I follow stock market wave counts because like most of you I am sometimes interested in things economic, and how they effect us - until they get boring. With that .. here is ..
A Brief History of Health Care
During the 1920s, individual hospitals began offering pre-paid services to individuals, leading to the development of Blue Cross organizations in the 1930s. The first employer-sponsored hospitalization plan was created by teachers in Dallas, Texas in 1929.
There weren't even insurance companies until the 1920's. Good health care then was largely for the well-to-do, and middle-class. Somehow, sadly, we actually survived several thousand years without insurance companies, and now, of course, some politicians and corporate types couldn't possibly do without them. And, if there is any factual basis for the TV Drama, The Knick, minority populations and immigrants were ill-treated in such a pay-your-way system. Ill-treated is probably kind; I am sure deep in my bones it was actually much worse for the poor than anyone can describe or picture.
Then in July 1965, Congress enacted Medicare and Medicaid under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history. And, the United States of America became an insurance company for people of age. And, under Medicaid a certain portion of the poor were then covered, also reducing discrimination in health care.
Later, in 1980 President Ronald Regan defeated then President Jimmy Carter and discarded the proposed Mental Health Systems Act which would have continued funding to local mental health treatment.
And in 2010, President Barrack Obama signed into the law the Affordable Care Act to expand the number of people who could be covered under an insurance plan of some type, and provide a basic suite of essential services, including some level of mental health care.
State of the Art
So, now we find ourselves with a health care system which is largely centered in hospitals and doctors offices, using miraculous imaging technology, advanced surgical tools, and medicines developed by large drug companies - many of whom support candidates friendly to their industry with very large donations to their various campaigns and causes. We still have private insurance companies and we have the federal government also insuring health care for some.
No matter your opinion, the facts are that somehow this invented-on-the-fly system of health care and health care insurance, along with improvements in food sanitation & disease prevention, has resulted in dramatically reduced infant mortality and increased life expectancy in the United States - from roughly 47 years in 1900 to roughly 79 years today in 2017. It's hard to argue with the result. We're doing pretty well, and now the issue seems to be, "do we want to continue as is or change things?"
If we're going to change, as a group, we should have pretty good reasons for doing so. And this is where things can get sticky - because then our oughts & shoulds will likely become involved.
From a purely economic perspective, the Medicare experiment has taught us that the Federal Government can indeed run a health care system and do so quite well for a select group of people. Whether we as a nation can afford to do that remains to be seen. But, we know this works.
There are many people who's economic experience it is that, "getting a good job with good benefits" was one reason to try to grow up well, learn, follow-the-rules, and become a good citizen and employee. Health care coverage was an incentive to undertake socially acceptable conduct. It is also within our experience, that, over time, there has been some reduction in discrimination against minorities and immigrants. But, we must admit some people prefer to still show this behavior. It's their choice. No one requires them to do it, and yet the law of the land is one of non-discrimination.
Still, for numerous reasons, just as some health care was getting better, one of the major providers of health care benefits began slowly and insidiously to pull a switch on us. We might work for a corporation for benefits, but then they began charging us for the health benefit, too! At one point, many employers stated, "We don't want to be in the health insurance business. That's not our main mission and we are mission focused." The employers paid us, but then they told us to pay them back!
We also can not deny, that for all the money we might put into a child's health care, it can almost all be literally wasted if - one day on the streets of Chicago or literally any other city - that child's life is ended in a gang murder. What's the point of a vaccination for that victim?
And, there has been another recent trend that shows up in the data. For some reason, with the best health care in the nation in 2014, "Adult Obesity rates exceeded 35 percent in four states, 30 percent in 25 states and are above 20 percent in all states. The lowest rate was 20.2 percent in Colorado. [Behavioral Risk Factor Surveillance Survey, 2015]. While in 1985, no state had an adult obesity rate higher than 15 percent; in 1991, no state was over 20 percent; in 2000, no state was over 25 percent; and, in 2006, only Mississippi and West Virginia were above 31 percent."
So for all this health care, we were getting heavier and heavier, though the trend has leveled off to some degree and is declining in some cases.
And, we also now know that in the U.S. it is an objective fact that we are paying more for health care per person than in Canada or the U.K. at least.
