charged or why.  People want healthcare to continue living and will accept whatever the Wizard-insurance company/doctor tag-team dictates.  The healthcare providers manipulate every charge in their system to morph around the Medicaid and insurance reimbursement contracted rates and binge on out-of-network charge rates and the un-insured non-Medicaid to make up differences.  Doctors are often clueless to the actual dollars that are billed for their services and what is actually paid by the patient.  Some doctors are buried in debt, with all the money going to intermediaries.

Healthcare cost have gone up exponentially, not just because people are sicker, but because the administrative costs of the healthcare process are out of control, profit is insatiable and our population is at a higher median age.  Doctor can not give straight procedure costs.  A doctor has to negotiate with the patient’s insurance company.  God forbid a person really gets sick because one or two days in the hospital may cost a person more than a new car or a year’s salary. 

The average patient is distracted by a measly twenty or forty dollar co-pay, rather then the two hundred dollars the doctor bills the insurance company and the $850 to $1,200 monthly employer portion for a family’s health insurance a person might be lucky enough to have. 

We act as if because our employer facilitates the payment for the “employer” portion of our health insurance, that we are not really paying that either.  Employees pay the insurance costs regardless of what label we put on the payee.  The pre-tax employee portion subtracted from a paycheck might as well be converted to additional federal income taxes to finance a universal system to foster a system that recognizes our mutuality.  Employer-based plans just trap employees in gold-fish-pond-size risk pools.  God forbid someone in the accounting department needs a liver transplant, because the forklift operator’s rate is going to increase. 

Like our obsession over the per-gallon-gas digits on the roadside stations of America we are myopic over the dollars we see.  We lose track of the shell-game our insurance companies are playing behind the scenes with our money. 

It should cost us a substantial payment of a hundred dollars per hour or so to consult with a doctor.  In realty when all our payments are combined we do, but when the portion comes out of our wallet rather than our paycheck or our employer’s bank account before it gets to ours we ignorantly cry foul.

Doctors are highly-educated degreed professionals who need to be compensated for their skills.  We tend to put the face of the poor sick kid who can not see the doctor as the poster child for healthcare.  As if, we ever made up a point-to-point, payment method from patient to doctor to compensate the doctor for the value of the doctor’s services we would be discriminating against the destitute. 

Why couldn’t Medicaid be paid out on a debit card on as needed basis?  Imagine instead of having the $800 individual or $1,500 family monthly premium we are paying either through lower wages from our employer or directly through employee premiums, being paid out in stacked twenty dollar bills to a doctor.  How many times do we pay and not even see the doctor that month?  We have no idea how much money we are funneling into all the different players in our three-card Monty charade of a healthcare system. 

The excess between an individual’s co-pay and his cost output over a given time period, say a month are retained by the private health insurer and not restricted for the betterment of his eventual care.  These dollars are unrestricted and go towards another participant’s care or the administrative costs of the company under a non-profit paradigm.  There is no assurance for a future period once the month ends; the spoils are spent. 

As humans we imply a relationship of justice, as if I pay in for years, a duty is owed back to the individual to at minimum utilize the preponderance of ones input to fund a portion of ones health care costs.  This assurance, this sense of justice can only be achieved within a common system, where this time period of a month expands to the spectrum of one’s lifetime.

What can we do?

A universal single-payer healthcare system will inherently reduce administrative costs, rather than raise them.  It will take the horde of health insurance companies and their built in profits out of the picture as well as the administrative costs associated with the federal government’s current disaggregated non-digital method of assessment of income qualification thresholds.  Even private non-profit health insurance companies manipulate their structures to increase internal payouts for administrative costs and cry poor to their members.

The question I ask myself is what fundamental health benefits do insurance companies and restrictive Medicaid and Medicare billing sub-systems create?  These companies are not innovative captains of industry revolutionizing the economy and creating public good.  They are leeches.  They are finance companies, in other words a bank.  They are inherently superfluous, and perpetually incapable of providing full time period assurance, since one is constantly potentially capable of being excluded from one of the sub-systems by the system jettisoning the burden of health care outside of that sub-system. 

