And Then There Was One

ORIGINAL DATE OF PUBLICATION is March 14, 2010.

Eric Nelson, a regular contributor here, offered his view of a health care solution (Risk-Based Health Care Premiums: A Modest Proposal).  Well done Eric. In this post I offer an Altered Focus for you, the reader, to consider.

Recently I heard a Professor of History from the University of Virginia respond to the suggestion made by actor Tom Hanks that World War II was largely driven by racism. His premise is made by drawing comparisons to modern day rhetoric with that of WW II rhetoric. Hanks concludes our fight with the Japanese and ultimately our use of “the bomb” was from a racist motive to utterly and completely wipe them out.  I think the 1940’s era phrase he invoked was “…just wipe them all out!“, referring to how America should dispatch with Japan.  Unlike any true historian, he reflected current wartime rhetoric about our enemy, Al Qaeda, and the calls to “…just wipe them all out!” as proof to cast a new light on World War II motivations.

The historian referred to this as “presentism“, that is to say, taking today’s values and overlaying them on past events and coming to new conclusions.

Every historian would agree that Japanese soldiers were trained to believe surrender was shameful, hence, even in the face of overwhelming odds, they fought to the death. It’s not like Americans didn’t understand the concept. We have our own historical example in the Alamo, surrender was not an option despite the odds. In both situations the invading armies offered a solution that was unacceptable to the smaller, soon to be defeated forces.  In time, there was only one choice, “…just wipe them all out!”

History is replete with examples of nations trying to find solutions to problems, but in the end, there is only one! Curiously, many of these solutions were on the table long before they became acceptable.

Most Americans are uninformed when it comes to the history of health care in the United States.  If you’re older than 50, you may recall a few home visits by your family doctor, much younger than that and you were likely born in the era of Doctors Inc.  Historically speaking, hospitals are a recent invention, even more recent is medical insurance. Until the 1930’s sick people were treated by family doctor’s and largely worked out simple payment plans with them, often being forgiven the majority of the dept for a doctor’s attention. It would seem doctors did not worry about wealth as we understand it today, their calling was that of healers.

Early medical insurance did not cover doctor visits at all, but was a hedge for lengthy hospital stays. It was at the point insurance companies discovered how much money could be gleaned from an otherwise healthy population that new coverages started to show up in policies as an inducement to win customers. The concept of deductibles was a device that gave insurance companies a hedge against the odds (perhaps even an unfair advantage the way it was used), after all, if their clients had to pay first dollars for typical medical needs, it gave them all kinds of lead time to jettison the frequent users (remember they had to demonstrate deductibles had been satisfied), thus saving the cash for their company.  Another trend cropped up in the 1960’s, doctors incorporated to protect their assets from taxes. Americans didn’t become medically litigious to any degree until the 1970’s, with the advent of the 1980’s any poorly executed medical procedure was an excuse to sue.

Somewhere in all of this, the perceived value of your doctor increased in society, giving rise to the God complex associated with many talented doctors and surgeons. When it became apparent that doctors could be wealthy in a few short years after completing their education, young would-be practitioners flocked to medical school. The dramatic rise in costs associated with getting a medical degree may have led to our current state of affairs. Imagine this, the typical cost of a medical degree in the United States often tops $130,000 as compared to the $20,000 price tag for most other degrees. With this in mind it’s easy to see why new doctors have little interest in home visits and keeping their rates down.  They have student loans and malpractice insurance to pay!

Where is this all leading, you may be asking at this point. We have a hot debate regarding health care coverage in this country and it has polarized us. The plans being offered by our ruling party come with a steep price tag, with most experts believing that citizens will just have to accept higher taxes to pay for the proposed changes. The minority party screams foul and demands a continuation of “market driven solutions” and largely business as usual. I think we will likely endure a tragic dance with some combination of both, still paying higher taxes, still paying deductibles, when the final outcome will still end up being a single payer strategy.

And then there was one! A single payer system is the one plan that actually has a chance of covering everyone in our country for the least cost.  Did it every occur to you why neither party has put a single payer solution on the table?  I have.  I conclude that nearly the entire medical community, and I include the health insurance companies, understand that it would mean their lust for money would take a back seat to actually servicing us again. Politicians on both sides like the campaign money too much to “screw the pooch” as they say.

Consider this – each of us is paying for “medical bandwidth” that we never use.

For example, our home owners policy has medical coverages, as do our automobile insurance. Further, states require workman’s comp insurance, not to mention many of us carry health insurance through our employers and they too, offset our cost by paying most of the fees. Yet with each, we still have deductibles, term limits and opportunities for insurance companies to reject claims for no other reason than the bottom line. Even the government won’t allow us to deduct medical costs until they’re a significant part of our income, and then only the amounts over and above.

I’ll say it again, this country has billions of dollars in medical bandwidth that goes unused each year, and over 30 million (some say as high as 40 million) people without coverage. Statistically speaking, these folks are pretty much as healthy as you or I. We aren’t saying 30 million would suddenly overwhelm the system.

Insurance companies won’t go away either, plenty of room at the trough remains.  For example, our single payer system doesn’t have to cover the cost of prescriptions, or time missed from work, these can be ongoing opportunities for insurance companies; even supplemental plans for private rooms when hospitalized and dental work can still provide revenue.  Some of the workforce may lose their jobs from consolidation to a single payer system, but not all. The government can contract out the collection of the medical invoices and the handling of administrative duties to many of these companies. Government doesn’t have to necessarily grow because of this.  The current governmental agencies that handle medicare could be re-purposed too.

If we reclaim and reallocate all the medical insurance payments we already make, I believe there is enough medical bandwidth for everyone without increasing our costs at all. Add to that, a single payer system that covers everyone means we won’t have medical included in home owners, auto or workman’s comp.  Even medicare goes away.  Why?  BECAUSE EVERYONE IS COVERED,

For a period of time doctor’s and insurance companies will have to adjust, even medical schools will have to rethink their costs.

We can’t make the mistake of “presentism” in analyzing why America didn’t take the single payer path years ago.  Our nation’s social framework today is so much more complicated. Companies making profit from providing good service isn’t a bad thing, it’s a globally embraced ideal. It seemed so “American” to invent health care coverage the way we did. It’s enough to accept that times have changed and it’s time we changed too.

Our country has a long successful history of “…and then there was one” type strategies.  We have our public school system, our interstate highway system, our power grid system, our national guard, our military and so forth, all that have contributed to our success.  Take way the greed motive from medicine and you have a formula for a successful American health care system to meet all our needs.  Perhaps one day, doctors will see the value in home visits again since their compensation will be the same as in-office appointments.

Thanks for reading this far.

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