Removing cost from the equation

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Removing cost from the equation

Poor Char­lie Gard. First he is born with a nasty genetic defect, one so rare that only 16 peo­ple are known to have it. Then, when there is a chance to save him with an exper­i­men­tal surgery, the British Health Care Sys­tem tries to over­ride his parent’s deci­sion and pull the plug on his life sup­port. Luck­ily, he’s caught the atten­tion of Pope Fran­cis and Pres­i­dent Trump, so per­haps he might still make it.

Health care remains divi­sive in Amer­ica. Plenty of peo­ple want a sin­gle payer sys­tem, while oth­ers argue for pri­va­ti­za­tion, and still oth­ers a mix or other vari­ety. The media doesn’t help one bit, whether it says that unin­sured peo­ple are rob­bing us blind, or that pri­va­ti­za­tion would con­demn poor peo­ple to death. That sort of over-​the-​top talk doesn’t con­tribute to the conversation.

So let’s start this dis­cus­sion with a point: you can’t put a price on human life. You can’t argue that one person’s life is more impor­tant than another, because when you start to do that, you risk find­ing con­ve­nient ways to kill of those you don’t like (see Eugen­ics, Jews, the obese, Repub­li­cans, etc.). Lit­tle Char­lie Gard’s life doesn’t mat­ter to most peo­ple, but his par­ents are will­ing to give up most every­thing to keep him alive. You’d prob­a­bly feel the same way about your own kids or spouse. I know I felt that way about Rebecca.

Now, you can put a price on med­ical pro­ce­dures. I’ve seen Rebecca’s bills, as well as my own the few times I’ve had to use a civil­ian care provider. Doc­tors, nurses, and all sorts of med­ical pro­fes­sion­als have to get a pay­check. They have fam­i­lies to pro­vide for, debts to pay, and hob­bies to pur­sue, just like all of us do.

Here’s the tricky part: in most cases, we have no idea about prices. How much does heart surgery cost? what about a “well­ness checkup” (and what does that even mean)? I don’t know, and I bet you don’t either. So there is prob­lem num­ber one with our sys­tem: the aver­age per­son has NO IDEA what most med­ical pro­ce­dures cost.

This is impor­tant because when you buy insur­ance, you’re pay­ing to reduce risk. When you buy car insur­ance, the friendly insur­ance lady tells you what a deductible is, as well as what things are and aren’t cov­ered. Do you care about your glass always get­ting chipped? Then you pay extra to get a zero deductible on glass repairs. Are you look­ing to save money and sim­ply cover cat­a­strauphic things? Then you take a higher deductible so your annual cost goes down. If you’ve ever bought home­own­ers insur­ance, renters insur­ance, or most other forms of insur­ance, you’re used to doing this.

But in all these cases you know costs. You know what you paid for your car. You know about how much a new roof costs. You’re famil­iar with these costs, and so you’re doing math in your head when you buy insur­ance. Not so with health insurance.

Now comes another fun part: you can’t shop eas­ily for health insur­ance. Oba­macare did try to build a web­site to do just that, and sadly, it failed mis­er­ably. Plus, good luck with state lines, because every state has dif­fer­ent rules on health care. Imag­ine hav­ing to use a dif­fer­ent Ama­zon app depend­ing on where you live. If you move a lot like most of our younger pop­u­lace is, this would get aggra­vat­ing fast.

So we have a non-​portable sys­tem that you don’t know the cost of, but you’re expected to pur­chase it. Add to that the lack of elec­tronic med­ical records and a large and diverse pop­u­la­tion, and it’s a recipe for dis­as­ter. And because much of it is run/​paid for by the gov­ern­ment, you have the final kicker: gov­ern­ment is about con­trol­ling costs and not tak­ing risks, which Char­lie Gard just found out this past week.

My bet­ter sys­tem would have the gov­ern­ment license com­pa­nies to pro­vide health care plans, allow plans to cross state lines with­out penalty (sort of like driver’s licenses), and pro­vide stan­dards for elec­tronic med­ical records. Let com­pa­nies set var­i­ous tiers of cov­er­age, and make them pro­vide the infor­ma­tion in a read­able for­mat, sort of like read­ing the FDA label on food. Let the bot­tom tier of health care plans be crazy cheap, like ambu­lance ride and emer­gency room only. I think Obama had a good idea on exchanges, but then tried to push too much in the basic plan, plus add devi­sive things (like abor­tion) that all but guar­an­teed fail­ure. It made healthy peo­ple not buy plans, and forced law­suits from Catholic hos­pi­tals that could have been avoided.

The biggest change needs to be cost trans­parency. The places that do this best are vet­eri­nar­i­ans and elec­tive surg­eries. Want to neuter your cat? You can get costs eas­ily from 10 dif­fer­ent vets, prob­a­bly most of it online. Want big­ger boobs or your vari­cose veins fixed? You can get costs for that too. But if you want to see a dieti­cian, or get a bro­ken arm fixed, you won’t know the cost until you walk out the door.

