Dear America – We Have A Health INSURANCE System, Not A Health CARE System; They’re NOT The Same Thing

Until we get the framing right, we’ll never fix the problem: our health CARE system is broken because it’s NOT a health CARE system. It’s a health INSURANCE system.

The first question anyone gets asked when they walk into any facility for health CARE isn’t “How can we fix you?”, it’s “How ya gonna pay for this?” Right off the bat, that’s ass backwards. The inmates are in full control of the asylum.

No other industrialized nation has a system like ours — where most Americans get their health INSURANCE (not care) through their employer. There’s a reason — and it’s not because we’re so clever and exceptional. It’s a historical anomaly that we’ve simply never dealt with, addressed or even admitted to.

Back during World War II, every available dollar was put toward the war effort. Rules prohibited companies from giving employees raises or raising salaries for new hires. Big companies, wanting to compete for the best employees, needed another incentive so they began offering free health care — well, they’d pay the insurance premiums.

Note — big companies were able to do it because they could afford (at first) to handle the additional admin and cost of running a health insurance program. As the war went on, more big companies offered the same health insurance benefit. Then the war ended… but the health insurance benefit didn’t — even though it should have.

After the war, all those big companies looked to get out of the health insurance business. They subcontracted out the work to the burgeoning health insurance industry to serve as the “gatekeepers” between workers and their health CARE. To keep costs down, the insurance companies eventually cut deals with doctors to get better rates. All very reasonable except that the insurance companies had now created EXCLUSIVITY where there wasn’t any.

Suddenly insurance companies could control which patients a doctor could see. And then they made their gatekeeping integral to the whole health CARE system itself.

Corporations — like health insurance companies — have a fiduciary responsibility to their shareholders (the preferred class, not the regular class of shareholders) first and foremost. They have NO actual responsibility to “patients”. The insurance company doesn’t actually care what happens to any patient. It’s in their interest to spend the least they can get away with on each patient while collecting the maximum amount of income from him/her.

Is universal single payer perfect? FFS, there’s no such thing as “perfect”. But at least it takes the FOR PROFIT gatekeepers out of the health CARE equation. There will still be gatekeepers for sure — government gatekeepers. But We The People can control how they keep the health care gates for us. We can’t do the same with a corporation.

It is even more absurd to run around all Chicken Little-like about Elizabeth Warren says she’d pay for her Medicare For All plan — without comparing it to either 1) what our current health INSURANCE system costs each & every one of us in cold, hard cash terms or 2) ever asking a Republican EVER what their “health care plans” cost or how THEY might get around to paying for it.

FFS – the Republicans pulled off a massively destructive (to the middle class) tax cut to the rich that they had no intention of every paying for — except by gutting social security and welfare.

America keeps getting tripped up by greed. Greed is what allows Big Pharma to charge extortionist prices for insulin when it’s inside America’s borders and reasonable prices everywhere else.

Greed never makes anyone smarter. It ain’t gonna cure anyone’s ills either.

Advertisements

Hey, America — Here’s A Really Dumb Idea: Let’s Put PROFIT INCENTIVE At The “Heart” Of Our Healthcare System…

There’s a very good reason no other industrialized country has profit incentive built right into its healthcare system: a corporation’s bottom-line fiduciary responsibility is to its shareholders (the ones holding preferred shares, not the poor, dumb humps holding “common” shares) and NOT “health care customers” aka “patients”.

If a profit-driven health insurance company gave in to patients instead of providing a generous dividend next quarter, it might face a stockholder revolt. The price of its shares might plummet — and with it, the value of the company. All because it did the right thing instead of the financially expedient thing.

Ever wonder why pharmaceuticals are so much more expensive here in America than in pretty much any other country? Have you seen Big Pharma’s bottom line? They’re making money hand over fist from ;us. Be thankful you’re not a diabetic in America. The real production cost of a vial of insulin is between $2.28 and $3.42, while the production cost for a vial of most analog insulins is between $3.69 and $6.16, according to the study in BMJ Global Health.

