America Has A Health INSURANCE System, Not A Health CARE System; They’re NOT The Same Thing

Repeat: America does not have a health CARE system. What we have is a health INSURANCE system. They are not the same thing. The first question we ask anyone who walks in the health system’s door isn’t “How can we fix you?”, it’s “How’re you gonna pay for this?” That’s deplorable. It’s disgusting. We are the only civilized country on earth where that happens. Correction — because that happens here? There is no way we can claim to be “civilized”. Civilized people don’t put profit incentive at the core of their health CARE system

It’s a testament to how thoroughly the insurance companies have bamboozled Americans that most Americans don’t even realize what they’re fighting for when they insist they want to keep the health insurance they have no matter what. Insurance companies don’t provide health care. They provide “GATEKEEPING” services. That’s it. Their job is to stand between us and our health care providers, deciding whether to let us see them or not. A “good health insurance plan” will let us see the health care providers we want — provided they’re “in-network”. A crap plan doesn’t cover anything so why bother figuring out which doctors you like; you aren’t seeing them regardless.

The health insurance companies — like for profit hospitals — are not in the business of curing patients so much as they are in the business of charging them maximum dollars for minimum services. For profit health insurance companies LOSE money every time they have to pay for an insured’s medical expenses. In their ideal world, everyone’s paranoid about their health — paying in — but incredibly healthy — requiring no paying out. Keep in mind, a publicly traded company has a fiduciary responsibility to their shareholders, not to any “patients”. Patients (that cost money) and profits are mutually exclusive propositions.

That’s why Americans have to worry every time they get sick even IF they have decent insurance. The insurance might not cover what they need — and they won’t know about it or know how desperately they need it until it’s already happening. And that’s IF they have insurance. Without the insurance, they’d be completely at the system’s mercy — and our health insurance system has zero mercy.

How the hell did we get into this mess? To a degree, it started during WW Two. In order to direct as much money as possible to the war effort, we made it verboten for big companies to give good employees raises or to raise the salary being paid to new, skilled hires. Big companies still wanted to incentivize their best employees to stay or to motivate new, quality employees to hire on, so they started offering “hospital insurance”. The new hires seemed to like it.

In time, the war ended. So did the moratorium on raises. But, the employer-provided health insurance didn’t end. In fact, it became the “state of the art”. Though the logic behind employers providing their employees health INSURANCE (not the actual care) no longer held, the idea flourished. That was the beginning of our national health care nightmare.

While more big, medium and (now) smaller companies were forced to offer health INSURANCE to their employees, they didn’t have the ability or desire to administer the policies and their implementation. They turned to the newly burgeoning “health insurance business” to do that. The insurance companies, once empowered, were not going to give up that power easily — because that power (to decide what they’d pay for and what they wouldn’t) was the source of their money. The unions — as they should have — took full advantage of their negotiating power to carve out the best health insurance plans with the most coverage for the least out of pocket for their members. Of course they don’t want to lose that!

But even so — what the unions have isn’t the health CARE, it’s the commitment of the insurance company to cover more care. To be a “good gatekeeper” instead of a “mean one”. That is, after all, what insurance companies are: GATEKEEPERS — standing BETWEEN Americans and their actual health CARE. The reason some Americans got angry about Obamacare is because their gatekeepers refused to play along — and deliberately kept Americans from the health care providers they preferred.

I’ve joked here about the kind of health “care” coverage Republicans would create if they were honest about their intentions. I called it “TrumpCare Pick-An-Organ” because the concept was why insure organs that might never go bad on you? Why not gamble a little and save some money. You’ve got two lungs, two kidneys, two kinds of intestines — who needs it all? More to the point, who needs to waste money insuring it all? Why, nobody, of course! It went something like this…

Ask yourself — why are Republicans so opposed to universal health coverage — where every American, as their right, receives excellent health CARE. Who pays for it is never a question because WE DO. Through out tax dollars.

