“Life insurance pays off triple, if you die on a business trip.” – Fight Club
Now these are the results that a functioning health care system should provide. Including the hat.
The health industry in the United States is a mess, probably worse than a woke vampire movie where vampires use pronouns like undead/cursed and make their victims go to DEI training (Death, Exsanguination and Immortality) before selecting them based on their social privilege score. Talk about sucking!
But back to the point: the system is a mess. Case in point, the insurance companies are for-profit institutions. As, um, you might have noticed from recent events this leads to almost inevitable conflict between the patient and “their” insurance company.
This has created some really perverse incentives, especially for the company. If they can successfully deny enough claims, their profit goes up, so their best bet to make the most money is to not allow claims, just like the best way for some specialists and hospitals to make the most money is to do the most testing. “Hey, this is the machine that goes ‘ping’, and it’s useful to see if you have the Hong Pong flu.”
For no reason at all.
Oh, and lawyers? We didn’t even mention them. Lawyers just love to find that doctors missed giving the right test so that they can sue them. So, we have the groups all competing for an economic slice of the pie. How big is the pie? In 1960, it was a manageable 5% of the economy of the United States. The average life expectancy then was somewhere around 70 years old.
In 2019, healthcare costs were over three times as much, at 17.6% of the economy. Lifespan had gone up to almost (not quite) 79 years.
So, 12.6% of the economy for an extra 8 point something years? Is that a good deal?
Well, not exactly. Lifespan is certainly extended by modern medical care to some extent, but a huge amount of that uplift is due to factors that have nothing to do with the increased costs of health care. But some of it is better health care: much better trauma care has also made events like gunshot wounds and car accidents more survivable, so the average is going to go up because people aren’t dying young in car crashes as often.
What did the CEO know about the Clintons?
But people aren’t smoking as much, either. Also, cars and roads are objectively safer than in 1960 by an order of magnitude, and since car deaths are skewed to young men, that really helps the average life expectancy. And all of these things have increased life expectancy:
- Nutrition
- Clean Water
- Sanitation
- Neonatal Healthcare
- Antibiotics
- Vaccines
As you can see, many of these things aren’t healthcare, and with the exception of neonatal healthcare, they’re all stupidly cheap. So, a big part of why health care costs so much more is that people are living longer and consuming more health care. If a smoker didn’t die of a heart attack from smoking at age 45 at nearly zero medical cost, now they’re living longer and using medical care at age 80.
This is not a bad problem.
Looks like I picked the wrong week to give up dad jokes.
The other part, though, is that there are so many more vampires surrounding the money trough than there were back in the day.
- Insurance Companies (as noted earlier, insurance companies actually make more “shareholder return” by denying claims and treatments, so if they spend $1 to deny $2 in claims, they’re still up $1)
- Ambulance Chasers (attorneys produce great benefits against those who practice irresponsible care, but the lottery attitude of many juries giving ludicrous awards raises costs for everyone)
- Big Pharma® (Goldman-Sachs actually asked the question if curing diseases is a sustainable business model, versus forever dispensing medicine to be people who are just sick enough to not die, so the model is to sell more drugs)
- Hospital Administration (which has to be doubled to account for insurance claims, government required paperwork, Ambulance Chasers and managing television doctors)
- The AMA (who has artificially limited the number of doctors produced by American schools to keep doctor salaries up and hide the stethoscope shortage)
- The Government (who builds entire bureaucracies to regulate medical care and administer payments and . . . to hire more bureaucrats)
- Illegals and Deadbeats (the system must treat them, by law, in an emergency setting, and guess who pays the bills?)
The current medical system is like a vampire-hydra: cut off one group sucking money out of the system, and another two will emerge.
In the 1980s, healthcare went from a still-manageable 6.9% (1970) to 12.1% (1990) – nearly doubling in size. This was largely driven by a 1986 law (EMTALA) that made emergency treatment a right at any hospital that receives Medicare, whether or not the patient had any ability to pay. It’s like saying that if I’m really thirsty, that McDonald’s™ has to give me an iced tea.
What do you call a talkative Columbian? Hablo Escobar.
And, like usual, everyone points to cheap strawberries as the benefit, but skips the $19.75 Tylenol™ pill in the hospital. Healthcare in the United States is so expensive (at least in part) because to so many it’s free. This increases the recordkeeping, and hospitals have to spread their bills on decent hardworking non-deadbeats.
So, it’s broken. How do we fix it?
On insurance, The Mrs. has a simple idea: make it illegal.
All of it. Medical services are cash on the barrelhead. You pay for the services you get. That sounds drastic, but when I really thought about it, this would eliminate the entire medical billing bureaucracy. We talk about a capitalism, but health care tied to insurance is anything but capitalist, especially with all the mandates and cost shifting from programs like Medicare and Medicaid.
The Mrs.’ solution has some real-world evidence to show she might be on to something – real prices for services insurance doesn’t pay for like breast, um, augmentation and laser eye surgery have gone down in real terms. Force doctors to post prices, and for emergency services, well, I’m sure we can figure out ways that hospitals can’t create “pay $90,000 for this shot of anti-venom that cost us $125 or you die” scenarios.
They know a thing or two, because in hundreds of lifetimes they’ve seen a thing or two.
Cap malpractice awards to reasonable levels.
Pharmaceuticals are a bit stickier since we want to foster innovation, but how many of them take public institute research to make their drugs? And we can certainly streamline the FDA, especially for sketchy drugs that might help people that are otherwise terminal.
Get the federal government mostly out of health care, except to prosecute people for fraud. Like the people responsible for the Vaxx®. And make the penalties criminal.
Eliminate free care. If it’s so important to you that people who can’t afford to get treatment, get treatment, don’t use my wallet to assuage your feelings. Pay for it yourself, Sally Strothers.
A Christian cross might make a fictional vampire recoil in horror, but the lack of a money trough will make the health-care-hydra vampire wander away to try something else, hopefully by finding a real job, or, failing that, being paid to suck something else.
Doctor got his degree from Columbia. I told him I wanted one from America.
