I bet you were wondering where Health Care Tuesdays went…but never fear.  So, I know I talked about doing the whole myth of moral hazard, but then I saw this article about one of my favorite state senators, Gil Cedillo (D-LA).

State Sen. Gil Cedillo was at his wit’s end. Hospital officials were threatening to move his septuagenarian mother to another hospital because of an insurance snafu, and her family was not sure her heart was strong enough. Having lost his wife, Ruby, to cancer in 2002 after a long battle, Cedillo knows more than he cares to about the frustrations of navigating the health care system and dealing with insurance companies. Cedillo was able to resolve his mother’s problem — with the help of a highly placed former colleague… But health care advocates and providers say their stories illustrate that no one is exempt from the vagaries of the system. (SacBee 5/29/07) 

Flip it…

See, the insurance companies know they have you by…ummm…[pick a body part here], and they have no real need to provide real quality service.  I mean, why bother, right? It’s not like you can go anywhere when you actually need to make a claim. No other provider will take you if there’s a looming claim, so why not treat you like some sort of football. They’ll just play you off against whatever they can. Just check out CarlsbadDem’s diary.

So, in Sen. Cedillo’s case, it was playing games with the hospital.  And that seems to happen quite frequently. In fact, frequently enough to be the subject of pending legislation, SB 389 authored by Sen. Yee (D-SF/SM). The thing is, that patients are nothing more than source of losses for insurance companies. I mean, after all, once you are sick, the likelihood that you get sick again goes up. So, if they lose you, oh well, one less loser sucking up resources that could go to their shareholders.

Can we continue to have this massive source of waste in our health care system? Is this at all sustainable? well, the answers point to no. No other major industrialized nation relies on insurance companies so heavily.  Look, here is the best possible scenario for an insurance company: they pool everybody’s risk and then dole out money for care.  See, the critical thing is the word everybody. If they don’t have everybody, some healthy people will opt out and that will cut into the bottom line.  What is the obvious answer to that? Well, if you are Mitt Romney, that is individual mandate.  What a frickin’ joke. 

And if you adjust that thinking cap, you’ll soon realize that this is a truly public good. Like good public education, we all have a vested interest in insuring that our society stays as healthy as possible. Even if we force everybody to get insurance, we then have to deal with the various InsCos jockeying for the healthiest patients and trying to dump the costly ones. So, we truly need one company. Are we going to bestow those massive profits onto Blue Cross? or perhaps some other Fortune 500 company? Or, we could just bypass all that and just use an entity that requires no profit. Yes, it’s the government! And the answer is called Medicare for all.

Surely, it’s not perfect, but we are in an unsustainable position that will eventually take down the health care system as we know it.  That’s just the way it is folks.

(oops. Feel free to disagree, I know this one is contentious. – promoted by Brian Leubitz)

The health care debate seems to be very troubling for a lot of people, and that’s understandable. And, hey!, it’s a big issue.  So, for now on, I (or somebody else) will be doing a Health Care Tuesday Post.  I know, I know, it’s no Freaky Friday or Manic Monday, but Health Care Tuesdays are what I have to offer…so go with it.  I’ll try to get these up every Tuesday around noon, but well, timeliness isn’t necessarily my best quality.  But they will be up on Tuesdays!

First, I think it’s great that people are talking about health care solutions.  That is an important first step that we all have to take.  You know, admitting you have a problem is the first step to recovery.  And so with us, here in California and the nation.  We must admit that we have a problem with our health care system before we can truly fix it.  And so, props go out to the Speaker of the Assembly, the Senate Majority Leader, and yes, the Governator for at least talking about the issues.  While they may not have all the answers, they have nudged us along on the important road to those answers. So…thanks.

Flip it!

But, what does it mean that our health care system is broken. Well, let’s look at Ezra Klein’s Health of Nations series. First of all, if you haven’t read those posts, do yourself a favor, and read them. But, a quick comparison to other industrialized nations, and you’ll see the problem.  Here is just one quick metric: number of years of life lost per 100,000years.  Ezra’s source is in French, so I’m just trusting him. WHO Data and OECD Data (XLS) also went into this table.

So, clearly we are spending money without getting anything in return. These additional expenses can be attributed to several different causes, and attribution of fractions to these causes is beyond the scope of this post.  But the # 1 expense that we are paying that these other industrialized nations are not is clear: insurance company expenses and profits. Over thirty cents of every dollar spent on health care goes to administration and profits for these massive corporations.  You know, it’s important that Wellpoint make its numbers or the Street will punish them.

How messed up is that? It’s like boxing Mike Tyson (the 1980s Mike Tyson, not the sad crying 2001 Mike Tyson) with your shoelaces tied together. Just when we get a punch in against illness, the insurance companies want their third.  The infant mortality rate is the highest of any industrialized nation, and Wellpoint is concerned about what the Street will do if they don’t keep on rescinding coverage for those with the audacity to actually use their insurance by getting sick. 

But here’s the political problem with ArnoldCare, FabianCare, or really any non-single payer program, if we expand health insurance instead of health care, we will be further lining the pockets of these corporations who already have a major lobbying presence in DC and in Sacramento.  We have now given the bunker buster bomb to the rogue nuclear state just to make sure that no real progressive change can ever happen.  Look, as the Senate Majority Leader Harry Reid (D-NV) said in response to a question I asked about ArnoldCare when originally proposed: “The problem is that the insurance industry is the enemy of most everything we do today. “ This would be granting even more power to the already destructive insurance industry.

So, let’s just posit that some FabianCare type program works. And looking over the program details, I think that there will be some improvement, at least in terms of gross numbers of uninsureds. I’m not ripping on the Speaker here, he’s trying to get what he thinks is the best available program passed given the political constraints. So, the program works and we cut down the number of uninsureds to say, 1 million people in the state. I think we can all grant that would be a really good result given the metric of # of uninsureds.  So, who are those uninsured people now? Good question, but do you think they have very good lobbyists in Sacramento? Probably not, b/c they are the last 1 million, right?  How are we going to go that last mile? The critical mile, if we have now bolstered the economic situation of the insurance companies, giving them additional resources to fight against single payer.  So, say we get a Dem. governor, are we really going to be able to get SB 840 passed when the InsCo lobbyists actually get to worrying about it? I mean, now they are just letting it go b/c they know they have Arnold to veto, do you think they would be so ambivalent given a Dem Governor? 

So, back to the titular question: when is good enough, just not good enough? Now. I appreciate the efforts of those who are working on insurance based solutions, but mustn’t we also realize that implementing these plans might be a huge boon for the exact reason for our health care crisis: the health insurance industry?  Wouldn’t this actually slow the implementation of the only plan that actually works: single payer.  Look, single payer isn’t perfect, but until resource scarcity is a thing of the past (you know on the 12th of Never), it is the only feasible solution.

I know that some people will disagree with me, and I surely appreciate that.  I suppose having overpriced health insurance is better than flying with no net.  That is a scary thing (and it’s something that I’m staring down the barrel of), but deals which only prop up the insurance industry as they continue to raid our health care system will not truly solve the problems that we are facing.

So, over the next few weeks, I’ll address several major issues in the arguments for and against single payer guaranteed healthcare.  Next week (probably): The Myth of Moral Hazard.