One of the problems Americans have with paying taxes is that we see all that money as wasted — like it was deliberately shoveled down a black hole. Throw waste atop that and the whole idea of paying taxes feels like theft. But, what if every citizen was given an itemized statement every year that showed to the penny where THEIR tax dollars went, what they were spent on and what they bought FOR that taxpayer.

We’d see clearly where our money was being wasted, for sure! But we also could point to things that our tax dollars bought for us — that we wanted — that our tax dollars could provide far more economically than via the private sector? Health CARE, for instance… Every other civilized country on earth does this more cheaply than we do and with far better outcomes.

That’s because socialized medicine is better medicine. Yes, profit incentive creates an environment conducive to innovation. One could get rich. But, in the health care environment, getting rich is counter productive. The need for profits and the need for good patient outcomes are not natural allies. In our insurance-based system, the profits always win out. The people almost always lose.

Or end up with medical bills that, ultimately, will kill them.

Universal single payer is the only answer. Personally, I’m with Bernie Sanders here — to keep the health insurance companies around is to invite abuse and just more stratification of services. Money will attract those more interested in greed than health care. The promise of health care is merely the bait in the “bait and switch”.

America’s Tax Problem Isn’t That Taxes Are Too High, It’s That We Don’t Think We GET Anything For Them…

Americans have always hated paying taxes. “No taxation without representation” was one of our first great marketing triumphs as a young nation. Wanna know who WE are? We’re the “We ain’t paying no stinking taxes” guys.

The colonists saw their tax dollars going out and nothing coming back in return.

What made it worse — the things they could point to that their tax dollars were funding included the British soldiers who, the Americans increasingly believed, were oppressing them. Americans, it turns out, HATE paying to be oppressed.

We resisted any sort of federal income tax for 140 years (caveat — the federal govt briefly imposed an income tax during the Civil War) until the 16th amendment was ratified in 1913 — that’s the one that made a federal income tax legal. Just for information’s sake, the first federally imposed tax was an inheritance tax. We knew even back then that the rich were hoarding cash.

When someone holds out their hand to you — expecting YOU to put cash in it — you kinda want to know what you’re getting for it. Even if all you’re responding to a threat with a bribe or a payoff, you KNOW what you’re getting — a few moments of relative peace until the next time they come with their hand out. You may not like what you’re getting, but at least you can identify it. Most Americans couldn’t tell you what they get for their tax dollars — other than the military and “the federal government” in all its polymorphous splendor. The problem is, aside from the military (which is mostly other people doing what they do far, far away), Americans see their tax dollars as paying for nothing.

Taxes are a black hole that mocks us relentlessly. Only a sucker pays taxes. Isn’t that what we’re taught?

We laugh at Europeans because they pay such high taxes — Just above 60% in Denmark, for instance. The sub headline from this article (from US News & World Report, 2016) says it all: “People in the European country see taxes as an investment in their quality of life”. They’re laughing at us a lot harder than we ever laughed at them. By virtually every metric — other than self-delusion — Northern Europeans like the Danes (the ones paying the highest taxes) are far, far, FAR happier than we are.

They’re far healthier than we are. As is said — they work to live. Americans, OTOH, live to work. Yeah — the ones paying the higher taxes are far happier than the ones begrudging every tax dollar spent.

But then, Europeans like the Danes can point to things they GET for their tax dollars. They GET health CARE from cradle to grave.

That’s especially foreign to Americans because we think in terms of health INSURANCE, not health CARE. That’s because our system evolved out of an historical anomaly that arose during WW II. The first employersponsored hospitalization plan was created by teachers in Dallas, Texas in 1929. These were small, very localized health plans that were meant to deal with catastrophic situations. Hospitalization. In the absence of any sort of “national health system”, every locality did what it did in its own way.

During WW II, the federal government directed every possible tax dollar its way. It was illegal, during the war, to give employees raises (or to raise a salary so as to attract talent to a job). But fringe benefits like, say, “health insurance” didn’t count as salary. Big companies (they could afford to) offered “health plans” instead.