“Anyone with Type 1 diabetes should be able to buy insulin for under $100 per year, including the long-acting forms,” said Andrew Hill, a study co-author and senior visiting research fellow at the University of Liverpool. “Pharmaceutical companies cannot justify charging governments $532 per person per year in the U.K. and $1,251 in the U.S. Yet, they do.

$100 vs $1251 for a year of insulin. That’s quite a mark up for a LIFE-SAVING PRODUCT. Know why that mark up exists? Profit incentive.

It’s the same reason an ibuprofen tablet that costs a few pennies to make costs $100 if a hospital hands it to you. It’s not costing $90 to make, package and transport that tablet. Virtually all of it is profit.

How did we get here? How did we let the biggest wolf of all – the insurance companies — become head gate-keeper in our health care chicken coop? That’s what insurance companies are — they’re gate keepers who get to decide which doctors we get to see. No one — repeat, NO ONE — loves their insurance company. They like that the company — with its clever “plan” — allows them (with deductibles and out-of-pocket costs) to see the doctors they like. They like that the GATEKEEPER says yes.

But the gatekeeper can say no, too. And often does. The gatekeeper can make up all kinds of bullshitty rules to “explain” why we CAN’T have the care we need.

The fact that we have insurance companies as gatekeepers is a historical anomaly. During WWII, all financial resources were poured into the war effort. Companies weren’t allowed to give employees raises. That made attracting new talent to a company (or retaining good talent) harder. To incentivize workers, large companies offered health insurance. People liked it. Why wouldn’t they? More big companies started to do it.

Then the war ended. But the employer-provided health insurance didn’t. In fact, it proliferated despite the fact that it really wasn’t good for any of the companies to keep providing it: it’s expensive — and when you factor in the cost of providing this perk, it makes the good or service that much more expensive. Example — in the competition between Boeing and Airbus to build and sell large commercial airplanes, Airbus always had a huge advantage. The cost of worker healthcare was built into the cost of every Boeing plane — making them more expensive to buy and less profitable for Boeing. Airbus, on the other hand, didn’t have to pay for its workers health insurance — that cost was born by whatever government the worker lived under because that country provided universal singer payer health CARE.

Europeans needing health care get it — no one asks how they’re going to pay for it first. Everyone KNOWS how it’ll get paid for. They skip that and move right on to the health CARE — like they’re supposed to.

America has great health care for those who can afford it. Otherwise, we have a system designed to make rich people richer and sick people die.

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.

Americans Need To Get It Out Of Our Heads: We DO NOT Do Everything Right

My gut is, this very American attitude — “How WE Do It Is How It Should Be Done” — flows from, the MALE of the American species. It’s definitely got a “I alone can fix it” pong to it.

You know how men are kind of “famous” for refusing to ever ask for directions when lost? Yeah — same chromosomal character flaw. We don’t HAVE to know how to do something, we assume we can figure it out. Then, when we stare at the wreckage our ignorance produced, we can blame the manufacturer or inadequate customer service for the mess. Men — dirty little secret here that I just KNOW I’m gonna pay for — are a lot like Ikea product instructions. You’re never going to “read them” through first; instead you’ll plunge in and get two-thirds of the way through before you realize you put the key piece on BACKWARDS at the very beginning and now the whole goddamned thing has to be taken apart so you can start over.

That’s men. That’s us. No kidding.

Men were mostly responsible not so much for founding the country as taking credit for it and making up all the rules. Women’s role in the founding has gone — shocking, right? — under-reported. I guess, in the men’s minds, someone had to “put the kettle on”. Being men, in whose same minds they were always right, they applied that fallacy to the document (and the country) they created.

If we — White Christian Men — say a thing is so, it MUST be so. Now go and Manifest Destiny already.

White Christian Men decided that slavery was okay. They thought it passed muster that black people were 3/5 of a white person. These things are embedded in our character. They’re part of our swagger (along with the things for which we’re justifiably celebrated as a culture). It’s a package deal. Like everything. Good is a fellow traveler with bad.

