The topic line says it all. It’s the way both sides of the political aisle shut down discussion on any particular topic they don’t want to have a civilized debate on, especially when money is involved and someone’s scamming someone else.
Take the abortion issue generally. What always comes out at a pro-life march? Photos of an aborted fetus.
Why? Because it’s guaranteed to nail the emotional response button and as soon as you accomplish that rational debate and discussion on any public policy matter ends.
Where did it start this time? With a TV host who made an issue out his newborn kid that had a congenital problem and required immediate and very expensive surgery to correct. He waved the aborted fetus picture and got Obama to chime in immediately on Obamacare and the AHCA.
Then I had a guy who ran that same crap in my thread on my reform bill proposal. I banhammered him and explained why — that I simply will not tolerate the waving of “aborted fetus pictures” on any topic here and his was one of the most-egregious examples I’d seen in my time writing The Ticker.
So let’s analyze the root of these issues in the context of health care, without waving said pictures around. Be warned, however, if you choose to comment: I don’t do the aborted fetus thing and if you try it you’ll get banhammered too. Keep the discussion on policy rather than trying to play the “emotional” game and you’ll be fine.
These issues all turn on what are called “pre-existing conditions”, for the most part. All of them are very expensive in our current medical system. About 5% of the population have them in the most-serious (expensive) form at any given point in time but up to a quarter of the population has them in some form or fashion in a means that may not be ruinously expensive now but it will be later. For the purpose of health insurance how you wound up in that 5% or 25% does not matter — only that you are if in the 5%, or are very likely if in the 25%. The former will preclude you from being insurable under any rational system because the probability of the bad event is 1.0; it already happened. The latter will radically increase the cost of being insurable under any rational system because the probability of the bad event approaches 1.0; that is, while it didn’t happen yet it is nearly-certain to do so. Think of the latter case as being similar to trying to buy house insurance while under a hurricane warning — there’s no guarantee you will get trashed but no insurance company will ever write such a policy because the risk of damage is so high that they’d be crazy to do so.
These issues come in three basic forms distinguished by how and why they occurred. Let’s enumerate them:
- Chronic and expensive conditions that are a result of either lifestyle choice or bad luck and which can be relieved or eliminated through a lifestyle change. Type II diabetes is the poster child for this group and I’ve written an article on the issue called “The Low-Hanging Fruit” for that reason.
- Chronic and expensive conditions that are a result of lifestyle choice but cannot be relieved through lifestyle changes after the fact. There are a huge number of conditions for which this applies, including drug or alcohol abuse that has resulted in severe body malfunctions (e.g. cirrhosis, cancer, etc), lung cancer, emphysema, heart disease or strokes as a result of smoking, HIV contracted due to consensual anal sex or IV drug use, the majority of cases of Hepatitis-C (same) and more. These are all disorders and diseases for which the person involved was responsible for the condition but can’t fix or materially improve it by changing their lifestyle now, although they certainly could prevent or reduce future harm were they to cease whatever they were doing.
- Chronic and expensive conditions that are the result of bad luck. We all get one draw at the genetic lottery. Some of us get a great draw, most of us get an “ok” draw with a few bad spots mixed in, and some get a really crappy draw. The kid born with hemophilia, a genetic heart defect, Down’s — all are examples. There are plenty that come along later in life too although many are not obvious. It used to be that virtually anyone with periodontal disease or a high cavity rate (leading ultimately to root canals and tooth loss) was accused of failing to brush and floss. We now know that’s false; a huge percentage of the people who have such problems in fact got a bad genetic draw and even with perfect oral hygiene they’re likely to have major problems down the road.
I separate this into three subdebates for a reason, but as a group all three of these are something that a large percentage of the population — somewhere around one quarter of all persons in the country — will fall under at some point in their life, with about 5% of the population under the most-severe (in terms of expense) forms of one of the above in the present tense.
The basic issue with all three is that all are flatly unaffordable under our current medical system. None are “acute” situations (e.g. a broken leg, a car accident, etc.)
There is a further division found in the latter two of the above categories — whether there is any rational expectation that the condition, even with the most-aggressive treatment, will ever be remedied.
For a huge percentage of the sufferers in the second two categories the answer is no. If you have MS you will always have MS. You might control it, at least for a while, but it will never go away. The same is true for the person with Downs; they will always have Downs. Ditto for hemophilia. There are many such disorders and diseases; hell, even Lyme can fall into this category and while many cases are preventable not all are.