Then the war ended — and these health plans should have ended right along with it. From Wikipedia: In his November 19, 1945 address to the nation, President Harry Truman proposed “…a national system that would be open to all Americans, but would remain optional. Participants would pay monthly fees into the plan, which would cover the cost of any and all medical expenses that arose in a time of need. The government would pay for the cost of services rendered by any doctor who chose to join the program. In addition, the insurance plan would give cash to the policy holder to replace wages lost because of illness or injury.”

Americans liked the idea — a lot. But the AMA hated it. So did the Chamber of Commerce and The American Hospital Association. They denounced it as “socialism”.

And that is where America’s shot at Universal Single Payer Health CARE died.

The people who opposed it did not oppose it on medical grounds, they opposed it for monetary reasons. Greed mattered more than medicine. FACT.

If Truman had done what Obama did — muscled his way past the greed as best he could — we wouldn’t be laughing AT the Danes and the Swedes and the British and the Germans and the French and the Canadians. We’d be laughing with them.

These systems aren’t perfect. Not by a long shot. Nothing is — can we please accept that fact? But — the data’s pretty conclusive — if you want to measure a health care system by its successful health care outcomes? We’ve got it all wrong. We pay far more and get far less.

Ah, but — what if we payed less (our individual piles of money are the same pile whether we pay taxes with it or out-of-pocket health care costs like deductibles & co-pays) and got a whole lot more for those very same dollars? What if — in addition to cradle to grave health CARE — we got the knowledge that we could NEVER go broke or lose our houses because we or someone we love got sick?

What if Americans — instead of merely seeing a deduction already taken from their paycheck or a check written to the US Treasury in blood — got an itemized bill that showed 1) what they themselves owed but (more importantly), 2) also gave them a detailed breakdown of where every single penny went. And what if some of those things their every tax dollar funded was good health care with the doctors they like?

Caveat — it’s not just the tax system that needs overhauling. It’s the whole nature of the health CARE system. In a universal single-payer system, every physician who wants to have a license to practice medicine will have to take part. Part of our “you know what you’re paying for system” would now include your education. Want to be a doctor? We’ll pay for it — you’ll pay for it (via your taxes). But then you won’t leave college/university hundreds of thousands of dollars in debt. You will have to spend your early years as a doctor inside the National Health CARE System. You’ll learn a ton. You’ll be well compensated — but you won’t be overly compensated.

Health care cannot be a wild, wild west of greed. It simply can’t be run that way — otherwise you get what WE have where people get billed $3200 cos they caught coronavirus. That should be a joke that we all laugh at because it’s so incomprehensible.

That’s our reality. It’s why people like the Danes laugh their asses off at us.

There’s no such thing as a “rugged individual”. That’s a bullshit myth “rugged individuals” (men — almost exclusively men) tell themselves to justify their greed.

They’re the ones benefiting from our tax system.

Can We PLEASE Get This Straight? NO ONE Loves Their Health INSURANCE…

Somewhere, an evil genius is smiling so hard his face hurts. It might be the same evil genius who came up with a “Mission Accomplished” banner for the background of a speech by George W. Bush — on an aircraft carrier — during a war he started for no reason.

Yeah, I know the banner SAYS “mission accomplished” but I doubt BushCo could have actually pointed to what mission they meant and what, if anything, had actually been accomplished. “Americans love their private health insurance” comes from the same wellspring of evil-genius-strength bullshit.

The core problem with American healthcare is that its emphasis is immediately on the wrong syllable. When anyone walks in the door of the American Healthcare System, the first question isn’t “How can we help you?”, it’s “How are you gonna pay for this?”. If you can’t answer that question satisfactorily, you might just be screwed. But, hey — even if you DO have insurance? Between the co-pays, the deductibles and all the other out-of-pocket bullshit, you could STILL be screwed.