But, in our case, that “bad” has caught up with us. I blame the high bullshit content of our swagger.

America does not do healthcare right. We don’t do public education right. We don’t do secondary education — college, university, trade school — right. We don’t do taxes right. We don’t do humanitarianism right any more (we’re hellbent on the exact opposite). On healthcare — we’re the only country that ties healthcare to employment. There’s a REASON we’re the only country stupid enough to do that.

During WWII, employers weren’t allowed to give raises to employees (the money was redirected toward the war effort). To keep good employees from leaving — and to entice new hires — companies offered up healthcare instead. Lots of companies did that. Then the war ended. But that job benefit didn’t. The companies found it hard and expensive to keep providing healthcare. Insurance companies took over the workload — and sank their hooks in deep. They put themselves at the core of American healthcare.

The first question you get asked when you seek medical attention in America isn’t “How can we help you?”, it’s “And how are you going to PAY for this?”

Money, sadly, sits at the heart of what ails America. Greed has undermined the Greatest Experiment in Human Self Government Ever. Let’s be honest, if greed’s involved, the fix is always in. Nothing “trumps” greed. Ever.

America’s greatness flows from its largesse — which, in turn, flows from its diversity. Nothing but cold, Christian calculus (as opposed to Jesus-like, Do-Unto-Others thinking) flows from the White People who believe THEY and they alone are the keepers of the American Flame. They’re the remnant of the Boys Club that — thinking it was always right — sat down to make up the rules some of us still follow that others (Republicans all) blatantly piss on.

I guess “doing it right” is a matter of perspective. If you’re the majority of Americans — we feel in our gut that children dying on our southern border is us DOING IT WRONG. If you’re a republican however… if you’re Donald Trump — you’re a guy waving his dick around, thinking how awesome you are — and how “right” everything is in the world.

Revealed: The Secret 2020 GOP Health Care Plan: “TrumpCare PICK-AN-ORGAN”

As everyone knows, Republicans leak like a sieve or an old guy’s pecker. That’s how we got ahold of their radical new healthcare proposal — “Trump-Care ‘PICK-AN-ORGAN”.

Pick An Organ Front Card

Who wants to pay for health care YOU won’t ever get — or “might not” ever need?  Only a schmuck pays for other peoples’ healthcare, amiright?

Think of it THIS WAY:  You have lots of organs.  What are the chances any will ‘go south’ on you during your lifetime?  Your lungs?  Probably not — unless you smoke.  Your kidneys — You have two — you’re playing with house money.  Your heart?  Well, okay — that one could be a problem but if your heart’s going south on you — you’re pretty much toast anyway, right?

The point is, Trumpanistas, you’re too smart to INSURE organs you don’t need to — or are worth the risk NOT to insure.  And that’s why you’ll love “TrumpCare PICK-AN-ORGAN”! C’mon — I’ll show ya how it works —

LUNGS

07_Organs_Lungs_Front.pdf_1600x

Odds are nothing will happen to either of em.  But you want to play it safe — so we offer options to allow YOU to decide:  Insure Neither Lung, One Lung or Both Lungs!

See?  Easy!  Now, of course, the trick is, if you insure just one?  Ya better hope like hell you insured the correct Lung — the one that’s gonna be needing insurance…

LET’S TALK INTESTINES!

human-intestines-sciepro

If you’re like the average Joe, you have LOTS of this stuff inside ya.  You have intestines to spare.  In fact, you have so much intestine you even have two kinds (I know — weird, huh?)   But do you really need to insure both?  Do you really need to insure ‘ALL’ of it?

And what about your APPENDIX?  You don’t even use it — hell you haven’t used it in millions of years.  Only an idiot insures something he can’t use — amiright?

I KNOW THAT’S MY LIVER BUT WHAT THE HELL IS THAT ‘GREEN’ THING?

cartoon-of-human-liver-and-gallbladder-vector-7563173

The Truth is — Outside of your heart and lungs, your stomach and your anus, you haven’t a clue how any of your plumbing works.  You know you HAVE a Liver and you remember somebody lecturing you once about alcoholism while you were passed out in a drunken stupor but that was so long ago.

