Note: I wrote this a few years ago when I hit the age of eligibility and Congress was still discussing obamacare. You remember how they kept saying romneycare was the model for obamacare? Sure… The details may be a tiny bit dated, but the story is still as valid and as infuriating today as it ever was.
Don’t stop writing to your congressmen and senators. Keep up the pressure on them to do the right thing, stay true to their oath of office, and save us from all this insanity.
Time marches on. And so it came to pass that I turned 65 — and my health insurance company notified me that they are dumping me and I should go on Medicare like the good little fuddy-duddy that I am supposed to be. And so I was confronted, personally this time, with the mess that the wise men with their good intentions have created in the name of social justice and compassion over the past four decades. (I wish I were a better writer; this is supposed to be dripping with sarcasm.)
Now, you can skip to the end to get to the point of this diatribe, but the details are instructive in themselves, and reinforce the point.
To introduce the details, let me just say that my mother had a simple answer to all this. She wanted nothing to do with any of it. She did not want to sign up for anything that would cost her a penny. I managed to sneak Medicare Part B by her only because the premiums are deducted from the Social Security checks, so she never had to write a check herself. Was she ever mad when she found out! When her Medicare Supplemental plan started charging a premium, she dropped it. When her drug coverage also stopped, she stopped taking her medicines. She saved a bundle. She lived to be 96. I got stuck with her unpaid bills for the usual end-of-life care.
I decided to be a little more responsible toward my own kids, so I plunged into the morass with both feet. The supposedly oh-so helpful Medicare.com or AARP.org are anything but. And you can’t sign up on-line, either; you have to go into your local Social Security office, where they browse the forms and do all the typing for you. They promise to guide you through the rest of the maze, until you realize that in typical bureaucratic fashion they only engage in what in computer programming they call indirect addressing — they don’t tell you what the information is, they tell you where to look for it. So you go there (go, call, search the web) and the info you need is NOT there. Then you spot on some random page an obscure link to some local volunteers who help the confused old geezers.
So there it is. Just the simplified instructions alone is a stack of colored papers half an inch thick. The first step is, what the heck does Medicare cover?
Part A covers hospitalization, Part B covers outpatient and doctor’s office visits. Part A is automatic; do you even want Part B? If so, just the outline of services, co-pays and limitations runs to two dozen line items.
The second step is, do you want a PPO or an HMO to supplement Medicare? Why? Because Part A and Part B leave a whole lot of expenses to be paid out of pocket. Good luck doing that when you are on Social Security. And no, you don’t sign up through Medicare. That would be too simple.
In any one geographic area there may be 4-6 different HMO’s, and you have to choose on the basis of premiums, co-pays, deductibles and limitations which vary with each of a dozen mind boggling criteria; and there is an infuriating mix of options and costs and qualifications that differentiate one plan from another. Going with an HMO means that you’ll lock yourself into a specific geographic area, a hospital and the HMO’s set of doctors. And you still have to see if they cover medicines. But at least the volunteer geezer-helpers created a table that includes all the numbers you need to know. As it turns out, contrary to popular impression, the premiums, co-pays, deductibles and limitations of an HMO plan are not much different from Medicare’s, so it is not clear why you’d want to choose an HMO, unless you really must pinch pennies. I must have missed something, but that just illustrates the bigger problem.
If you want to keep your present doctors or your right to choose your hospital and doctors, then you look at a PPO. Wouldn’t you know it, there are literally a full dozen varieties of plans. And wouldn’t you just know it, there is a different set of well over two dozen insurance carriers. A carrier does not have to offer every plan, but, the feature set of each plan is the same with every carrier. But by this time your mind is numb. And still you must persevere because of course they all play with the numbers and so each line item will differ with respect to an array of premiums, co-pays, limitations, costs and qualifications. And this time you have to contact each carrier separately to get all their latest premiums, co-pays, limitations, costs and qualifications. Of course I want to choose a PPO because that gives me maximum freedom and lets me have as much control as the wise lawmakers who devised this infernal system will allow me — while I am still relatively safe from infirmities such as senility that would keep me from understanding any of this stuff.
