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.


Fan Friday—Rich vs. Poor

I was reading a discussion the other day about healthcare, and how Sanders’ plan relies on a $15 per hour minimum wage. Now, I haven’t really been involved in a political discussions, although if you can’t tell, I’m a conservative. Always have been. To me, that means we don’t adjust the budget after the money is spent, but use a budget as a limit for those dollars, and government should butt the hell out of probably 75% of the things it’s involved in.

Once upon a time, I was a single mom and worked fulltime as a waitress. Someone could have made a sitcom of my life; or maybe a docudrama. Yeah, probably that. Anyway, I had no health insurance; my kids were covered under Medicaid except for counseling and dental.

I always thought that was dumb, because if parents can’t work due to illness or injury, the kids will be in even worse shape and welfare will only increase. I still think it’s dumb.

As I said, I worked fulltime; as the only parent, I didn’t feel as though I could work 60 or 80 hours a week, although I did that before I had kids. And I still think that the vast majority of adults can do that, particularly those in two-parent households and those with no children at home. But I also made sacrifices.

Adults need to make choices. Yes, the cost of living has risen since those days, some 25 years ago, but it seems that today people want things right away—the nice home, the nice car, vacations, clothes, etc. And they’ll pay for those, but then claim they can’t afford necessities.

This is the problem.

If you work at minimum wage for 40 hours a week, you earn $15K. If you work 50 hours, you earn almost $19K. If you work 60 hours, you earn nearly $23K.

So if you use the standard one-third of income for housing in my former situation, you’d pay about $400 a month for rent. Doable in many markets, but not all; some of those expensive cities have higher wages, some don’t. Sometime you can move, sometimes you’re stuck. I get all that. I’m looking at generalities, not exceptions.

I had just moved from an apartment to a rental house and I was paying $650 in rent, or about half my income. That was my choice. I was able to pay bills and feed us.

But I didn’t go shopping or take vacations and no, I didn’t have health insurance because I didn’t NEED it—I had one, maybe two doc appointments a year. Was I just lucky? Maybe. I was also pretty tough, and by that I mean I didn’t whine about being sick or run to the ER for everything little thing. I used that scarce commodity, common sense. Same with the kids.

Of course I realize everyone’s different, and this was several decades ago. Even then, I thought the government should stay out of a lot of things. Insurance is one of them.

Insurance is to “insure” you against catastrophe, whether medical or property. It wasn’t meant to cover exorbitant costs associated with either, or even small costs like $100 for a doc visit. And by the way, the reason for that $100 doc visit is because of the costs of medical school (college), malpractice insurance—yet another kind—and overhead, mostly for all those people in the office to process the insurance payments.

Insurance companies are, IMHO, the single biggest money suck of all time.

If I were running for president, THAT would be my platform: ditch them all.

I have no idea how to implement this regarding healthcare—we’d probably be better off if actual presidential candidates admitted that, and other things, as well—but I do know that costs have little to do with skill, knowledge, experience, and amount of time spent on appointments and surgeries.

Think about it—without an office staff of twenty, or ten, or whatever, how much of that actual $100 for the appointment could be reduced to say, $25? I used to go to a clinic that charged that. They provided any information for the patient to file an insurance claim, if they wanted to and had insurance, but otherwise you came in, saw the doc, got a scrip if you needed it, and paid $25.

And no, he wasn’t a quack. He was a retired med school professor.

Charge everyone with a driver license maybe $25 a month in case of accident. With 214 million licensed drivers in the US, that comes to $5,350,000,000. Surely enough to cover any accidents.

I haven’t had an at-fault accident in a very long time, and honestly, I don’t remember the procedure. But, in spite of the law, the government mandate, the guy who hit my car while it was PARKED IN MY DRIVEWAY had no insurance; he didn’t even have a license. Guess who got screwed?

Even though I’ve always paid car insurance, for the last thirty-some years.

Homeowners insurance? Well, that’s a little trickier. But in spite of having that, guess who got screwed when a creek rose and the sewer company responsible for it refused to pay? Yep. Me again.

Put limits on claims. Eliminate civil claims that get tagged on to insurance payments. Nothing gripes me more—okay, that’s not exactly true—than those lawyers on TV, the ambulance chasers, who say GET WHAT YOU DESERVE when you’re involved in a car accident.

Sometimes, an accident is just that.

What it boils down to is that no one NEEDS insurance—it’s there to cover your butt just in case. And even so, with health insurance, so much is still your responsibility that people with coverage still end up filing bankruptcy or paying off bills forever.

People need healthCARE. Most need to drive. Most will need a little help if a tree falls on their house.

But someone is getting all that money we’re paying in, and it isn’t us. Someone is getting money from the cost of groceries, and it isn’t us and it isn’t the farmers. Someone is getting money for medical care and it isn’t doctors and staff.

And I doubt we’ll ever know who that is.