One might argue that private health insurers compete to gain the business on a business entity by entity level; however the end consumer is a living human with real variable health issues.  That human has no choice.  He or she has a take it or leave it purchase decision limited to a single vendor.  How can any champion of the free market conclude that the market risk is linked to market price?

Private health insurer’s value is portrayed as risk mitigation.  However who they serve is not entirely under either the insurance provider’s control or the consumer’s control.  How can a health insurance company’s market practices claim to be optimal or even fit for a free market system?

Health insurance companies are financial mechanisms whose values are based on the quality of their lawyers.  They can be replaced with a better mechanism to facilitate the consumer obtaining and paying for the same healthcare product at a lower net-cost through single payer healthcare with internalized recognition of our mutuality.

Healthcare costs are a function of the salaries paid to doctors, nurses, and facility management personnel, the overhead of the buildings, equipment, insurance, taxes, legal costs to survive in the medical industry wasteland, and maybe highest of all pharmaceutical drugs. 

Every other industry comes up with a standard pricing system for services, advertising, and presents the costs to the consumer.  Why should a liver transplant or a broken arm be any different?  Why can’t a medical facility put prices on a website?  Why can’t they complete for the price of an average walk in visit?  Why is the cost of a doctor or surgeon’s time such an immeasurable good?  Even lawyers have per diem rates.  (There is a reason and the reason is because health is not a free market system.)

Industry Motivations

Insurance companies use to be glorified finance companies investing up-front premiums, earning interest and paying out healthcare costs approximately equal to the premiums originally collected.  After September 11, 2001, every insurance company including health insurance companies evolved. 

The industry parlayed the claims of huge payouts and new threats from terrorist’s acts affecting their investment portfolios and diminished stock prices into the justification for raising premiums at unprecedented levels. 

As real world costs diminished the profit elasticity in the industry expanded.  The management and the stockholders of those company’s expectations for higher returns increased.  Health insurance companies ballooned in the ultra-profitable financial services sector of the economy.  The internal mechanisms of the industry became obsessed with externalizing people with costly health issues and utilizing the labyrinth of byzantine verbiage in insurance policies to create loop holes for exclusions to pay “uncovered” aliments.

If the health insurance company’s and the government’s bottom lines are motivated by the same issue: “finding a way to not pay,” then how much money and time is spent trying to fund not paying and documenting information to see if a person qualifies to be covered?  Entities hold people over the coals if there is a box not checked or T not crossed or if they can prove you lied on question sixteen, even when you didn’t.  God help us if our company had poor leverage because the boss or the secretary had cancer or birth complications. 

How much administrative time at private non-profit health insurance companies is spent doing that?  How many people die or have our health issues compound because of that?  Wouldn’t the total costs of the entire system decrease exponentially if this entire motivation was removed?  Prices by the nature of the hybrid system are a mirage to motivate the healthy individual to obtain insurance rather than pay al la carte under the bankruptcy-inducing cataclysm that cancer or a car accident represents.  Under a common system, this anomaly is removed and a sanity of linking price to cost has the potential to evolve.

Employer Linkage is a Dead Paradigm

Right now health insurance is tied to a person’s employer.  Maybe that linkage made more sense when the average job was more manually labor-intensive; the workplace was dominated by men in the breadwinner role; there was much higher loyalty in the employer / employee relationship and America did not have over half of its workforce set to retire in the next fifteen years.   Maybe associating health costs with the type of work someone did was pertinent. 

However, in today’s insurance environment that thought process is much more applicable to a workers compensation or disability policy than a health insurance policy.  The entire prerequisite linkage between our employer and our health insurance/coverage should be abolished.  Use segregated income tax withholdings for funding with employer independence to produce a universal portability.

Linking a person’s wage to their health care contribution to the whole (i.e. healthcare-tax increases as wages increase), allows minimum wage employees and employers to function in a common system as those in higher salary-based industries, given that each human in the combined economic systems requires service under a common health care infrastructure.

We would not get automobile insurance through our employer.  Why is it so challenging to purchase comparable health insurance like we can buy automobile insurance?  Why can’t we buy into the local municipality’s health insurance pool?  Why couldn’t all Americans buy into the federal pool?  Why not Medicare for all? 

