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What the New York Times Doesn’t Understand About Health Care

On July 29 the New York Times published a story on page one (digital edition) about what the nation should do now that the Republicans have failed to unmake Obamacare and “reform” our health care system.

The headline for the story was: “Consensus is Health Care Law Can Be Fixed – Now the Hard Part.”

The headline alone made it clear that the story was going to be another classic example of insidious insider misdirection. We’ll come back to the idea of consensus, but let’s start with the idea that our current health care system can be “fixed”.

Ridiculous. The system as currently constructed is not good enough and cannot be fixed. No amount of shoring up dysfunctional limbs of an unworkable Okie rig of a system is going to take care of that. Obamacare is better than the racket insurance companies were running before its passage, and still a failure – certainly by the standards of health care delivered in other industrialized nations.

And as for consensus, I guess what the NYT means is the consensus within the D.C. insider world populated by corrupt and realist politicians and the lobbyists representing the corporations that define what will and will not be allowed to happen in D.C. Clearly the NYT is part of this world. The consensus certainly doesn’t extend to the very large and real movement to create a single payer (Medicare for all) health care system in this country. They are not mentioned in the story.

This is the NYT trying to establish the parameters for the debate over what to do about our obviously failing health care system.

So the consensus they claim is a sham, and it’s conclusion – that Obamacare can be fixed – is absurd.

Under Obamacare, a huge percentage of US citizens – I’d estimate that at least a quarter to a third, and soon to be more – are uninsured or under-insured (meaning enrolled in health plans with deductibles and co-pays so high that it dissuades the policy holder from accessing appropriate care for economic reasons). This number will rise quickly in coming years as insurance companies continue to impose rate increases that vastly outstrip wage increases. The NYT cites instances of insurers in several states seeking rate increases of 20% to 50% this year alone.

When a person doesn’t get the care he/she needs when it is needed, more often than not the future cost of care for that person is going to be greater than it would otherwise have been; these costs must be absorbed by the system somewhere (often via emergency room visits)With ; and the eventual cost to the system is greater than it would have been had the policy holder had better benefits. In other words, this way of managing costs through higher up front charges actually costs more in the long run. The entire concept of consumer-driven health care is based on this idea, and it’s a complete crock of shit. If a person has to spend more of her hard earned income on medical care, she will make better choices and not waste scarce health care dollars. WRONG!!

Giving everyone better benefits will reduce the cost of the system over time, not increase it. That is part of the solution. You don’t find the NYT discussing that (even though they cited several examples in the article of people with high deductible plans and high premiums, and one example of someone who chose to forego necessary treatment because they couldn’t afford the co-pays).

Instead, what does the NYT think is the first thing that needs to be done to fix the system? We must stabilize the “very jittery insurance markets”. In other words, for the NYT it’s first and foremost a crisis of uncertainty for insurance companies. Let’s take care of the insurance companies first.

Which brings us to a huge part of the problem with the system: the insurance companies themselves.

The NYT identifies this problem: high prices and lack of choice in many parts of the country.

What they’re saying is that the market has not been able to solve the problem of getting people health care they can afford, even though there is universal demand for it, and even when the government is backing them up with subsidies for low income people. They just can’t find a way to make a profit, so they charge inflated prices or abandon the market altogether (blackmail).

This is because the underlying costs of our health system – the costs of providing care – are too high before the insurance companies get their hands on it and drive up costs even further. They just add 15-20% to the cost right off the top, a little of which is profit but most of which is the added bureaucratic cost required to set up and maintain a ridiculous phony market system for health care that exists in its present form only to create the opportunity for profits.

And in this phony, so-called-free-market system, they don’t even compete. One insurance company does not offer better health care than another. What they offer is different purchasing plans (financing schemes), and the current crisis proves there is little competition on price. They’re just they’re to collect their cut off the top. And the NYT wants to start fixing the system by guaranteeing that they continue to receive that share/profit.

Let’s be clear. The recommended NYT approach is not just concerned about securing the cost of health care. They’re trying to secure the privilege/opportunity for these companies (and their shareholders, meaning mostly people who are already rich) to continue to make a profit off of health care.

Instead of competing, the insurance companies are gaming the system to make their money. Blue Cross Blue Shield of North Carolina admitted to NYT reporters that although they are seeking a 23% rate increase for next year, they “would have sought less than half that amount under more predictable circumstances.” Translation: they’re so worried that they might lose some money next year that they are adding on an extra 10%-plus charge – money they admit they don’t even need except for the unbearable “uncertainty”. And the system tolerates that, because the system really is about allowing for profit rather than just paying the cost of health care. And if it turns out that they don’t lose money next year, o well, they get to pocket the inflated rate increase anyway. Do we have to allow them to keep their overcharges no matter what happens in the so-called market? No, but that’s what the system does. The NYT solution to this: rather than helplessly watch them jack up the prices because they are worried about risk, we should subsidize them more so that they can charge less and still be assured of making a profit. Then we won’t have to worry about them jacking up the prices. Get it?

Of course the real solution is to cut the insurance companies out altogether (Medicare for all), and use the quick 20% savings to shore up the system while figuring out ways to address the underlying problem of the high cost of care: lower drug prices, fewer unnecessary services (defensive medicine, over-prescribing for economic reasons only), more accessible intake providers to get people into appropriate care faster, and many more adjustments that are practical and well known within the industry. Remember, other countries do it better than we do. They spend far less and get better results. We are not so “exceptional” that we’re too stupid to learn from their success. Of course the NYT does not consider this a reasonable possibility.

The NYT looks at the current arrangement and concludes for us that it cannot be fundamentally changed. Why? Take the RX overcharging problem. The NYT says “there is little agreement on the best way to fix the problem.” Why? Because proposals that might help – like allowing the importation of cheaper drugs from overseas (which is just another bandaid anyway) – “are fiercely opposed by the drug industry – a potent lobbying power in Washington.”

So the NYT is willing to admit there is a problem, but the NYT is buying into the notion that we need to return to a fundamentally flawed system that doesn’t work and never will, largely because of the power of lobbyists – meaning corruption – what occurs when the influence of special interest money applied to legislative processes results in decisions that favor those interests and not the citizens of the nation. But the NYT doesn’t recommend reducing the power of lobbyists as part of the solution.

The NYT is willing to accept all this as just the landscape – the background that cannot be changed. They’re willing to accept not only just about everything that is wrong with our health care system, but also everything that is wrong with our system of government (our mis-aptly named democracy), in a tour de force of complicity and so called journalistic neutrality that shrinks from raising even the most basic of the hard questions that need to be addressed.

O, by the way. No, you can’t have a system that makes sense, like Medicare for all. That’s not even under discussion. This is where the NYT wants the national conversation about our health care crisis to be now: we’re not really going to discuss how to fix the health care delivery system; we’re just going to discuss the best way to allow insurance companies to continue to screw you.

(On July 30 the NYT ran the same article again, but changed the headline to: How to Repair the Health Law (It’s Tricky but Not Impossible). I guess they decided that consensus was not really a thing.

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

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