FacebookTwitterGoogle+RedditEmail

The Alt Facts of Republican Health Care

Now we know the Republican three-stage strategy for gutting the American health care financing system, with the acceptable collateral damage of denying insurance and health care to millions of Americans.

Republican Speaker of the House Paul Ryan told us what their brilliant plan is. Stage One: jam through a law repealing as much of Obamacare as possible with only Republican support.

Stage Two: let Health and Human Services Secretary Tom Price try to use regulatory controls to prevent the resulting upheaval in insurance markets. (Translation: to keep prices from rising so fast that more millions of people find insurance unaffordable and drop out, driving up prices even faster for those that remain, a feedback loop known as the death spiral in the insurance bizz.)

Price’s job is to prevent a meltdown in the 2018 prices for coverage (2017 prices are already set), to give Republicans time for Stage Three: to browbeat Democrats into accepting the fact that neither Obamacare nor anything like it is coming back, and agreeing to more legislation that will create a health care system more to Republican liking. They continue to insist they can devise a system that will cover more people at lower prices because it will be based on free market principles and not subject to so much government control.

Of course, Stage Two proves that the whole scheme is nonsense. If they had a plan that had any chance of accomplishing what they want, why would they need Price to impose regulations (meaning some form of direct or indirect price caps) on the free market loving industry they intend to rely on to fix the current problems. I thought the whole point was to get rid of government control. Stage Two is a tacit admission that the markets will go berserk, prices will skyrocket, and the only way to stop it from happening is to impose government controls. Well, they’re right about one thing. Guaranteed that insurance companies will take the opportunity (game the system) to increase premiums an additional 15-25% because of the uncertainty (added potential risk) the changes will produce. Good luck stopping that with your controls.

A very elaborate system of financial gymnastics is not working now to hold down the cost of health care. Neither the Obamacare controls nor the proposed Republican controls address the actual causes of cost inflation in American medical care. Take the not even remotely free-market controls that allow the pharmaceutical industry to charge ridiculous prices for prescription drugs. Drug costs are escalating faster than overall medical costs, thus accounting for progressively more of the market. They won’t let the free market operate here – which would clearly lower the costs for all of us – because that would take away the regulatory structure that has been created to support high prices for this industry, by sheltering it from the free market.

Here’s another reform they won’t make. This is the most obvious fix. Take the insurance companies out of the mix altogether. But this is the private enterprise, allegedly free market part of this racket. This is where a public good is turned into a private, money-making opportunity.

All the insurance companies do is provide financing for the health care system. They do not provide one overpriced emergency room visit worth of health care to anyone. Nada. Never have. They simply handle the money. For handling the money they take their share off the top. But it’s not that easy. To create the opportunity for profit, they had to build a lot of complexity into the system. If you want to create competition, you also have to have uncertainty – about what is covered, who is covered, what is the price. So you have to create a large system and bureaucracy to keep track of who is covered – eligibility – and to deny coverage to those who are not covered, and to determine what services are covered and under what circumstances. And you have to create a lot of plans to give consumers of health care a choice.

That last sentence is full of so many lies I don’t know where to start.

The idea that health care is just another consumer good is preposterous – but I suppose necessary in a system hell bent on convincing all citizens that there is no such thing as common goods. Anyway, people don’t shop for health care like they do for a new pair of shoes. Consumers make choices. In important health care situations/decisions (that means almost all of them), the only choice that matters from the consumer point of view is whether you are going to get the care you need or not. And the answer is always yes, I need it so I’ll take it. This is a case where having choices is not a better deal. It’s a choice you shouldn’t have to make. You should just have health care and be able to get what you need.

All this complexity – these wonderful choices – costs the system anywhere from $300 to $500 billion a year. There’s a lot of bureaucracy, sales forces, IT departments, clerks in doctor’s offices involved. None of it is necessary to deliver health care. It is only necessary to provide someone the opportunity to make profit off the system.

So if we simply create one plan for everybody, we can save $300 billion-plus off the top, before we cut back one doctor visit. We’re not taking away $300 billion in profit from someone. The insurance company profits are a small fraction of that amount. Most of that $300 billion savings comes from reduced overhead – admin – necessary only in order to enable someone to make a profit. We’re spending hundreds of billions in overhead to allow insurance companies to profit $10-$20 billion if they’re lucky. That’s just stupid. Yes the profits are obscene, but not so much by their magnitude. What’s obscene is setting up a system that harms so many for such little profit, and then defending and sanctifying it as rooted in some  divinely ordained, mysterious but infallible process for how to allocate resources and profits and thereby order society. Come to think of it, I wonder if the invisible hand of the market is bigger than Trump’s hands.

$300 billion-plus buys a lot of healthcare. This is the low hanging fruit that would pay for many of the fixes the system needs, while reducing costs significantly at the same time. More health education, more primary care providers (not necessarily MD’s – see Cuba), more intake into the system, to get people the treatment they need sooner and on the track to better health, and off the track to deteriorated conditions and a lot more expense. In other words, to improve the health of Americans.

This is the easiest way to start. The Republicans definitely will not do this.

And that would make you happy, if you preferred your free market insurance industry bureaucracy to make decisions about whether the high-priced plan you are paying for will even cover the procedures you need, and which doctors (not necessarily your own) they will pay to perform the procedures. But I mean, wouldn’t just about anything be better than some horrible government insurance plan that just covered you for everything you need with no questions asked?

Nor will the Republicans do anything else meaningful to cut costs except reduce benefits and the number of people covered. They won’t take on the hospitals or the doctors. They won’t address the epidemic of over-prescribing – some estimates contend that more than 25% of all medical procedures performed are unnecessary. They’ll muck around with the financing, but they won’t do anything about how health care is actually delivered.