The answer is the system is set up exclude where ever possible, because health is not a free market good.  Why shouldn’t health coverage be facilitated through the tax system since free market principles can’t reach purchasers?

If America can not accomplish this than what country can?  Oh that’s right, several far less wealthy than America.  Their systems are not perfect, but like most things the solution is in the synthesis.

Employers all over this country are paying through the roof to offer health plans.  If employers could exclude enrollment to certain employees to lower their own costs, how far would employers go?  Will employers start paying Obama-care fines, forcing private workers to buy into local pools only for the whole nation to end up in one American-health-care ocean pool?  Is this the eventuality of 2020?  Is this the underlying truth of our current healthcare path? 

The lack of a properly-planned organized web-based digital-infrastructure to aid small-business compliance will doom Obama Care by not bearing the burden of cohesion on the government rather than the people.  Government should only do what we can not.  We can not organize this shit on our own, because of our greed and the un-mitigated externalities only government can internalize.  Bombing small business with disorganized compliance minutia is the old way.  While a start, the Affordable Health Care Act is not the end solution.

How many people risk poverty at the loss of their job, not because of their salary, but because of the inability to replace the associated health insurance if they or a member of their family have significant health costs?  How many people pick between medicine and meat?

Macro Economic Impact on America

The burden on U.S. employer’s to directly fund health insurance under the current system puts the average U.S. worker at a considerable competitive disadvantage to his foreign counterpart.  U.S. companies are outsourcing labor at an alarming rate and a huge reason is the associated employee benefits number one of which is health insurance attached to the U.S. employee.  This importation of our labor force has considerably diminished the tax base in America and the buying power of the average U.S. worker and should be at the forefront of global human rights arguments in Asia, Africa, Central and South America.

We sacrifice the macro-level good of an increased buying power of the middle class, because we do not have universal healthcare.  We create short-term gains by importing labor, because United States employers do not have the mutual assurances of a level playing field concerning healthcare costs. 

Meanwhile most government employees have little to no employee portion to healthcare premiums.  The government employees have little risk of being fired for lack of production.  Government employment is the last bastion of the defined benefit retirement plans as well as the virtual guaranteed employment for life.  Despite the fact that many of these state pension plans are dangerously underfunded by trillions and these liabilities are hidden from the public in accounting technicalities.

A governmental accounting standard known as GASB 45 has phased into place, which forces governments to budget for the healthcare benefits the taxpayer’s promise to retired and current government employees after retirement on a present value basis.  What this means to us as taxpayers is that the hidden costs of government employees working anywhere between ten to thirty years and retiring at 55 and obtaining a guaranteed benefit pension are not our only financial conundrums.  The best American financial investment is not contributing to our 401k’s it is getting a government job in our early forties.

Governments are promising to pay heath care costs or allow former employees to stay in their health insurance groups inflating the costs.  This accounting standard does not create these costs, it just means the current recognition of these costs are about to be a very significant issue.  To continue these promises the government is going to have to raise more tax revenue to pay companies like Blue Cross for it. 

(Blue Cross, Humana, are versions of Goldman Sachs “too big to fail” enterprises.  Ssshh, ssshh America!  What happens when there are not enough able-bodied healthy Gen Exers subsidizing the bulging decaying Boomers?)

GASB 45 allows the entity to phase in the accrual of this liability over thirty years.  So even now government financial statements do not tell the whole story.  The unfunded pension liability gaps are not on the local government’s books yet either.  My point is not that these policies should be discontinued.  My point is the hypocrisy.

The same politicians lining campaign-contribution chests with money from drug and health insurance companies to perpetuate the current system are the same people whose families do not have to worry about health insurance and often have lower average employee contributions than these individuals would in the private sector.  The politicians may have worked for the government a decade to qualify for a benefit that given the lower median retirement age of a governmental employee may pay out from ages 55 to 95, often more years than their employment. 

Government employees have no problem showing themselves, their families and co-workers human compassion with our tax dollars and hiding the liabilities worse than Enron.  The average private sector employee is on our own when we retire or worse we have to shed our assets in order to qualify for some form of government assistance the former government employee takes for granted.  Who wants to work an entire life for intentional impoverishment to find nursing care?
Pt 3 Continued Health Care Section Two