Sunday, July 16, 2017
The Absurdity of "Pre-Existing Conditions."
The big debate on Capitol Hill these days is how to "repeal and replace" the failing Obamacare health insurance program with something else for which 50 out of the 52 Republican Senators can bring themselves to vote. Or, maybe modify it, or tweak it, or adjust it, or something. Anything...
That's because Republicans can, for the very first time, use an arcane parliamentary Senate rule to pass new legislation using "reconciliation." It normally takes 60 votes in the Senate to end debate and discussion on a particular piece of proposed legislation and head off to a vote, which then will pass or fail on a majority rule basis. But, because then-Majority Leader and Democrat "Dirty" Harry Reid used reconciliation to pass Obamacare back in 2009, for the first time in more than 230 years, Republicans can now use the same trick to replace it. It's much more complicated to explain then that, but hey, for the purposes of this unassuming little blog posting, that's good enough.
Anyway, one of the key components of the 2,700 page, five and one-half foot tall Obamacare legislation, which I have read, painfully, by the way, is that it covers "pre-existing conditions." Doncha' just luuuuv Swamp Speak? That little term means that you don't have to buy health insurance under Obamacare until you get sick.
That means the whole principle of shared risk and shared responsibility and shared reward that our insurance markets have been based upon since before our ancestors boarded the Mayflower and sailed off from Jolly Old England have been turned on their ear. Now, under Obamacare, you can wait until the thing you're insuring yourself against has ACTUALLY HAPPENED before you have to insure yourself against it.
Lemme' say that again. The simple fact it, when you buy insurance you're betting the insurance company that the thing you're insuring yourself against WILL happen, and they're betting you that it WON'T. That's how they can sell a package of car or home or fire or casualty or theft or health insurance to a broad swath of people, betting that only a small percentage of the total number of insured will suffer any kind of loss for which the policy purports to insure them against.
In other words, out of, say, 100,000 health insurance policy holders, the insurance company might discover from its actuaries (professional, highly-paid, math whiz guessers) that 1 or 2 will get brain cancer, 65 or 70 might suffer a broken bone, 26 will get measles, and 34 are expected to develop diabetes, etc.. The others will happily pay their premiums without getting anything of substance in return, but knowing that they're covered, just in case. And that those self-same premiums will cover the other folks' calamities while they themselves remain healthy, and that there will be some profit for the insurance provider left over. That's the incentive for the insurance company to place these high-stakes bets. And that's the way the game is supposed to be played.
Buuuuuuut, when you permit people to wait until they get sick, the cost of insuring the entirety of the whole will go up EXPONENTIALLY! Think of it this way: You buy a car but don't buy insurance. You have a wreck. And then you want to buy insurance to cover the cost of the loss you just suffered. "Hello, State Farm? You don't know me, but..." Fat chance! So why would you expect to be able to wait until you get sick to buy health insurance?
But then-President B. Hussein Obama and his cadre of sycophantic Progressives saddled America with a "poison pill" that will haunt us forever. They subsumed fully one-sixth of America's economy and put it in the clutches of the Gummint. And they did it without a single Republican vote!
Using it, they gave us what we think of as an "entitlement," and we all know that once an entitlement is given, it MAY NOT be taken away. So now the Republicans are suffering through trying to figure out how to "repeal and replace" something the electorate may not be willing to let them retrieve from those clutches.
And don't give me that crap about health care being a "right." It isn't. Here in good ol' 'Murica it was written by our Founding Fathers that we have, via the Constitution and the Bill of Rights, the right to..."Life, Liberty and the Pursuit of Happiness." Notice there's nothing in there about "health care." Except the lefties in our Great Land wishes there were. And if they wish hard enough, I mean really, REALLY hard, they think, maybe they can convince us sheeple that it should be. And "should be" should be enough to pass a passel of laws making it so. Got it?
So, thus far every single proposed "fix" to Obamacare has included "pre-existing conditions" as a foundational part of the proposed plan. Trump wants it. The female senators want it. Squishy moderate Republicans want it. And Democrats demand it, even though they are uniformly unwilling to even discuss repealing Obamacare. But Obamacare is going down in flames, and they know it, but they won't acknowledge it. And the majority of their followers blindly accede to the marching orders their Lefty masters puke forth. Truly sad, my friends. They are what's wrong with America.
The ONLY way to make this whole mess work is to repeal it and replace it. With what? Lemme' tell you...
1. Catastrophic Coverage: What we need is a basic health insurance policy that assumes responsibility when a catastrophe happens. A serious car wreck. Stage 4 cancer. A stroke. Something that doesn't happen every day, like a simple broken bone, or to everyone. Just the unlucky ones. My dad used to sell health insurance and his Number One Product was catastrophic coverage policies. No dental, no vision, no nothing except catastrophes. We should do that again. And we should demand that our citizens purchase it so that any illness or injury that befalls them will not impose a burden to their fellow 'Muricans.
And the price of the premiums for this coverage should be based upon your age and sex and lifestyle choices and pertinent other factors. Your next door neighbor shouldn't be made to pay for your poor lifestyle choices. Or your bad luck. You should. That's the way it has always been, and should return to being. Makes sense, right?
