A Little Off-Topic—Access to Affordable Healthcare

“Access to affordable healthcare” seems to be a rallying cry these days, particularly with the recent dismantling of Obamacare. Let’s break this down, shall we?

We’ll start with “access.” This means, of course, both the availability of physicians who provide healthcare and their locations.

According to this map, there are doctor shortages across the country, mainly in sparsely populated areas in the west and southwest. As expected, the largest concentration of medical personnel is in large urban areas. This is nothing new. Folks who live in rural areas commonly have to drive some distance to see a doctor, shop for groceries, and do their banking. This, too, is nothing new.

Yes, transportation can be an issue for some people, but that has always been the case and likely always will be. However, this is not about improving infrastructure, but about healthcare.

Let’s look at “affordable.” What’s affordable to some is not to others; but I guarantee you, people who can “afford” to pay a large sum to see a doctor or pick up a prescription, know when they’re being scammed and overpaying.

Two things come into play here: capitalism and the free market versus having a “right” to healthcare. As Americans, we are capitalists. Businessmen charge what the market will bear and people can choose which businesses to patronize based on cost, among other factors. However, in the medical field, costs are all comparable and there is another factor to consider, the skill of the physician. Much like, say, in a retail establishment, where you choose to shop based on cost, product, quality, and customer service.

The next question is that “right” to healthcare. Do we have a right to this? If it’s a right, it should apply to all equally, correct? So everyone should pay the same amount, and that amount being affordable to all, which means, by extrapolation, that everyone should pay the same fee regardless of class, salary, or assets.

Is healthcare a right? Freedom of speech is a right, it applies to all regardless of salary; freedom of the press, the pursuit of happiness, equality, all are rights. Healthcare, however, is not in the Bill of Rights, but should it be? The problem with this is that people are individuals, with different medical and physical needs, and healthcare itself cannot be applied equally across the board.

For instance, one person sees a physician once a year for a check-up, and his neighbor goes four times a year to manage a chronic condition. You can’t generalize based on gender, age, economic status, or any other factor.

People, too, should largely be responsible for their own health. And we’re not talking necessarily about lifestyle choices, but self-sufficiency. Some people who contract the flu virus get rest and drink a lot of water and take OTC meds; some people run to the ER for the sniffles or a scraped knee or imaginary complaints. Some folks can handle more pain, some freak out and request codeine when an Advil would do.

But the big question is whether healthcare is a right and should be available to all. Once upon a time, those who could afford a doctor when they were ill would be healed; those who could not, would likely die. But that isn’t the only scenario in modern times. There are plenty of options to take care of sick people—and we don’t mean chemo or dialysis, but regular, every day illnesses—that don’t involve a doctor at all.

Now let’s look at the word “healthcare” itself. What is healthcare? In simple terms, it means taking care of one’s health. There are a number of ways to do this: healthy eating, exercise, and avoiding all that bad stuff which, depending on which study you read during which year, can be any number of things. Doing or not doing these things will improve the odds that you will remain healthy.

Often, of course, there are things which one cannot do alone, and that is when one must see a doctor, the professionally trained person who knows more about health in general that you do. You should be informed and discuss the plan with this doctor, and the two of you will come up with a plan to better care for your health. Sometimes, yes, this involves more cost and more medicine because the illness or disease is one which requires this.

“Affordable access to healthcare” is simply a way of saying that everyone should be able to find and pay for a physician to help them be as healthy as possible. That is ALL it means.

And now, for the bombshell: nowhere in this treatise, until this point, did anyone mention “health insurance.” Insurance is not care. Health insurance is not healthcare. Until we make this distinction, any Federal plan for healthcare is going to fail.

We already know what healthcare is, and now we’re going to talk about health insurance.

Originally, health insurance was for big things, like surgery or a broken leg. As healthcare evolved, and more treatments were available for more serious diseases, like cancer, insurance would help pay for these things. This is what we know today as “catastrophic” coverage. Back in the day, people would pay for a doctor visit or pick up a prescription at the pharmacy and pay cash.

Because it was healthcare, and it was affordable.

And if you did have health insurance, you paid a token amount into a pool of people, often at your workplace, and yes, some of them needed that surgery or extensive treatment, but most did not. If they had a cold, they’d take some Nyquil or whatever and suck it up, not run to the ER or doc’s office.