Be that as it may — This is probably you:  “What in hell’s name is that green thing — and please don’t say I have one…!”

Yeah, you have one all right — and it costs a BOMB to insure it — IF you insure it…

YOUR SPLEEN — 1-2-3-ANSWER QUICKLY:  ‘WHAT’S IT DO?‘

human-spleen-visceral-surface-synthesizes-antibodies-53319933

Not a goddamned clue, amiright (and “The spleen ‘spleens’ ain’t it”)?

Here – we’ll even show you a spleen and point out all its bits.  Does THAT help?  No?

And you want to insure this WHY?

AND THEN THERE’S THIS ORGAN…

cerebro-humano

Insuring brains is expensive.  In fact, it’s SO expensive, you’d have to be crazy to pay the freight.  So why bother.

TrumpCare ‘PICK-AN-ORGAN’: ‘Hey — look at all the money YOU just saved!’

Finally – The ‘Health Care’ Trumpanistas Deserve: “TrumpCare PICK-AN-ORGAN”

Hey, Trumpanistas — Still fuming over ObamaCare?  Still cursing the day your insurer was FORCED to insure your pre-existing condition without bankrupting you?  Still hating on having to pay for other peoples’ health care — including WOMEN?

Well TrumpCo has exactly what you’re looking for — a ‘health insurance’ plan that has the same grasp of what ‘insurance’ is as YOU apparently do — NONE!  Introducing, New Trump-Care ‘PICK-AN-ORGAN’: The Health Care ‘Plan’ designed for Trumpanistas.

Think of it THIS WAY:  You have lots of organs.  What are the chances any will ‘go south’ on you during your lifetime?  Your lungs?  Probably not — unless you smoke.  Your kidneys — You have two — you’re playing with house money.  Your heart?  Well, okay — that one could be a problem but if your heart’s going south on you — you’re pretty much toast anyway, right?

The point is, Trumpanistas, you’re too smart to INSURE organs you don’t need to — or are worth the risk NOT to insure.  And that’s why you’ll love ‘TrumpCare PICK-AN-ORGAN’ —

Pick An Organ Front Card

LUNGS

07_Organs_Lungs_Front.pdf_1600x

Odds are nothing will happen to either of em.  But you want to play it safe — so we offer options to allow YOU to decide:  Insure Neither Lung, One Lung or Both Lungs!

See?  Easy!  Now, of course, the trick is, if you insure just one?  Ya better hope like hell you insured the correct Lung — the one that’s gonna be needing insurance…

 

LET’S TALK INTESTINES!

human-intestines-sciepro

If you’re like the average Joe, you have LOTS of this stuff inside ya.  You have intestines to spare.  In fact, you have so much intestine you even have two kinds (I know — weird, huh?)   But do you really need to insure both?  Do you really need to insure ‘ALL’ of it?

And what about your APPENDIX?  You don’t even use it — hell you haven’t used it in millions of years.  Only an idiot insures something he can’t use — amiright?

 

I KNOW THAT’S MY LIVER BUT WHAT THE HELL IS THAT ‘GREEN’ THING?

cartoon-of-human-liver-and-gallbladder-vector-7563173The Truth is — Outside of your heart and lungs, your stomach and your anus, you haven’t a clue how any of your plumbing works.  You know you HAVE a Liver and you remember somebody lecturing you once about alcoholism while you were passed out in a drunken stupor but that was so long ago.

Be that as it may — This is probably you:  “What in hell’s name is that green thing — and please don’t say I have one…!”

Yeah, you have one all right — and it costs a BOMB to insure it — IF you insure it…

 

YOUR SPLEEN — 1-2-3-ANSWER QUICKLY:  ‘WHAT’S IT DO?‘

human-spleen-visceral-surface-synthesizes-antibodies-53319933

 

Not a goddamned clue, amiright (and “The spleen ‘spleens’ ain’t it”)?

Here – we’ll even show you a spleen and point out all its bits.  Does THAT help?  No?

