Week of 08/05/2019

Why Healthcare Reforms Inevitably Fail
– by David Matthews 2

The big talk of the 2020 Democratic presidential wannabes is healthcare reform.  Everyone seems to have their own spin about how to fix the problem of healthcare in America and a lot of them circle around some kind of Medicare-For-All plan.

It’s easy to see why this seems like a good solution to the problem that is our failing healthcare system.  There seems to be some “simpler” system that bypasses a lot of the bureaucracy and ballooning costs created by Big Healthcare and Big Pharma, and it “seems” to work for this select pocket of American society, specifically the elderly.  So... why not make this the default for everyone else?

Well it does sound nice... on paper.  Because that is the only place where it works... on paper.  In the fantasy of people eager for a government solution to a problem that government helped to create.

Picture healthcare in America as a four-door pickup truck.  It seats the driver and up to four passengers, with one in the front and three in the back.  The pickup truck has all sorts of safety features... mostly for the driver.  The front-seat passenger has some of the features as well.  The ones in the back only have one safety feature, the seatbelt.  That’s it. 

The wealthy in America are the drivers.  They get the best safety features.  And because they know they’ll be safe, they can drive that truck as recklessly as they want to.  They’ll take it off-road and hit every pothole they can and drive at obscene speeds and do donut-spins because they can.  It’s fun for them.

The upper-middle-class are the front-seat passengers.  They get some of the safety features, but not everything, and they can’t be assured that they’ll be safe when the truck is driven recklessly.

The lower-middle-class are the back-seat passengers.  They get the minimum amount of safety and no say at all how the truck is driven.  They’re there for the ride, whether they like it or not, because the driver also controls the door locks and the windows.

What about the poor and the elderly?  Well, they’re in the back.  In the truck bed.  Yes, in some states it’s still legal for people to ride in the bed of a pickup truck at all times.  And they have no safety features at all.  No seats.  No seatbelts.  No means to protect themselves from being flung off.  No protection from the elements if the truck doesn’t come with a cab in the back.

Not a good arrangement if you think about it.  It sucks if you’re not the driver.

Here’s the hard truth about Medicare that people don’t want to talk about: the very reason why it exists is because Big Insurance would otherwise not cover old people!  They’re old!  They’re on their last years of life.  They’ll need healthcare far more than younger people.  And, besides, a lot of them are on fixed incomes!  You can’t gouge those people and expect them to “work harder” to make up the added costs.  A lot of old people can’t work.  And a lot more shouldn’t but they still have to.

Medicare, like Medicaid, was a needed government solution for people who would not be able to survive under the healthcare system that we all are subject to in America.  So, yeah, Medicare and Medicaid exist, but governments large and small have been trying their damndest to make it as minimal as possible, and as impossible to get, never mind to use.  They don’t want more people on these kinds of programs.  They want to get rid of them!

This is why conservatives have hated and despised the idea of “Medicare-For-All”.  It’s not that it won’t work.  It’s because they never wanted Medicare or Medicaid in the first place and they want to get rid of both these things entirely.  They want that money to go to war and police and prisons.  The only way that conservatives would ever support Medicare or Medicaid would be if they were prison programs and being old and poor and sick were crimes.  And, even then, they would rather those folks die and die quickly.

But this brings us to the fundamental problem with healthcare reform in America.  Any kind of healthcare reform, be it Medicare-For-All or tweaking the Affordable Care Act or the much-promised-but-never-materialized Trumpcare idea, has one fatal flaw to it.  It tries to work within the current framework of how healthcare operates in America and tries to restrain it from its natural tendencies.

Healthcare in America is a huge damnable stinking commercial business.  Everything from doctors to nurses to technicians to pharmacists to Big Pharma to Big Hospital to Big Insurance and even to ambulance services are all regarded as businesses.  Businesses exist to make a profit.  Period.  If they don’t, then they are failures.  Healthcare in America is designed to make a profit first and foremost, and to provide a service second, if that.

Yes, doctors have their Hippocratic Oath of “do no harm”, which is why they have middlemen in the form of bureaucrats and managers and Big Insurance and Big Pharma doing all the dirty work for them.  And these people have their own Hippocratic Oath that says “Where’s my money, bitch?”

And this business model is no different than any other business in America.  They want profit now, they want it no matter what it takes to get it, they want it in ever-increasing numbers in every cycle without fail, and they don’t give a care who is harmed in the process.  It is systemic and institutionalized greed, period.

Once upon a time, the healthcare system worked because the business model was considered sustainable.  Greed wasn’t an issue then.  And there were a lot more young and healthy people working.  However, with real wages stagnating for most Americans since the 1970’s, and with corporate greed and their blind fixation for profits running rampant, and with a continually aging population, the system no longer works.  It is failing most Americans because each of the business models in healthcare are demanding more and more money that those Americans simply do not have.

To reform healthcare in America is to essentially interrupt the very business model that the whole healthcare system in America operates under.  It tries to prevent Big Healthcare and Big Pharma and Big Insurance and doctors and nurses and technicians and ambulance services from making a profit at all costs.  It tells these groups that they cannot gouge their patients and customers like any other business is allowed to do.  This goes against their very nature.  It violates their business Hippocratic Oath.

So... yeah.  They’ll scream against any reforms put on them.  They’ll throw temper tantrums.  They will hold up patients as political hostages.  They’ll pay off politicians and regulators to do everything they can to bar or eliminate any kind of limitations put on them.  No different than any other kind of business in America.  Because that is what they really are: a business!

Let’s get brutally honest here... any kind of healthcare reform that tries to work within the system today is doomed to fail.  And, yes, that includes any kind of Medicare-For-All program.  It is doomed to fail because the real problem is not with healthcare, but that business model that demands profit above everything else.  Price restrictions, not being allowed to deny people who can’t afford higher costs, executive pay packages, these are all heresy to any kind of business, and they will do everything they can to co-opt and neutralize it.  If not today, then in the next election cycle, or the one after that.

As I mentioned in my column back in 2018, the Affordable Care Act was actually the healthcare industry’s best opportunity to show that they could work things out within the for-profit framework.  It was an opportunity for them to still make billions with relatively modest limitations.  But their systemic greed and lust for profits would not allow them to accept those limitations.

The only way to truly fix healthcare in America at this point is to take away the business model and make it a government service like the police and fire services.  We pay taxes for police and fire services.  Nobody talks about making a profit for these things or to deprive people of these services.  We don’t plan on being robbed.  We don’t plan on having our house go up in flames.  But when it happens, we expect those services to be there for us.  Likewise, we don’t plan on being sick or injured.  But when we do, we expect those services to be there for us.

As I said last year, I really wish that there was another way.  I wish there was truly a marketplace solution for healthcare.  However, the marketplace has proven that it is the problem.  As long as you have a for-profit system, then that is what it will be... just for profit.  If you want that to change, then you have to take away the for-profit model.  Anything else is just wasting time and doomed to fail down the line.