If you chose to go with a PPO, or if you chose an HMO that does not cover prescription drugs, then you’ll want to sign up for Medicare Part D. No, not through Medicare. That would be too simple. This third step requires that you to look at yet another set of well over two dozen insurance carriers, and choose on the basis of yet another set of premiums, co-pays, limitations, plus their formulary — will they even let you have the medicines you need? This time we run into a truly devilishly complicated system, which even includes a “doughnut hole” where there is absolutely no coverage, with co-pays and limits maliciously calculated so ‘most everybody will fall into it. If you are so decrepit that you need to spend over $6K out of pocket on meds in a year, then the insurance in their infinite kindness will pick up 95% of any costs above that.
So there it is. It is so simple anyone can do it. All it takes is days and days of browsing the web and trudging through automated phone menus, staying calm as the idiots on the other end give you the runaround because even they don’t understand any of this and no two of them gives you the same information. You hang in there until you end up with a matrix of several dozen line items vs. several dozen insurance carriers. Then it’s a simple problem in matrix optimization to find the best combination — for you — of nearly a thousand matrix elements with random boundary conditions. What, you don’t remember your matrix algebra from college? You never played with spreadsheets on your computer? Where have you been in the last 50 years?
None of this is accidental. It was designed this way on purpose, to soften you up for the ultimate remedy, and to give employment to a vast army of paper pushers. It’s a social welfare program presented as a mockery of good old American free enterprise. The chief characteristic of free enterprise, of course, is competition, which means many players, therefore many sets of specific details to distinguish one competitor from another. So, to make a choice, you can listen to someone’s advice, or educate yourself in yet another 2 or 3 professions. But all this is a sham because this time it is the government that sets the rules and imposes the infernal complications. Why? To make you so disgusted that you will hit the streets and burn the barricades to protest for the siren song simplicity of single-payer (i.e., government) health insurance. They have to make you hate your doctors, hate your insurance, hate the very concept of free enterprise, so you will not only submit to but doggedly fight for socialism.
To top it all off, this is the messy model that some are now trying to apply generally to the entire population (“obamacare”). By now this should not be a surprise at all. They are not interested in helping the needy. They are interested in maximizing the bureaucratic overhead, to maximize the population totally dependent on the system for their livelihood and well-being so they would reliably keep voting to keep the power structure in place.
But if they were honest, if there were an ounce of intellectual or moral honesty left in any of the players — the politicians, the insurance carriers, the armies of “advocates” and “experts” now agitating for health care “reform” — then they’d admit that free enterprise has the only possible answer.
But first let’s identify the problem. We the people get sick, we need help from those money grubbing doctors and heartless hospitals and evil drug companies who are conspiring to bankrupt and exterminate the population in the name of saving Mother Earth. (The ignoramuses who came up with these epithets do not even think to explain how the providers might expect to stay in business if they rob or kill off their customer base…) In this suit-happy culture with sky high malpractice insurance rates we have to pay for all the needless, excessive CYA tests and treatments that these conspirators force you to submit to. But, but… health care is a basic right, like… like… oh, never mind like what, it’s a basic right, OK, you heartless bourgeois reactionary exploiter of the people, you. It’s “free,” except you’ll never see one half to two thirds of your paycheck to pay for it, but it’s free, OK? And so you find all the illegals with their dozens of snotty kids jamming the waiting room in the ER all day because one of them has a sniffle. Oops. It always happens like that, it is a law of nature. If something is “free,” demand for it skyrockets until the supply must be rationed. Just ask the Canadians who come to the US to get care that is denied to them at home; just ask the Brits and Euros who suffer and die waiting for severely rationed treatment, or die prematurely simply because treatment is flatly denied by the bureaucracy. If something is “free,” demand for it skyrockets until the system collapses. Old doctors give up under the increasing strain, potential new doctors go into easier professions, and we are left with an under-brained, under-experienced under-qualified staff doing more harm than good. Just ask anyone who’s lived in the communist workers paradise of eastern Europe in the 20th century, or in east Asia even today.
