Additionally, neither the Democrats‘ Obamacare nor the Republicans’ Trumpcare can truly meet the unrealistic expectations of the American public. The public has four major expectations, which are inherently mutually incompatible.
The public wants: (1) freedom to choose doctor and hospital; (2) the latest modern, state-of-the-art technology in diagnostic equipment and medical and surgical treatments; (3) no delay in appointments and treatments; and (4) minimal (or at least, reasonable) cost. People can have two, perhaps three, but in no way can they have all four. That is the reality.
Because this is the weather. It occurred naturally. Our health care system is not man-made, and therefore cannot be changed except here and there around the edges. We can’t actually make anything better.
Also, allow me to introduce you to the world we live in now, in which appointments and treatments ARE routinely delayed even if you have Cadillac insurance, and lots of places have one busted-ass hospital or none at all. If you’re a woman who needs reproductive care, you already have to drive for miles, go out of state, or get legit procedures refused because of said hospitals’ conscience clauses. Walgreens and CVS have eaten every family pharmacy, religious ownership of health care is its own clusterfuck, and your doctor’s office parking lot during flu season is like the Hunger Games.
THAT is the reality.
Neither political party wants to tell the truth, that health care costs keep skyrocketing, fueled by new diagnostic and therapeutic modalities. For example, many of those drugs are heavily advertised on TV, such as the Xeljanz arthritis drug at about $50,000 per year. Then there is the Harvoni or Sovaldi drug to treat hepatitis C, with one $1,000 pill per day for 84 days. Think of that cost, $84,000 times 3 million people.
Which is why fuck those companies, because unless those drugs are made out of fairy wings and blue diamonds, ain’t no way they actually cost that much. Stop confusing “this drug is expensive” with “this drug’s company wanted to charge a bucket of money for it.”
This is not an argument not to change things. This is an argument to nationalize the entire health care system from drugs to delivery rooms, prohibit prescription drug advertising on TV, and put people who are grifting off the illnesses of others into goddamn federal prison.
Even with negotiated lower costs, exotic, high-tech treatments will still be financially ruinous. Also, with people living longer than ever before, they are seeing more degenerative diseases (vascular, cancer, mobility), all of which take an increasing toll. We are seeing more complex multiple system diseases, many with prolonged recovery times. No wonder costs are sailing out of sight.
Just die. It’s cheaper.
I often analogize that the federal government could require an automobile to protect all passengers in an up-to-120 mph crash. We do have the technology to do it, but the cost of your basic low-priced car would probably be over $100,000. There is a cost and a benefit to everything, and medical care is no different.
Yet how seldom we hear this argument when it comes to a national defense. It’s almost like there ARE unlimited funds for some things, if we value them highly enough.
Since there is not an unlimited amount of dollars available, whether by individuals, private insurance or government programs, there have to be rational ways to decide how and where to get the most bang for the buck, and frankly, the political parties and the public must get real as to what is possible.
Perhaps we should begin classifying people by their projected recovery and usefulness to society thereafter, so as to decide who deserves medicine. In the entirety of human history that’s never gone wrong.
The best cost control is when there is a direct relationship between buyer and seller. Perhaps, for outpatient services, we should do what some European countries do — the patient pays the doctor directly, then he turns the receipt into his or her health insurance plan for reimbursement. This puts a great restraint on doctors running up the tab because they have to look the patient directly in the eye.
If you think a doctor has never lied to a patient, you might want to meet this bunch of guys in Tuskegee, Alabama. They all have syphilis for some reason. Maybe you can explain it to them.
But the way it works in our country, the patient never sees the bill, and it becomes a game between the doctor and the insurance carrier.
I will grant that when I ask my doctor how much something will cost, he acts like money is a disgusting sex act and he can’t believe I’m uncouth enough to bring it up in church. HOWEVER, the idea that patients don’t see a bill is high-larious, considering how many medical bankruptcies result among the insured.
Also, although there is no constitutional mandate to provide medical care; perhaps economic reality dictates that the government could provide a basic Volkswagen plan for everyone, and if individuals want to purchase a Buick or Cadillac level of care, then that should be their right to do so.
This would literally be Obamacare if Republican governors hadn’t decided to fuck the program in the hopes of blaming a black dude in order to win elections. But you keep going.
Bottom line: We as a nation, can no longer provide an unlimited social goody list without making sure these desires are on an actuarially sound basis.
Oh, go crowdfund your cancer treatment. I’m sure the market will make the best possible decision as to your actuarial soundness. YOU ARE MAKING AN ARGUMENT FOR DEATH PANELS.
The days of counting on an ever-increasing number of young workers, in high-paying largely manufacturing jobs, to fund seniors’ health care and retirement are over.
Amazing how this seemed to end right around the time the Baby Boom started racking up the bills.
At last, we must recognize, that just as a family needs to be realistic about finances, our federal and state governments must be, too.
Okay, so we’ll take our two unwinnable wars and all our tax cuts and cancel that shit so we can pay for Becky down the street to get a pelvic exam. Why is fucking over poor people always the answer? Why is “a well-child visit for a low-income family” always the hill we gotta die on? We can afford all kinds of stuff. We just hate admitting what we want to afford, so we say we can’t afford it and we get ALL KINDS OF MAD when someone points out that actually, what utter crap.
The people who will relentlessly police the shopping carts of the poor and crab all day about how much soda they buy never really do catch on that government shops pretty shitty, too, and should forgo a few T-bones in favor of paying for chemo. Maybe the government could sell some of its bling.