2. Government-Run Health Clinics: It has been illegal for years for a health care provider to turn away someone in need. That's why our hospital emergency rooms take anyone, anytime, legal or not, and whether they can pay or not. And that's why it costs those with health insurance $5,900 to set a broken bone, instead of a hundred bucks or so. This is a stupid system.
The solution: Have the Gummint offer a paid-for medical education for would-be qualifying physicians, physicians' assistants and Registered Nurses, require that they work in government-run health clinics for, say, ten years in exchange, and pay them a fair wage during their work-off period. Just like the Feds offer the GI Bill for returning military veterans, they should offer a freebie education for those willing to trade a few years of their newly-trained life in exchange. Oh, and get them a starter Cadillac too. That would eliminate doctors leaving med schools with $500,000 in student loans. It would prevent doctors from refusing to see Medicaid/Cal patients because the reimbursement rate is so low. And it would also eliminate the costly burdens placed on community hospitals by vote-hungry politicians.
Put these clinics next door to or near hospitals, require that they take anyone, anytime, and charge them based on their ability to pay, or even free, if necessary. Hospitals would no longer be burdened with the unreimbursed cost of treating the indigent, so their charges would go way, WAY down. And the community would have a health care resource for those in need. Find fault with that scenario, if you can...
3. Permit Health Savings Accounts (HSA's):
Permit "HSA's" so The People could pay for their own minor medical problems with pre-tax dollars. Kind of like paying for your retirement with a 401(k). And then require that the hospitals and other health care providers publish their charges for all medical and surgical procedures, so patients could shop and compare, thus putting We The People in charge of our own health care and enabling competition to finally break into the medical field (Whaaaat a concept!). And then let taxpayers transfer anything left over from their HSA into their 401(k) retirement accounts. Smart, huh?
Did you ever ask a doctor or nurse what a procedure or test or X-ray or drug or shot they want you to undergo actually costs? Well, if you did, as I have, the odds are likely 100% that they won't know the answer. Nobody except the hospital's Chief Financial Officer knows the answer.
How is it that little clinics in Tiajoewanna knows how much to charge you for a medical procedure, and is happy to advertise it, but your local community hospital does not? That, my friends, is a system in need of change. Rapid change!
4. Permit the Sale of Health Insurance Across State Lines: You can buy car insurance across state lines. And home insurance. And theft insurance. And dental insurance. So why not health insurance? Right now there are states with only one single health insurance provider. And because of O-Care, even NO insuror! In Nevada 14 of its 17 counties will have NO health insurance provider starting in 2018.
No sales across state lines = no competition. No competition = artificial - and HIGH - prices. Permit the sale of health insurance across state lines and watch the cost of coverage go WAY DOWN! That's called "market forces." It worked for car insurance, and it worked for life insurance. It'll work for health insurance.
5. Do Away With Unlimited Jury Awards:
It's absurd that "slip and fall" attorneys can swoop in and collect enormous fees for suing everybody who moves after an accident or injury. These ambulance chasers usually charge 40% of any award they achieve. And if the award is in the $Millions, their fees can be yuuuuuge! And carefully selected juries that believe it's somebody else's money anyway are complicit in these awards becoming absolutely ridiculous. That's why judge shopping, and jury shopping, and even venue shopping is so popular.
My solution? Establish a schedule of permissible dollar awards for various degrees of injury, or death, and require the jury to abide by that requirement. Say, up to $250,000 for serious injury not leading to death. And say up to $500k or even $1MM for a death, depending upon the education, training, abilities and income of the deceased. That would bring down prospective awards dramatically, and also bring down insurance premiums. There is NO free lunch, regardless of how many underemployed lawyers there are, or how sorry the jury feels for the aggrieved. And finally...
6. Turn Matters Back Over to the States, Where They Belong:
The 10th Amendment to the Constitution specifies that authority over all matters not specifically granted by the States to the Federal Government remain the province of the various States. And nowhere is it written in our Founding Documents that the Feds were ever given authority over our citizens' health care. Nowhere.
Thus, my final suggestion is that the Feds determine how much it would cost to provide Medicaid/Cal to every uninsured American, and then send that money to the States according to their various populations. My own calculation places the number at somewhere between $7 Billion and $10 Billion a year to cover all the uninsured. Compared with the $One Trillion Dollars over ten years that Obamacare costs us, that's a real bargain!
The States would then determine how best to make sure their citizens are insured. Whether they simply expand their Medicaid/Cal roles, like Ohio under Governor Kasich and a handful of other Republican Guvs did with the advent of Obamacare, or come up with some other delivery scenario their citizens choose. HMO's? PPO's? Concierge physicians' organizations? It would be their determination!
Then, the voters could hold their local politicians' feet to the fire concerning the health care programs they develop and administer. With the decisions being made much closer to the customer (the taxpayer!), the decisions are likely to be better and more responsive. What a concept!
So, my friends, that's the Chuckmeister's Rx for what ails us. And since I spent more than 40 years in the health care industry, I'm pretty sure my plan would not only work, but would cost less also. What do you think? If you like it, pass it along to your friends. And ask them to do the same. Who knows? We might actually change some minds along the way...