A Prescription for Fixing the US Healthcare System
conversableeconomist.com
conversableeconomist.com
Any plan that isn't "doctor prescribes it, government pays full stop, if you suspect actual fraud you can claw it back." They understand administrative bloat when it comes to cost sharing but then immediately walk into it again with the endless bikeshedding and guaranteed politicization of what will be covered. I don't want federal agencies subject to administration changes to be a shortcut for evangelicals to de facto outlaw birth control nor do I want new coverage to move at the speed of congressional incompetence.
Having doctors in the family, and having been on my own personal health journey, modern medicine, while incredible in some aspects, is profoundly rudimentary in other regards.
So many people in chronic illness communities finally get access to insurance with big hopes, and it turns out the doctors don’t really know what to do with health failures without any obvious blood markers or scans. So folks get shuttled from doc to doc to speciality to specialty with very little hope of improvement.
While I could propose a hypothesis, what we could use is funding and research that specifically looks at studying and deploying larger scale and better blood markers of health. Specifically intracellular measurement based markers.
Some useful areas that are likely profound, but not limited to, ought to be with plasma and intracellular anti-inflammatory markers, the molecular/nutritional components that drive said markers along with the ability to influence various food industries to then address these things in the food supply via various fortifications, similar to how milk has vitamin D added, and salt has iodine added to it. Now a days, we are adding omega 3s to milk as well, which is pretty crucial imo.
The challenges I see are multi-fold. We need better campaigns that make various nutritional knowledge more well known, so folks can be more informed. The food industry will need incentives to take on the cost of fortifying their foods with various vitamins and minerals. Then there is an aspect of having nationwide marketing to get folks out exercising more. Weights, sports, walking, anything such that folks are getting out more.
This would fundamentally start to lower the demand generated on the healthcare system for invisible issues that seem to have no solution.
Pharma and food will hate it. Medicine will likely embrace it. And the populace would absolutely take it for granted, but we would see many aspects of our nation get better. I’d be willing to bet that a concerted effort would improve the populations mental health, productivity, happiness, educational scores, reduce disability, reduce welfare needs, etc and every other measurable metric could become better.
It’s a bold claim, and I’m happy to get into the details as to why, but currently, only the richest folks that care can optimize their lives in these ways, but if we can accelerate the deployment of these things, there’s incredible gains to be had.
The fundamentals is that as a society we are getting older and sicker. Insurance fundamentally is about cost and risk sharing. The young are paying into a system that is mostly used by the old. That is unsustainable. In a private market, we are seeing doctors refusing to join certain insurance plans. And some insurance plans dropping certain coverages or pulling out of some markets.
I believe the fundamental fix for an aging sicker society is more healthcare and more affordable healthcare. Train more doctors, nurses, pharmacists and other healthcare providers. We need to increase supply to catch up with demand.
Another perspective: the young are paying into a system that they will mostly use when they are old. The old are using a system they paid into when they were young.
Health insurance is not insurance and the sooner we stop thinking that way, the better.
Why so? Let's compare.
You have car insurance - you're in an accident, your car is totaled. Insurer decides the fair market value for your car is $25K and for the sake of argument we'll say that's accurate and reasonable and acceptable.
Great, they're going to send you a check for $25K, right?
Hold up.
You have a $1,000 deductible. So now your check is only $24,000. Okay, sure, you knew there was a deductible.
Now they're talking about your $2,000 co-pay? Your check is only going to be $22,000 now! Bah, that sucks, but okay.
What's this? "Your contribution towards the value of your vehicle, your co-insurance, is 20%, which is $5,000. We have deducted this from your check." So now your check is only $17,000.
This is why healthcare "insurance" is not insurance.
And the part where your insurance decides who your allowed providers are. Can you imagine totaling your car, and the insurance company says, "Sure we'll pay out, but only if you buy your new car from Hyundai."
I agree. I'd go so far as to say its evil, and the banality of evil that results in discussions surrounding this topic seems to be fairly delusional, which is rather unfortunate.
