Well, we just elected as President of the United States, a candidate who said he wanted health care reform and wanted to reduce the vast influence lobbyists for the health care industry have in Washington. We also have elected a majority in both houses of Congress who should be inclined to move significantly.
But, is there really a consensus which has a chance of gaining real traction?
These diaries could help pursue a kind of public, thinking-out-loud, grassroots think-tank process for deliberating issues like this. This assumes that one starts from a standpoint of honesty, albeit sorting out ignorance from hard truths that can be agreed on as "givens." Discussion is hard to glean useful comprehension from, as a lot of it depends on abstractions and assumptions that just get repeated. Sorting that out isn't easy and it is hard to see where agreement might form on even basic definitions.
Politically, however, unless some consensus can be achieved, the traction for moving the ball downfield will be on the side of the established lobbing community.
So, where to start?
My place to start is where my entrance to the health care issue started: After I left home, I never needed to go to doctors except for a few minor emergencies that cost about 50 bucks.
A couple of years into my fifties, I developed what I thought was the flu. In a rural area where we lived, I had my wife drive me to an Emergency Room, not sure if I needed to go there. They diagnosed a gastroenteritis bug on top of Diabetes, which I didn't know I had.
Given that this was in the middle of the Navajo Nation, and I wasn't eligible for checkin to the small community clinic, then air-ambulanced me to a city 150 miles away over the desert.
When the billing for this started to come in, this was an education.
The hospital stay for two days of observation with some education about what Diabetes is and how to deal with it, cost in the neighborhood of $12,000. Pretty pricey hotel rooms in Hawaii are said to go for as much as $6,000 a night. The real shocker was the air ambulance. The 150 mile trip was charged at $28,620. I'll never forget that figure. I called the company accountant just to make sure I wasn't seeing things. From really pushing her for about a half hour on this, I gathered that the comparison for this is what the Bureau of Indian Affairs pays to air ambulance enrolled tribal members who are indigent. The BIA pays about $1200 for the same trip. As it happened, to make my mother happy as she was dying from late stage emphysema with heart disease complications, I researched an air ambulance trip from Austin, Tx to Seattle, Wa. The only air company I found that would do that was out of Minneapolis. They had to find a highly qualified critical care crew out of the Mayo clinic, to fly down to Austin, then to Seattle and back to Minneapolis. Bottom line: about $28,000. Even in a state of hypoxia my mother didn't see any sense in that.
The accountant told me that the rate was actually conceptual and that it was put out there for the purpose of
negotiation with the insurance company. The insurance company did negotiate it down - to only $20,000!
A further dodge when pressed about rates is that state governments create a "reasonable" rate which is what sets the going rate - not the "free market."
My conclusion from thinking about this for a couple of years: Health care costs are socialized. Big Business lobbies state legislatures, where a lot of this dealing is done, for the purpose of behind the scenes collusion among pirates.
Legislators from backward communities in places like Arizona are eager to use the system to enhance a "scratch my back, I'll scratch yours" way of milking the public sector to enrich the private. They don't care what you call it as long as they get a piece of the action. There are a lot of people in on this, who may not recognize it for what it is and who will go along mindlessly with calling efforts at reform, "socialism."
Take the nurse who is part of the two person flight crew. He or she gets an hourly rate that is double or triple that of conventional ER staffing. Plus, because of high intensity competence needed around flying, they get really nice vacation packages. Are these people interested in seeing costs come down? Hell no. Are the air ambulance companies (or ground ambulances) interested in cost control? Hell no.
This goes for thousands of small services and goods around medical care that aren't pharmaceuticals and aren't doctors.
A lot of people believe that the purpose of government is to provide a gravy train. That is what happens when state agencies that set "reasonable" rates operate in obscurity out of the public view. Lobbyists for the industry who are there to increase the flow of the gravy train are unopposed in the system.
Most people who have insurance don't care what the insurance company pays as long as they pay it.
So if health care reform is to work, how will the costs be contained? There are no market forces here unless you consider a system people by pirates to be representative of the free enterprise system. Can a government agency of some sort replace the pirates with honest judges? Is that humanly possible? Those who argue that bureaucracies aren't good at this sort of thing may have a point.
The BIA in the case above may be an example of something. But what? If the BIA refuses to pay over a rock bottom minimum and you might as well negotiate with Mt. Rushmore, perhaps that is a way to do things. But would that be a fair way to treat all classes of cost in all situations? Probably not.
So, the political traction needed for health care reform, to me, seems to be in deep mud.
Getting insurance companies out of the picture would seem to be a good idea. However, this is a vast system that is so impregnated at every level, everywhere, with the expertise to at least manage the paperwork, that it seems like creating a system to replace it would be unimagineable.
How would the nitty gritty decisions be made about how much to pay for an ambulance ride, to pay a med tech, or how much a night in a hospital is worth?