So back to Stage Two and Tom Price and his chore to keep the system under control. Good luck on that one, given that you have ideologically blinded yourself to the simplest of common sense solutions.

Thus the Republicans will pursue Stage Three with the fanaticism of a terrier shaking a fake rat. (Alternative rat.) They will incessantly remind us that Obamacare was not working – a disaster in fact. They will desperately try to convince even the people who are paying lower premiums for better benefits under Obamacare (many in their base) that the obviously better deal they are getting under Obamacare is really a bad deal, and they have a better one coming. Alternative facts. What you know to be right from your own experience is wrong. Up is down. At the same time they will try to convince us that healthcare is too expensive because we use too much. Patients are the problem, not the doctors, hospital chains, drug companies, and insurance executives. We need to charge you more money for your health care so you make better decisions. That will bring the prices down (eventually, date unspecified). Austerity, disaster capitalism, call it what you will, as applied to health care.

Then when the Republicans can’t deliver a better plan, they will blame it on the Democrats for not coming to the table and helping to pass more new laws to make our free market dream system come true. This has already begun. See Ohio Republican Governor John Kasich’s op-ed beseeching Democrats to give up partisan bickering and help Republicans make a better plan.

Yeah, those same Democrats that brought you that horrible Obamacare. Remember how awful it was.

Say it long enough and loud enough and enough people will believe what you say. Maybe not this time though. Health care might be one area where people don’t buy the upside down bullshit this crowd is selling. Maybe on this issue the reptile brain kicks in and overrides the more easily manipulated rational mind – because this time, for many, the question really is down to survival.

More articles by:

Jeff Sher is a journalist specializing in the health care industry. He lives in San Francisco.

January 22, 2019
Patrick Cockburn
On the Brink of Brexit: the Only Thing Most People Outside Westminster Know About Brexit is That It’s a Mess
Raouf Halaby
The Little Brett Kavanaughs from Covington Catholic High
Dean Baker
The Trump Tax Cut is Even Worse Than They Say
Stanley L. Cohen
The Brazen Detention of Marzieh Hashemi, America’s Newest Political Prisoner
Karl Grossman
Darth Trump: From Space Force to Star Wars
Glenn Sacks
Teachers Strike Dispatch #8: New Independent Study Confirms LAUSD Has the Money to Meet UTLA’s Demands
Haydar Khan
The Double Bind of Human Senescence
Alvaro Huerta
Mr. President, We Don’t Need Your Stinking Wall
Howard Lisnoff
Another Slugger from Louisville: Muhammad Ali
Nicole Patrice Hill – Kollibri terre Sonnenblume
The Scarlet “I”: Climate Change, “Invasive” Plants and Our Culture of Domination
Jonah Raskin
Disposable Man Gets His Balls Back
Thomas Knapp
Now More Than Ever, It’s Clear the FBI Must Go
January 21, 2019
W. T. Whitney
New US Economic Attack Against Cuba, Long Threatened, May Hit Soon
Jérôme Duval
Macronist Repression Against the People in Yellow Vests
Dean Baker
The Next Recession: What It Could Look Like
Eric Mann
All Hail the Revolutionary King: Martin Luther King and the Black Revolutionary Tradition
Binoy Kampmark
Spy Theories and the White House: Donald Trump as Russian Agent
Edward Curtin
We Need a Martin Luther King Day of Truth
Bill Fried
Jeff Sessions and the Federalists
Ed Corcoran
Central America Needs a Marshall Plan
Colin Todhunter
Complaint Lodged with European Ombudsman: Regulatory Authorities Colluding with Agrochemicals Industry
Manuel E. Yepe
The US War Against the Weak
Weekend Edition
January 18, 2019
Friday - Sunday
Melvin Goodman
Star Wars Revisited: One More Nightmare From Trump
John Davis
“Weather Terrorism:” a National Emergency
Jeffrey St. Clair
Roaming Charges: Sometimes an Establishment Hack is Just What You Need
Joshua Frank
Montana Public Schools Block Pro-LGBTQ Websites
Louisa Willcox
Sky Bears, Earth Bears: Finding and Losing True North
Robert Fisk
Bernie Sanders, Israel and the Middle East
Robert Fantina
Pompeo, the U.S. and Iran
David Rosen
The Biden Band-Aid: Will Democrats Contain the Insurgency?
Nick Pemberton
Human Trafficking Should Be Illegal
Steve Early - Suzanne Gordon
Did Donald Get The Memo? Trump’s VA Secretary Denounces ‘Veteran as Victim’ Stereotyping
Andrew Levine
The Tulsi Gabbard Factor
John W. Whitehead
The Danger Within: Border Patrol is Turning America into a Constitution-Free Zone
Dana E. Abizaid
Kafka’s Grave: a Pilgrimage in Prague
Rebecca Lee
Punishment Through Humiliation: Justice For Sexual Assault Survivors
Dahr Jamail
A Planet in Crisis: The Heat’s On Us
John Feffer
Trump Punts on Syria: The Forever War is Far From Over
Dave Lindorff
Shut Down the War Machine!
Glenn Sacks
LA Teachers’ Strike: Student Voices of the Los Angeles Education Revolt  
Mark Ashwill
The Metamorphosis of International Students Into Honorary US Nationalists: a View from Viet Nam
Ramzy Baroud
The Moral Travesty of Israel Seeking Arab, Iranian Money for its Alleged Nakba
Ron Jacobs
Allen Ginsberg Takes a Trip
Jake Johnston
Haiti by the Numbers
Binoy Kampmark
No-Confidence Survivor: Theresa May and Brexit
FacebookTwitterGoogle+RedditEmail