Thomas Paine had quite a lot to say about "dead men ruling", and that applies to any system where those supporting it are treated no better than slaves.
The problem with healthcare is there is currently no market for it. The market that is claimed today is in fact no real market because it is supported wholesale by the government. For a market to exist, you must have competition, and that means you do not cooperate with your competitors. This necessarily requires there to be many competitors (not few) to the point where cooperation becomes impossible.
Any centralized system fails because of only a few archetypal failures. Mises covers these failures in his works on Socialism (1930s).
So long as there is no market, there can be no solution. It fails completely in 6 different common ways if its a modern central heirarchy, and if its one of any number of sub-niches it may fail in more ways than that.
The solution is dependent on incentives, and there can be no real incentive as long as there is free money on the table conjured up by the printing press in the form of preferential loans.
Money printing destroys markets slowly over time until they collapse to non-market socialism. This is seen as a sieving action of consolidation over time, its ruinous, and its been happening for well over 50 years now unmitigated. The final leg of the ponzi will occur when outflows>inflows or debt growth exceeds GDP.
The fundamental fix isn't a supply side issue. Its a regulatory/corruption issue tamping down any potential market.
Also is it even right as a society to allow medical technology that enables one oldest generation to horde all the resources, and as a result out-compete the young with regards to those resources; to the point where the young cannot secure a future and stop having children? The old will age and die regardless.
The birth rate is now plummeting because the old have enacted systemic changes and refused to yield their political power to the next generation which should have happened in 2000. People die of old age, there is no escape.
Its morally wrong to impose wage slavery on the young by virtue that you spawned them, without representation or consent.
The problem itself will resolve in a few years when the great dying starts happening. The folly and banality of evil, of the boomer generation will be one for the history books.
How does the saying go, one bad generation is all it takes for society to fall to ruin and destruction? We're living through the proof of that saying.
Trump said he had concepts for a plan to replace Obamacare after 9 years of trying to replace it and promising to have a plan in 2 weeks. What more does he want?
That is literally the status quo, especially considering the many limitations being placed on debt collectors and credit reporting agencies in relation to medical debt.
And if 2/3 of people will still have private insurance, the obvious pressure will be for services covered (which in this plan are TBD) to go to zero, and wait times to go to infinity. And even the 2/3 is simply a demand of the authors, because there's no way mentioned in this summary to enforce that arbitrary number. I suspect that it is a pure fantasy, based on the imagined attractiveness of this vague imagined healthcare coverage.
Amusingly, from my perspective some targeting of this 2/3 number would be an interesting plan (aside from the absolute arbitrariness of the choice.) If private insurance coverage creeping above 2/3 triggered an expansion of services, with a penalty that not keeping the number below that target would force a cash award to uninsured people of an estimated value of the level of service that would have attracted at least a third of people to drop private insurance, now that would be interesting. A mechanism like that could be the pressure towards the baseline level of service that is assumed to just happen here.
Still, why 2/3? Why would we reserve any room for private insurance covering basic care? Private insurance for luxury accommodations while having basic care, fine, but that's not healthcare insurance, that's hotel insurance. Private insurance for fancy cosmetic dental care, fine, there's a difference between healthy and beautiful, and teeth break all the time. But insurance for plastic surgery? Who would buy that? Just buy the plastic surgery. If you're disfigured, that should certainly be covered by the basic plan, no?
No surprise that the authors worked on ACA, which was just a Heritage Foundation plan, not some original creation. A completely amorphous "public option" doesn't improve it, and the same cowards and straw activists that backed away from it when ACA was passed would back away from it again. 75% of the people in the institutions on both sides of the issue of a "public option" would be literally the same, and without the unlimited mandate that Obama successfully steered into the toilet. The Medicaid expansion jammed into ACA provides most of this hypothetical basic health coverage, and if you want more, just continue to expand Medicaid.
Can a prescription to fix the US healthcare system have no coverage details and no plan to lower healthcare costs?