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Swampcare 2.0: Treating The Corpse While The Sick Die

By  |  May 5, 2017, 12:01pm  |  @stevengberman

Hooray! The GOP repealed Obamacare! Sort of. Kind of. Well, not really. Actually not at all.

The House of Representatives barely passed the new-and-remixed version of the bull with udders known as the American Health Care Act (AHCA). Now Republicans own Obamacare and its progeny. This will play about as well as Donald Trump did in Washington D.C. come November 2018. But the die is cast.

AHCA, and Obamacare have very little to do with health care in America, which President Trump suddenly realized was really complicated after hitting his head on a toilet in the Oval Office one morning. It’s really a national shame that we have 15 medical doctors serving in the House of Representatives and 3 in the Senate, and nobody in government knows enough to stop treating a corpse while living sick patients are dying.

Access to health insurance will not solve America’s health care problems. It never would, and it never could. The point of Obamacare was to do exactly what it did: destroy the insurance risk pool and market state by state until there was no choice but to go single-payer through the government. This is why Medicaid expansion was such a centerpiece of the program.

Single-payer health insurance in America would be an unmitigated disaster, because for-profit hospitals and drug companies would have a field day lobbying and winning hidden concessions. If you think the fraud, waste and abuse of the military-industrial complex is bad, or the subprime mortgage-FNMA complex is evil, the health care-insurance complex would dwarf them all. We’d bankrupt the treasury in short order.

The real problem isn’t insurance, which is a financial instrument to defer and assume financial risk. The problem is that health care in America is too freaking expensive. It’s too expensive because (a) college tuition for medical schools has ballooned and become a debt sinkhole for new doctors; (b) insurance carriers and their “care networks” along with hospitals have bilked consumers out of billions for decades; and (c) our litigious culture has made the first two items easily justifiable since medical malpractice suits can wipe out any doctor or hospital.

Doctors graduate medical school with between $155 and $264 thousand in student loan debt. They can’t even think about paying down that debt until they’ve completed their residency (residents get paid shinola). Then they spend half their career as an attending paying their student loans, and the other half paying for malpractice insurance.

Private practice general practitioners are basically middle class families at this point, caught between rising administrative, security, compliance (HIPAA and EMR), continuing education, and labor costs on one hand; and insurance carriers, Medicare/Medicaid (if they accept it), and slow-paying individuals without coverage on the other. Some specialties make doctors rich (sports medicine, anyone?) and some are only worth pursuing for altruism.

Hospitals charge $300 for a Tylenol; they typically bill for the entire contents of a “crash cart” if they have to open the cabinet to get a syringe (there’s $1,500). A single overnight stay for a non-life-threatening procedure can cost $20,000. That’s just nuts. If the patient doesn’t have a good policy, then they’re going to be bankrupt if they aren’t rich or able to sell some assets.

So what do Republicans do? They throw a little money at Medicaid, allow states to waiver out of Obamacare’s coverage standards (which Obamacare did anyway starting in 2017), and try to dress up the corpse they’re treating while the sick patient dies.

The solution to health care is to treat the cause. In England, where they have the National Health Service, patients have to wait between a few days and five weeks to see a doctor. And if they go for an ingrown toenail and decide to ask the doctor to check their prostate while they’re in the office, they need to make another appointment–one problem per visit, please. If a patient needs a procedure that’s on allocation, they have to wait. That means if a particular district has 20 knee replacements per year, and you’re number 100, you get to wait 5 years.

This is what happens when supply is limited and demand is unlimited. But the free market can’t totally handle health care either. Economics can’t account for a sick child who needs expensive treatment his parents can’t afford. Charity can’t cover 100 percent of everyone’s shortfall, so government has to get involved.

But instead of just filling the needs of those who can’t afford care, the government mandated that everyone has to buy expensive health coverage for things they don’t need. Then Republicans went in and said not everyone needs to buy expensive health coverage anymore. So the cost of care will keep rising, while the cost of health insurance will rise along with it.

The solution is to help doctors get their medical education without an enormous debt load, reduce the number and magnitude of malpractice lawsuits, and then require doctors and hospitals to give back a portion of their time and resources to help those who genuinely need care. After this, then the government can set up a universal high deductible for the uninsured, with a procedure for paying off guaranteed loans like we do with college debt.

If you don’t want insurance, you take the chance of having to pay your deductible back. At least the government would collect some of it.

Then deal with the drug manufacturers and end the gouging and ridiculous pricing.

Even if the government paid 50 percent of every doctor’s medical school tuition in exchange for 3 years of free services (given back over a career), it would be far, far cheaper than Bernie Sanders’ insane plan to guarantee everyone a free college education. And doctors have realistic skills (even bad doctors), while womyn’s study majors have no usable skills (besides teaching womyn’s studies).

Even if the government guaranteed that no drug would ever cost more than 10 percent of anyone’s monthly after-tax wages, and split the cost of that program 50/50 with drug companies, it would be far, far cheaper than funding Medicare for everyone.

I’m not saying I have “the” solution. But for God’s sake, what we’re doing is insanely wrong. This is all common sense. If doctors treated patients like our government treats health care regulation, we’d all still be blaming ethers and miasma for malaria.

The Democrats poisoned healthcare, and now the GOP is treating a corpse, while the patient dies. We should sue them for gross government malpractice. But we don’t need to, because soon many of them will be out of office.