Reasons To Change
Clearly, with a generally rising trend in life expectancy, from the perspective of a lay person, the only reason to change is to make things better. There are three reasons I can see why we might want to change the system.
- To reduce inefficiency, and therefore allow us to better afford health care
- To reduce the non-medical trauma to a patient dealing with the bills
- To further promote wellness in the population, in general, and in each person in particular
Part 1 - Insurance
It would be hard to argue that separate insurance companies must introduce some inefficiencies by fact of sheer duplication, different billing codes, even just different addresses or phone numbers that patients or care-givers have to memorize, deal with, etc. let alone that there is an entire industry that makes a profit providing the insurance. Somehow that profit must come at the expense of the patient in their cost of insurance, cost of care provided, governmental rebate, or some other method. Where else would the profit come from? With single-payer, an industry (that has served us well in the past) would be wiped out.
The people in this industry would likely be greatly opposed to losing their jobs. But what if they were intentionally re-deployed into health care - to further reduce the cost of providing care. They don't have to be doctors. But what about nurses, therapists, home care givers, health educators, etc? They would actually do a function - and not just shuffle paper and answer irate patient calls as to why their benefits were denied.
This answer, or an answer like this, in some form goes a long way to addressing the first two reasons for change. What if a health care bill recognized this shift in industry? Folks, the leather tanning industry just isn't around to the same degree it was before. Industries change. Can we recognize that? Is that "excessive government interference" or is it "forward-thinking"? Does it have to be single-payer? No, but a massive streamlining must occur - for our sake.
No one really wants choice of insurance, per se - what they likely want is choice of doctor, and choice of quality, affordable care.
Part 2 - Wellness
Regarding the third reason, most people are not going to like this difficult discussion. Given that life expectancy has increased. The question now is what is our quality of life during those years. Clearly, for the child gunned down in a city, that child wishes his attacker had better mental health and did not use the gun in the first place.
(When I watch Congress and the President, I can only dream of what could be different if mental health levels were substantially improved. I do not say that jokingly.)
We must create a new mental health care system in the United States. We must do it together, and we must do it for a reason. Law enforcement can not stop a murderous act before it happens. Only mental health care can do that. Who needs mental health care? I contend everyone does! From the time a child is verbal and can enter school, there should be mental health check-ups just as certain as there is physical education or vaccinations. Think of the societal problems that might be alleviated if people were more rational and their emotions were more in control.
We need to further switch from spending money on insurance to mental health care. If a child needs physical support, he or she also needs mental and / or emotional support. How can we just assume, that everything going on in a child's heart or brain is serving that child well? How we monitor, and how we intervene is a great discussion this nation should have. But we need to get something done here, and we need to get it done quickly.
By substantially improving mental health, we may eventually be able to reduce the cost of incarceration, and law enforcement over a longer period of time.
Part 3 - We can all become Physician's Assistants
Physicians are talented, well-educated, and they deserve to be well compensated for that education and skill. But who says that doctors, nurses and the hospital staffs are the one's who are primarily responsible for our wellness?
Who said that a person in 8th grade should not be taught how to care for themselves? When I was in 8th grade, they sure taught me about the Jain Temple in Kuala Lumpur. But did they ever teach me the importance of, or ways to control, the insulin level in the temple that is my body? No. Both of these are facts. Which would be more valuable to me? I don't think the contest would even be close.
We must get much more and better information and practical experience with satisfying nutrition, stress reduction, avoiding the ravage of tobacco smoke, dealing with addiction as a disease, ways to limit alcohol consumption, and the need for exercise. And we must get it from the time we are young.
In this category if we are going to be the physician's little helpers, then since health workers are paid, we must find a way to incentivize healthy behavior. It would be our payment. We do it partially now - non-smokers enjoy lower insurance rates. But is there some non-insurance way to incentivize lower risk individuals? How can we find a way to actually reward and reinforce the better behavior so that it continues? We must find such a way, and discuss it, until we implement a program in which we decide WE are going to reduce health care costs, not necessarily by haggling for drug prices, but simply by being healthier.
I hope you understand what I am trying to say, here. I would be very interested in your thoughts and contributions.
Thanks for listening.