With a sys­tem like this, peo­ple will have a bet­ter idea of what they are pay­ing for, and can bet­ter take risks. If you want to shop around for the flu vac­cine or a health checkup, you can. But if your child needs spe­cial­ized care, you may want to take the risk, since you know cer­tain death awaits. Or, maybe you think it’s not worth the risk, and you want to sim­ply stop care and allow for nat­ural death. Either case is OK, and it keeps health care in your hands, not the governments.

Let’s start with that…I think we’d see bet­ter care quickly, and start tak­ing back con­trol of our health care from the government.


This post rep­re­sents the views of the author and not those of the Depart­ment of Defense, Depart­ment of the Navy, or any other fed­eral agency. You should have guessed that when I said I didn’t like the cur­rent setup…

Please check out my blog and donate to Da Tip Jar!

Poor Charlie Gard. First he is born with a nasty genetic defect, one so rare that only 16 people are known to have it. Then, when there is a chance to save him with an experimental surgery, the British Health Care System tries to override his parent’s decision and pull the plug on his life support. Luckily, he’s caught the attention of Pope Francis and President Trump, so perhaps he might still make it.

Health care remains divisive in America. Plenty of people want a single payer system, while others argue for privatization, and still others a mix or other variety. The media doesn’t help one bit, whether it says that uninsured people are robbing us blind, or that privatization would condemn poor people to death. That sort of over-the-top talk doesn’t contribute to the conversation.

So let’s start this discussion with a point: you can’t put a price on human life. You can’t argue that one person’s life is more important than another, because when you start to do that, you risk finding convenient ways to kill of those you don’t like (see Eugenics, Jews, the obese, Republicans, etc.). Little Charlie Gard’s life doesn’t matter to most people, but his parents are willing to give up most everything to keep him alive. You’d probably feel the same way about your own kids or spouse. I know I felt that way about Rebecca.

Now, you can put a price on medical procedures. I’ve seen Rebecca’s bills, as well as my own the few times I’ve had to use a civilian care provider. Doctors, nurses, and all sorts of medical professionals have to get a paycheck. They have families to provide for, debts to pay, and hobbies to pursue, just like all of us do.

Here’s the tricky part: in most cases, we have no idea about prices. How much does heart surgery cost? what about a “wellness checkup” (and what does that even mean)? I don’t know, and I bet you don’t either. So there is problem number one with our system: the average person has NO IDEA what most medical procedures cost.

This is important because when you buy insurance, you’re paying to reduce risk. When you buy car insurance, the friendly insurance lady tells you what a deductible is, as well as what things are and aren’t covered. Do you care about your glass always getting chipped? Then you pay extra to get a zero deductible on glass repairs. Are you looking to save money and simply cover catastrauphic things? Then you take a higher deductible so your annual cost goes down. If you’ve ever bought homeowners insurance, renters insurance, or most other forms of insurance, you’re used to doing this.

But in all these cases you know costs. You know what you paid for your car. You know about how much a new roof costs. You’re familiar with these costs, and so you’re doing math in your head when you buy insurance. Not so with health insurance.

Now comes another fun part: you can’t shop easily for health insurance. Obamacare did try to build a website to do just that, and sadly, it failed miserably. Plus, good luck with state lines, because every state has different rules on health care. Imagine having to use a different Amazon app depending on where you live. If you move a lot like most of our younger populace is, this would get aggravating fast.

So we have a non-portable system that you don’t know the cost of, but you’re expected to purchase it. Add to that the lack of electronic medical records and a large and diverse population, and it’s a recipe for disaster. And because much of it is run/paid for by the government, you have the final kicker: government is about controlling costs and not taking risks, which Charlie Gard just found out this past week.

My better system would have the government license companies to provide health care plans, allow plans to cross state lines without penalty (sort of like driver’s licenses), and provide standards for electronic medical records. Let companies set various tiers of coverage, and make them provide the information in a readable format, sort of like reading the FDA label on food. Let the bottom tier of health care plans be crazy cheap, like ambulance ride and emergency room only. I think Obama had a good idea on exchanges, but then tried to push too much in the basic plan, plus add devisive things (like abortion) that all but guaranteed failure. It made healthy people not buy plans, and forced lawsuits from Catholic hospitals that could have been avoided.

The biggest change needs to be cost transparency. The places that do this best are veterinarians and elective surgeries. Want to neuter your cat? You can get costs easily from 10 different vets, probably most of it online. Want bigger boobs or your varicose veins fixed? You can get costs for that too. But if you want to see a dietician, or get a broken arm fixed, you won’t know the cost until you walk out the door.

With a system like this, people will have a better idea of what they are paying for, and can better take risks. If you want to shop around for the flu vaccine or a health checkup, you can. But if your child needs specialized care, you may want to take the risk, since you know certain death awaits. Or, maybe you think it’s not worth the risk, and you want to simply stop care and allow for natural death. Either case is OK, and it keeps health care in your hands, not the governments.

Let’s start with that…I think we’d see better care quickly, and start taking back control of our health care from the government.


This post represents the views of the author and not those of the Department of Defense, Department of the Navy, or any other federal agency. You should have guessed that when I said I didn’t like the current setup…

Please check out my blog and donate to Da Tip Jar!