DECEMBER 18, 2014 – It seems that once someone grabs onto an idea with political or ideological traits to it, they defend it till the end, in spite of new information, factual evidence contrary to that agenda or history to support a different result or outcome.
I must admit I have probably been guilty of it from time to time as well.
But nowhere does this play out more than within the Halls the Healthcare Kingdom, and I am often puzzled by this because we have so much history, it is a vertical driven by gathering facts, (you can’t be wrong or often people die), on accessing circumstance, analyzing symptoms and then creating a treatment regiment to combat the illness or injury presented by the patient. And this puzzles me as we don’t attack the challenges of reducing costs, or increasing access with the same diagnose and treat mentality within the vertical itself. We ignore empirical data, we ignore past treatments that went wrong, we involve additional decision makers and we acquiesce power to those not trained to treat the illness.
Yes I am using metaphors this morning as today my thoughts are going in an abstract manner, with the hope of maybe opening new eyes and changing old minds.
So in that abstract mindset, lets explore together some things that should not be disputed.
We have roughly 325 million people in the USA, and we billed in just the delivery of care 2.9 trillion dollars in 2013. So doing the math, the only exact science on the planet, this means per capita we spent roughly $9,000 per person (or billed this). And when you rank this to other countries we are in the top tier of how much per person we spend.
Now play along with me please, as I am trying to provide a different perspective to the madness and chaos these conversation seem to devolve into based on ideology.
Lets take ACA and deal simply with the promised cost to avoid any argument about what true costs are as they simply are disputed constantly.
So the stated goal of ACA was to provide access to care for the 42 million supposedly uninsured, the cost to do this per the promise was 900 billion over ten years. Well if you simply look at the math, these 42 million have always been counted in the per capita cost of care data, so we are adding an additional $2,300 per each of the 42 million to the cost per capita, or more simply put adding more per person for care. And if you are adding cost how can the promise of reducing cost ever have been real.
We also know that 85% of the population already had insurance. We also know that the insurance costs for those 85% went up as a result as well as the out of pocket costs for all those who were insured. Now this is not the actual cost of care, this is in addition to those numbers.
So stay with me please, if indeed you were going to commit 90 billion dollars a year to insuring that those without insurance had access to care, why disrupt the 85% who already had something they were happy with. Why not create a high risk pool and deposit the 90 billion into it and use it exclusively for those who were already identified as the ones in need. A finite cost, without changing a system that the vast majority were happy with. I suspect most would have not had a problem with this.
I do have to point out that according to the Census Bureau the uninsured were not who the powers that be wanted us to believe. These are the numbers from the same government that told you we were evil for not providing access to care for these people.
Of the 42 million, 18 million were under age 35 and CHOSE not to have insurance. A gamble indeed some would say, however the numbers are on their side, this demographic consumes less than 2% of all cost of all care in the USA. So they chose to buy homes and cars and other items rather than give money to a product they were likely not to use.
The second category were 14 million already eligible under Medicaid before expansion, which we have to assume they chose to not enroll because they had not needed the care in a recent time, if they had the provider of care would have tried to enroll them to get paid.
The last category were 11 million immigrants, either legal or not, for this example it was not stated.
So exactly who was it we had to disrupt the entire system for.
But setting aside the merit of how ACA was designed, would it not have been better to commit dollars to providing the access to care for the identified groups at risk, rather than disrupt an entire system? And would it not have been better to simply use the funds to provide the care, not insurance which will be paid for even if the care is not consumed.
Okay, I am sure I am losing your interest so just a couple of more comments, the true cost of ACA now is calculated somewhere between 200 and 300 billion a year of public money and has more than doubled the private sector costs for insurance as well as increased the per patient out of pocket costs, so in reality we have increased the actual per capita cost of getting access to care by as much as $6,000 per person, while promising to reduce costs. How does this make sense, how can math the only exact science be manipulated to say what you want it to say rather than be taken at face value and used to address the real problems of cost and access.
And then we have the history to compare past government programs in the vertical. Medicare was promised to never cost more than 5 billion dollars a year when passed, and that was projected out some 25 years when done. Last year it cost in public money more than 400 billion, a far cry from the promise.In Massachusetts the so called Romney care was promised to never cost more than 1 billion a year of public money and last year it cost the tax payers in that state almost 6 billion, 600% more than promised less than a decade ago, and this is what ACA was modeled after, so should we not expect the same cost results.
Until we attack the true cost drivers, we will never realize lower costs and more access, everything the government pushes on the vertical has unintended consequences on both cost and access to care. Much I have detailed for years.
We need to access what the third party payment system adds to the cost of care and find a better way.
We need to access the cost of restricting insurers to state lines and correct this.
We need to access the present state of malpractice laws and adjust them
And we need to access the state of regulatory costs and access if they are hindering or helping and adjust.
These fixes are in our grasp and would change the vertical in a positive manner for all consumers of care and providers of care.
There are simply too many mouths feeding off the 2.9 trillion dollar care delivery trough who bring no actual value to the delivery of care and too much money spent on the protection from needing care.
I would love to hear all perspectives and create debate that actually motivates real change to the real cost drivers, as we reduce cost, we increase access to all those supposedly identified as at risk. The higher we drive cost the further we move away from the always touted goal of providing more access to more patients. It simply is a math problem, the more expensive you make something the more you limit who can afford it, and it doesn’t matter who is paying for it.
We have to remember, government does not produce one dollar by itself, every dollar it spends has to come from the effort and production of something not of government, so not only do we pay more for the products and services directly, we pay more taxes to cover the costs on that side as well, and the math does not lie.