So, somehow we have to reduce demand to a manageable level without depriving truly sick people of the help they need. The answer is so simple it is politically not permitted to be put into practice. You pay for it yourself, just like you pay for all your other needs. You can chose to set aside a sizable portion of your income for this purpose yourself, or, if you are not that responsible to your own self, the government can force you or incentivize you to do so, in the form of tax-free health care savings accounts. You can spend some of it to pay for services directly and some of it to buy your own personal insurance, not dependent on your employment status.
(The same formula would work for your retirement fund, too — truly your own personal “lock box” and the government would not have to face such a huge unfunded liability — but let’s not “gore” to many oxen at the same time.)
The point is, as soon as you have to pay for the services yourself, something magical happens. YOU become the first to ask, am I really sick, do I really need to see my doctor? Yes, I do. OK, so next the doctor recommends a bunch of stuff. Now YOU ask, is all that really necessary, the most cost effective? Now you are a PARTNER with your ADVISOR in your own health care. But wait a minute, I am too ignorant or too stupid to know what I need and what my doctor is doing to me. OK, then trust him. But because YOU asked him to be cost effective, now he is thinking more clearly, too. And because you are FREE to take YOUR money to ANY doctor, ANY hospital and ANY insurance company at ANY time, THEY are now falling all over themselves to retain YOU as a client. And as always, in a free market, competition brings quality up and costs down to a level that is reasonable for both the consumer and the provider. The only losers are the leeches — the politicians, the bureaucrats, the paper pushers.
Let’s close this with three examples.
1. In the early 1960’s my parents did not have any beneﬁts from their employers or their unions, the teamsters and the garment workers. When my mother had complications from menopause and went to the doctor, the ofﬁce visit and the estrogen shot cost her $5 (about $50 in today’s money), and the doctor fussed over her for 15 to 30 minutes. The doctor had one nurse, and his wife did all the paperwork. When LBJ’s Medicare program kicked in a little later, the ofﬁce visit went immediately to $10, lasted no more than 10 minutes, and the estrogen shot was extra, because the doctor had to hire two paper-pushers to help his wife with the load imposed by the government. By the time my mother got on Medicare, the copay alone was $5 or $10, effectively helping her not at all with the her bills, in terms of her direct out-of-pocket cost.
2. In the early 1970’s, Blue Cross was advertising that they pay 97 cents of every premium dollar directly to the health care providers. In other words, their overhead for paperwork and profit was only 3%. A couple of years later their payment to providers fell to 95%, then to 93% by the early 1980’s, and to 84% several years ago. Just yesterday I saw a statistic in the news that the total number of administrative employees in the health care industry exceeds the number of doctors and nurses. Imagine that; more than half the workers have nothing to do with the actual delivery of care. Is that an example of American ingenuity? In the meantime, I’ve been paying $1500 a month for Blue Cross to cover a family of 4 under COBRA. These premiums have been shooting up rapidly over the years, as the good people of California thought it was their duty to load the plans down with all kinds of mandates, which have nothing to do with me or my family but everything to do with politically privileged special interest groups.
3. My doctor, whom I met through work and who therefore knew the terms of the insurance I had, one day started making a list of all the tests he wanted to run on me. I asked him about the cost for all that, and he figured it came to over $500 (in 1970’s dollars; more like $3-4 thousand today). I told him, doctor, I no longer have insurance; let’s be real scientists and reduce these tests to a minimum set that will still give you the information you really need. His eyes lit up and magically the cost came down to about $50 for an intelligently selected set of tests that gave him 99% of the data he wanted. He remembered this and years later he was still reluctant to be more “liberal” with his lab orders even after I got my insurance back.
Yes, the free market works. It works well if you let it. It will still work even if you try to kill it, but the mess you make will kill the patient first. Is that your ideal, a nation of dead souls and dead bodies, but long live the socialist workers paradise? The Soviet empire collapsed, not with a bang but a whimper — remember? Of course you do. That is precisely the unforgivable sin for which America must be punished by plunging it into socialism via universal health care.
Gee, I sure wish the House Republicans will remember this, now at the end of 2012, as they are looking for spending cuts to avoid the “fiscal cliff.” They ARE looking for SPENDING CUTS, aren’t they?
See also 14. How To Make Heath Care Cheaper