No other civilized healthcare system anywhere on the planet has profit incentive at the core of its healthcare. There’s a reason. Profit incentive and human well-being are completely incompatible when they’re both dependent on the same dollar. A corporation has a fiduciary responsibility to do the very best it possibly can for its investors. That means a choice between an expensive but uncertain procedure that might save a customer’s life (that’s what they are to the insurance company after all — customers) and a happy board of directors able to announce a bigger dividend at the next shareholder’s meeting. Guess who the corporation’s gonna choose?

Like I said — it’s their responsibility to do that. It’s not their fault exactly — it’s history’s. Ever wonder why it is that only in America does anyone’s employer pay for their health insurance? For real. This doesn’t happen anywhere else. And there’s a reason. It’s bad for business.

FDR toyed with making universal healthcare part of social security but the AMA didn’t want doctor’s fees limited by the government (cost controls, in other words). FDR made the political decision not to risk losing on both social security AND universal healthcare. He put all the chips on social security alone. Then WWII happened — and history caused American healthcare to zig when maybe we should have zagged.

Because all available money needed to go to the war, employers were not allowed to give good employees raises. Those same frozen wages made it hard to lure new talent (who could go elsewhere to an employer whose wages were frozen at a higher level). Thinking outside the box — what other benefits could be offered that would feel like salary? — produced the first direct employee sponsored healthcare.

The idea spread. People liked the benefit. In their minds, it was saving them money and providing them comfort. What’s not to love? Then the war ended.

With the war over, companies were free again to offer whatever salaries or bonuses or raises they wanted. They also were free to end the war-time benefit (replacing it with salary). They didn’t. Hell, instead of ending these programs, the big companies held onto it. This was back at a time when your average middle class American (remember them?) entered the work force at 18 or 22 (if they went to college) and whatever employer they started with? That was likely to be the employer who’d be handing them a gold watch upon their retirement 40 years hence. Your employment relationship was supposed to be as durable as your marriage.

While the big companies (who’d done a shitload of the hiring during the war) held onto providing healthcare to their employees, they farmed out the work of administering this employee benefit — and the healthcare insurance industry was born. Didn’t take long before the baby took over the nursery. Then the whole house.

Ask a company like Boeing what having to provide healthcare insurance to its tens of thousands of employees does to its bottom line and its competitiveness. The cost of that healthcare is massive and it gets reflected in the cost of each airplane.

Airbus, by contrast, doesn’t have to pay for its employees’ healthcare. In Europe, the government takes care of it, paying for it with tax dollars. That gives Airbus an advantage because they don’t have to build that cost into what they charge for an airplane. See? Employer-based healthcare is bad for American business because it makes them less competitive.

As for the healthcare itself — all the employer is providing is the insurance coverage. What that coverage is? That’s up to the insurance company.

The insurance companies can make up any rules they want. And they do. The most important rules of all — to them — is who they contract with and therefore who their customers will be allowed (by their made up rules) to see. Every last bit of this, remember, is made up. By a company put there to administer this thing.

To gate-keep.

Insurance companies are gatekeepers. Border guards that — so long as we pay our premiums and stay employed by the same bosses — will smile at us benignly each time we pass by. But we fear them. We dread them. What if they don’t smile next time?

What if, next time — when we’re really sick — they turn us away? What if they point to language in their dense boiler plate (something on page 58) that says our particular situation (as they’re interpreting it) means they don’t have to cover the procedure we need. We’re free however to pay for it retail-retail out of pocket.

Hey — we charge hundreds of dollars for insulin that costs relative pennies in Canada. Every last penny of that difference is profit. Let me repeat: PROFIT. People are dying cos they can’t afford their insulin. Retail-retail in American healthcare means the cost of a procedure and the procedure’s actual cost have nothing to do with each other. It’s like being charged a million bucks to go three blocks in a taxi.

What’s wrong with America’s healthcare system isn’t that the inmates are running the asylum. It’s that insurance companies are. And they couldn’t give a rat’s ass what happens to any of us.