And then those insurers became insurance companies and that’s all they did—they took money in order to pay it out if needed. And they hired more people to do paperwork, and paid more people more money to oversee those doing paperwork, and they hired additional folks to make decisions and then they added even more paperwork with little things like deductibles, co-payments, co-insurance, and so forth.

By the time they were finished, regular people were confused and paying out money left and right. For the exact same treatments and services they’d been paying a lot less for.

And those companies lobbied the government and convinced everyone that they MUST HAVE HEALTH INSURANCE or they would die. So people believed it and paid more and assumed they MUST HAVE THIS or they would die.

And they did not die, but they had a lot less money, and the insurance companies made out like bandits.

Think of the biggest scam or pyramid scheme you’ve ever heard of and multiply that by a few million.

So what if this happens:

The US population is 319 million, give or take a few. What if everyone paid $10 a month for catastrophic insurance—that’s $3,190,000,000. As in billions. Per month.

The average person sees a doctor three times a year, according to the CDC, and a 10-minute visit with that doctor costs about $70. That comes to just over $200 a year. Many people would have trouble finding $70 for a doctor appointment, so let’s cut that in half. Just $35 to see a doctor.

But wait, you say, we’re cutting the doctor’s income in half! No, we’re not—because he no longer has to hire someone to deal with the paperwork for that insurance company, because everyone is paying cash for all the regular medical stuff.

What about hospitals? Well, first we need to look at hospitals who overcharge (all of them) because “the equipment costs such-and-such” or because “of research and development” or even “blah, blah, blah.” Particularly those facilities that:

Spend millions on redecorating and remodeling

Pay large amounts for advertising

And while we’re on the subject, same goes for the pharmaceutical companies. They don’t need to advertise to consumers, especially while spending money on reps to market to doctors. Doctors prescribe, period. Remember when attorneys weren’t allowed to advertise? Hospitals certainly don’t need to advertise; they’re all over the place, and even have little blue highway signs so you can find them.

Hey, we’ve come a long way from large wards full of sick people to semi- and private rooms, and we certainly shouldn’t do away with these, but there are a lot of perks that could fall by the wayside—particularly those that they charge for that no one uses or wants or needs.

The average cost of a hospital stay, per day, is $2000. Let’s cap it at $1000. After all, no more expensive remodeling, no more ads, and no more people hired to do all that insurance paperwork. Come to think of it, the hospitals could probably cut back in a lot more areas, like executive salary. But that’s another post.

It’s interesting that, in one recent year, the average length of a hospital stay was four and a half days. Let’s say four days, since that half day is usually spent doing—wait for it—insurance paperwork to admit you or release you. So a total of $4000. And as long as we’re dreaming, let’s call that number all-inclusive, like a resort, only a lot less fun.

Now, if about 40% of the population is admitted to a hospital in a year’s time—a real number—that’s about 127 million people, at four days, at $1000 a day. Four thousand dollars per person, multiplied by 127 million, is a little over $5 billion dollars. And the so-called Federal insurance program would pay for this. All of it. Because, if you remember, they’ve collected over $3 billion dollars a month, or $36 billion dollars for the entire year.

The American people now have affordable healthcare—and, as a bonus, affordable health insurance! For just $10 a month, plus $35 per doctor visit when it’s needed, if it’s needed.

Let’s take a quick look at drugs—for example, Inderal. It’s been around for 50 years, is considered very safe, and treats migraines, anxiety, and high blood pressure. The generic cost was $4 a month; this past year, it jumped to $130 per month. Now, there’s no R&D for this drug, and there are no ads. Drugs like these should be capped and generically available, likely for around $4. Others, for example the EpiPen, are literally life-and-death drugs, immediate consequences, and should, humanitarily speaking, be of comparable pricing. We all know this. Everyone, even the price gougers.

Blood tests, chemo, and so forth should be market priced in line with the costs of doctor visits. How much R&D and advertising is required for these? None. $700 per year for standard blood work or $400 to read a PAP smear is beyond ridiculous. Ninety percent cuts for all!

The end result is that everyone can afford healthCARE. Even all the out-of-work hospital, pharmaceutical, and insurance company executives.



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