Why single-payer healthcare?
America’s healthcare insurance system has too many moving parts. Every extraneous moving part diminishes efficiency, increases confusion, and leaves dark corners where vermin thrive.
I blame capitalism. Capitalism works fine, don’t get me wrong, but capitalism is competitive, not cooperative. Healthcare can’t be competitive – not in a society that values every human life – but healthcare insurance is, as it should be, competitive as hell. The dichotomy creates absurdities, both logical and financial.
Don’t sprain yourself, I can see you waving: “What do you mean, healthcare is cooperative? Healthcare isn’t cooperative!”
If healthcare was competitive, rather than cooperative, there would be piles of dead bodies in every hospital parking lot. I’m exaggerating; they’d have them removed, but it would be a genuine problem. People would die because they lost the healthcare insurance “competition.”
Some would die because they couldn’t afford to pay for healthcare, some would die because they didn’t understand their healthcare plans, and some would die because fake healthcare insurance companies fleeced them, leaving them with a healthcare policy as useless as a pile of Monopoly™ money.
Medical professionals, unbound by cooperative concepts like the Hippocratic Oath or human charity, would ignore anyone not waving a thick wallet or a valid insurance plan, leaving them to pray or self-medicate. There are places in the world where that sort of thing happens all the time.
Not here, though. American medical professionals do not refuse patients in dire straits. I find it comforting that my society – the part of the world I live in – remains at heart a kind, caring society. We feed our hungry and we care for our sick and infirm, even when we know they have no means to pay. Charity is one of the nicest of all human traits. It’s beautiful. It’s sweet. It’s kind.
And it’s expensive.
There are hospital bills in circulation that have been floating around like ghostly little IOU slips for decades, about as welcome in collection agent inboxes as chain letters. The vast majority of them will never be paid. Billing agents compensate by padding their premiums, overcharging those who pay to cover those who don’t. In a competitive society, nobody volunteers to pay the insurance company’s bills; this is how it has to work.
Is this what we want? Do we want sick paupers wandering into hospitals to get expensive care without bearing any responsibility for their medical bills, while the working poor overpay for confusing, manipulative, insurance plans so they can afford overpriced, padded-bill care – from medical centers with so many unpaid accounts that they have to farm most of them out?
We need a system that requires … requires every American to take responsibility for his or her future healthcare needs. A national healthcare umbrella requires a national effort to keep that umbrella from folding up the first time it rains.
John and I are working together on a model that will incorporate the best of the various single-payer healthcare systems into one logical, transparent system that even a caveman can understand (apologies to Geico™). Our stance is that there is a logical, financially feasible solution to our long national healthcare insurance nightmare.
We intend to find it.
We will design a comprehensive plan that will work socially and financially, but not necessarily politically. We don’t care who needs to kiss up to big donors, many of whom are healthcare insurers. Our “client” is us. All of us. We aren’t running for office and we are building a system we can sell to the highest bidder.
In order to reconcile the two incompatible financial models – competitive with cooperative – there has to be some sort of buffer, a payment-to-coverage ligament, that holds the competitive insurance markets and the cooperative healthcare markets together. We need a system where the afflicted will know they are covered, but also a system where the bills will be paid. There is no such thing as a free lunch; the buffer has to account for that harsh but unavoidable fact.
That buffer exists. It already covers nearly 10 million Americans. It might even cover you.
The model for our buffer, the single-payer conduit that keeps both sides in line so they don’t try to kill each other, is the Veteran’s Health Association. The VHA system can be converted and expanded into a national single-payer health system faster, easier, and more logically than any other system we know about. It already has in place priority mechanisms for payment through national service, and its outlets are used to dealing with a single insurance provider.
The VHA has a bad reputation, and some of it is deserved, but none of it matters for our purposes. The VHA’s problems have everything to do with funding and mismanagement, and nothing to do with structure. We only care about the structure.