And you want to insure this WHY?

 

 

 

AND THEN THERE’S THIS ORGAN…

cerebro-humano

Insuring brains is expensive.  In fact, it’s SO expensive, you’d have to be crazy to pay the freight.  So why bother.

TrumpCare ‘PICK-AN-ORGAN’: ‘Hey — look at all the money YOU just saved!’

 

Introducing ‘Trumpcare PICK-AN-ORGAN’: The A La Carte Health Insurance Company

What to do about Health Care got you tied up in knots?  Join the party.  Better STILL (since it’s the Age of Trump) EXPLOIT THE PARTY!  With that in mind, meet New ‘TrumpCare PICK-AN-ORGAN’ —

Pick An Organ Front Card

Old Fashioned Health Insurance (OBAMACARE FOR INSTANCE) wants to TELL YOU what kind of Health Insurance YOU have to have.  They want to tell YOU ‘what’ you have to insure — even if you don’t have such a thing ‘installed’ to insure.

Like that’s fair?  Men shouldn’t have to pay for icky women’s parts and whatever mysterious things they do that costs so much freakin’ money!  That’s not how insurance works (it IS?  Well who cares — No one wants to swim in a ‘pool’ with some strange woman anyway).

That’s why we here at TrumpCare came up with our greatest great idea yet:  TrumpCare “Pick-An-Organ”.  Here’s how it works —

Think of Life as a Casino Game — and Your Body as ‘A Playah’ in that Casino.

Now — the point of the exercise — in the Casino Game — is to walk away with as much coin in your pocket as you can.  You DON’T want YOUR money to end up in the CASINO’S pocket.  So, you bet ‘smart’.  You don’t bet YOUR money on things that’ll never pay off.

With that ‘strategy’ in mind, we offer a product that allows you to insure the internal organs that probably will go bad or, maybe, could go bad while saving some money by NOT insuring the organs that probably won’t go bad.

For instance — You have TWO LUNGS.  07_Organs_Lungs_Front.pdf_1600x

Odds are nothing will happen to either of em.  But you want to play it safe — so we offer options to allow YOU to decide:  Insure Neither Lung, One Lung or Both Lungs!

See?  Easy!  Now, of course, the trick is, if you insure just one?  Ya better hope like hell you insured the correct Lung. The one needin’ insurance…

OR — LET’S TALK INTESTINES!

human-intestines-sciepro

If you’re like the average Joe, you have LOTS of this stuff inside ya.  You have intestines to spare.  In fact, you have so much intestine you even have two kinds (I know — weird, huh?)   But do you really need to insure both?  Do you really need to insure ‘ALL’ of it?

And what about your APPENDIX?  You don’t even use it — hell you haven’t used it in millions of years.  Only an idiot insures something he can’t use — amiright?

 

I KNOW THAT’S MY LIVER BUT WHAT THE HELL IS THAT ‘GREEN’ THING?

cartoon-of-human-liver-and-gallbladder-vector-7563173The Truth is — Outside of your heart and lungs, your stomach & your anus, you have, at best, a vague idea of how any of your plumbing works.  You know, for instance, that you HAVE a Liver and you think you remember once a matronly old aunt talking about alcoholism and some other old aunt’s liver.

Be that as it may — What in hell’s name is that green thing — and please don’t say I have one…!

And please don’t make me ‘insure’ the stupid thing!

YOUR SPLEEN — 1-2-3-ANSWER QUICKLY:  ‘WHAT’S IT DO?

human-spleen-visceral-surface-synthesizes-antibodies-53319933

 

Not a goddamned clue, amiright (and ‘it spleens’ ain’t it)?

Here – we’ll even show you a spleen and point out all its bits.  Does THAT help?  No?

And you want to insure this WHY?

 

 

 

AND THEN THERE’S THIS ORGAN…

cerebro-humano

Insuring brains is expensive.  In fact, it’s SO expensive, you’d have to be crazy to pay the freight.  So why bother.  Hey — look at all the money YOU just saved!