One person with such a disorder who goes to work for the hypothetical company with 100 employees can destroy the salary prospects for everyone who works there permanently. Take the person with MS that has a $70,000 drug they need to take to control their condition. If they’re hired by an employer with 100 employees that person will literally steal about $1,000 a year from every other employee in the firm for as long as they work there. Why? Because with overhead that $70,000 drug is about $100 large and the company will be forced to pay it in the form of medical insurance premium increases. This means they will be forced to reduce the salaries paid to everyone else by, on average, about $1,000 a year!
What’s even worse is that the employer is forced to conspire with the applicant to screw his or her employees! It is illegal for an employer to discriminate on this basis and as a result they are actively engaged in stealing the money necessary for that person’s treatment from everyone else on their roster and there is nothing they can do about it. In very severe situations this can actually force a company out of business entirely, at which point everyone winds up out of a job.
This is why “single payer”, incidentally, can’t — and won’t — work. A “single payer” system provides no incentive for any drug or medical company to figure out any way to reduce that cost — in fact, it provides the exact opposite incentive because everyone gets the treatment! Single-payer in any form always leads to rationing and the least-able to be paraded around on TV as “victims” are the first to be left out in the cold without a jacket to die. Governments are brutal in this regard because they’re faceless; witness the fact that everyone “hates” Congress but keeps voting to send their particular Congressperson back to their office!
Let me say this again just in case you missed it in the last paragraph: Single payer will kill 30 million Americans within five years of enactment because government will simply make a list of disorders and diseases sorted by cost and “aborted fetus” factor and draw the line at a point where the cost is high and the “swing the baby” factor is low. Anyone with a disease or disorder below the line will have their care denied and will die. Government won’t do this because it’s “mean”, it will do this because without immediate and continuing collapse in cost the government itself will be unable to fund not only the medical system but the lights in the Capitol.
A “no insurance” system (at all, at any price) on the other hand provides an incentive for firms to come up with a treatment people can afford to pay because otherwise they die and thus spend zero on health care (or anything else) in the future. Leave the social side of this alone for a minute and it’s quite clear what happens to cost if you give someone a blank check — and this is demonstrated repeatedly in the real world by the skyrocketing price of chronic disease drugs and treatments. Obamacare has made this much worse; witness the ratcheting up of Epipens, asthma medications and similar over the last eight years despite the so-called “underpayment” by Medicare and Medicaid that providers continually bleat about.
I’ll just take one example: Epipens. You may or may not know this but epinephrine, the drug in those pens, costs literal pennies. A (large) vial intended for veterinary use can be purchased over the counter for under $25. A 1mg ampule intended for “individual” use (1mg/ml) on humans can be bought for under $5 but requires a prescription. Diabetic-style syringes cost pennies each. Note that the usual Epipen dose is 0.3mg which means one “individual” ampule contains about 3 doses; the per-dose cost including the syringe is about $2.00!
It is only the lack of competitive pressure that leads people to be able to charge 100x the retail cost of the supplies for these things, and providing them under ‘insurance’ just makes the problem worse. If they had to sell them for cash Epipens would be $10 while the company would still make a 500% margin over the cost of the materials for packaging and similar.
For those people in the above three categories the first can be handled quite-effectively by simply cutting them off if they won’t make the required lifestyle change.
There is no answer in any form of public support for the second and third groups. The only means by which we can resolve that problem in the intermediate and longer term is to stop enabling people to steal a never-increasing cost-spiral from others. If we do that then companies will be forced to compete and find ways to treat these conditions at prices people can individually afford to pay because the alternative is that they sell nothing.
When you wave the dead fetus around what you are doing is enforcing theft against millions of others. You are destroying business on purpose by trashing their ability to pay their employees competitive wages because someone with a high-cost condition joins their staff. If you keep this up for long enough you will keep screaming until the government puts in place single-payer at which point the government will be unable to pay and thus will draw that line on the list of diseases and conditions which will kill millions of Americans outright.
There is one — and only one — answer: We must break the monopolies and enforce existing law.
If everyone has to pay the same price for the same drug or procedure then the only way a company can make money is to provide solutions to problems at a price people can afford to pay. The 0.1% are, in fact, 0.1%! If you can’t market your drug, device or procedure to the vast majority of the population of the nation because they can’t afford to buy it then in the medical field you have no market at all since these are not “aspirational” or “luxury” purchases.
This is what it comes down to folks, and if we are to make progress we must stomp on any who try to play a wave the dead fetus game — whether it be politically, in the media or our social circles.
The continuation of our way of life along with the operation of our federal and state governments depend on it.
Story originally published at Market Ticker.