My next post, on Tuesday, will explain the building blocks in more detail – how we intend to save the structure but knock down all the walls, peel off all the paint and fumigate the place. Thanks for reading.
Slack Chat: Wing-Heir’s Folly
T: Did you see this yet, John?
J: I did. It’s a really good idea; the state of Alaska has agreed to pay catastrophic claims, and therefore the main insurance carrier in Alaska changed their planned rate increase from 42 percent to 7 percent. Other states are looking at doing that as well.
Having the state – or the feds – as a backstop for catastrophic claims could go a long way towards calming the markets and dramatically reducing rate increases.
T: So Alaska is putting air bags in the system, so to speak?
J: Basically. Since Alaska is a relatively small state, just a few catastrophic claims could break the system. Having the state act as the “air bag” and pick up catastrophic claims, say over $100,000, would make it much easier for the carrier to make money – or at least not lose money – on exchange policies.
T: Has anyone from the GOP’s national leadership said anything about it yet?
J: I haven’t heard anything. I think that GOP moderates – the ones who didn’t promise to by God repeal everything Obama ever signed – would probably embrace it. It’s a realistic fix for one of Obamacare’s obvious system bugs.
T: Do you think the Alaska model can work elsewhere?
J: I think that it can. Other states are looking at it and trying to get the federal government involved, trying to get the feds to act as the air bag.
Insurance carriers love certainty. If they knew for sure that their losses on any one claim would be capped, they would feel better about offering exchange plans.
T: Will the federal GOP wonks appreciate a plan that works, or see it as a political setback, effectively ending their drive to repeal Obamacare?
J: There are a good many moderate Republicans – particularly in the Senate – who realize that kicking 24 million people off their insurance is just bad optics, not to mention bad politics. If they get their way, a properly crafted Alaska plan could pass Congress.
Whether Trump would sign it, I don’t know. It would probably depend on who talked to him last.
T: So Foghorn Leghorn will get on board. What about Yosemite Sam?
J: Well, the Tea Party Republicans will certainly look at it as a nonstarter, given that they’ve nailed their flag to beating Obamacare to death with an iron bar and roasting its rotting corpse over a fire on the Fourth of July.
T: If the general public polls in favor of the Alaska plan, at what point will the Yosemite Sams be forced to throw up their hands and accept it? Are they so at war with the Beltway that they’ll go down with the repeal ship, or will they find a way to cut their losses?
J: I think there are probably 20-30 hardcore Tea Partiers in the House who won’t be able to go back to their ruby-red districts if they vote for anything short of full repeal. The larger mass of House Republicans are sensitive to the political winds, though. If the Alaska fix gains traction in their home districts, they’ll fall in line.
They’ll drag the Sams along with them – by their hair if they have to.
T: How will the Alaska plan, if enacted at the federal level, affect a potential move towards single-payer healthcare? Is it grease, or gum?
J: I’ve always considered Obamacare to be a step on the road to single-payer. Stabilizing the ACA for the short- to intermediate-term would make it easier over the long haul to implement a Medicare or VHA expansion.
T: Do you think the current administration will get on board with expansion, or dig their heels in?
J: My money is on a lot of heel-digging. Trump promised to repeal Obamacare and he came out in favor of that fetid swamp of a Ryancare bill, so unless the Obamacare fix is wildly popular I doubt he’ll get on board.
Unless, of course, he can take credit for the fix.
T: The smart people in Congress should be able to convince the president that it was his idea, right? Like Hogan making Klink think everything was his idea.
T: Maybe that’s who Trump needs to be now – Colonel Klink. Does that make us the POWs?
J: Sure – and Trump’s base is Sgt. Schultz.
T: There is always another way to skin a stubborn cat. A little pragmatic truth goes a long way, doesn’t it?
J: It does. A stream of pragmatic truth can knock over walls a firehose full of idealistic truth can’t budge.
T: Jiu Jitzu politics.