Herewith, my thoughts on healthcare:
1. Healthcare is a fundamental right.
This is important, I think: I believe that healthcare is a fundamental right. Now, I know that lots of people will say, “You commie liberal, you think everything is a fundamental right.” I don’t, though. I really don’t.
But I can think of few things more fundamental than healthcare. What we’re talking about, ultimately, is this: the right not to die an untimely death. The right not to die because you’re too poor. The right not to die because you had a pre-existing condition. It’s life and death.
This is, I think, enshrined in our country’s Declaration of Independence. In that document, not a lot of rights are listed. Three, and only three, are referred to as “inalienable” (meaning: incapable of being alienated or surrendered): Life, Liberty, and the Pursuit of Happiness. Life. That is what healthcare is: the inalienable right to life, no matter how much money you have (or don’t have). It is simply not right that I can walk into a hospital and get excellent care from good doctors, and another taxpaying American can be refused the same treatment. We’re talking about the right to live. It’s…nonsensical. Criminal. Horrifying.
Life, Liberty, and the Pursuit of Happiness. We’ve all heard that phrase. It’s in the marrow of our national bones. How, then, do we reconcile this with the over 40,000 Americans who die each year (according to a peer-reviewed Harvard study) because they don’t have insurance? Not to mention those (like 17-year-old Nataline Sarkisyan) who were ostensibly covered, only to find that their insurance company would not cover a critical procedure (in her case, a liver transplant)?
If it is a fundamental right, then it is the very job of our government to ensure that it works for us. We think it’s important the they provide us with the opportunity for decent education. We think it’s important that they provide good roads. The government provides flood insurance, for crying out loud — how do we argue against health insurance?
This is simply true: whether through a public option, through some kind of nationalized medicine, through oversight, whatever — it is the job of the United States government to ensure that affordable quality healthcare is provided to all Americans. End of story.
2. The U.S. System is badly broken
Let’s get this straight: the concept of choice in medical care is nonsense in the U.S. I simply don’t understand it when people argue that there would be some curb on our freedoms if we were to involve the government in medical care. If you have ever had an illness or injury more serious than the common flu, you know that this is true. Do you get to decide what tests are run or not run? Not unless you have money to burn, you don’t. Do you get to decide on your doctor? Only with certain plans, and then only if they accept your specific insurance. The whole idea is the biggest crock of the debate.
So, within this limited-choice system: how are we doing? Well, let’s be fair: if you have untold money to put to the task, the U.S. can provide you with top-quality medical care. But overall the picture is less rosy. The World Health Organization slots the U.S. as follows in their various rankings:
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- In health-related expenditures per capita: #1. We spend more on healthcare per person than anyone else in the world does.
- In health-related expenditures as a percentage of gross domestic product: #2, behind only the Marshall Islands. The message again: this is super-expensive.
- In preventable deaths: #14, out of nineteen countries surveyed. Yikes, right?
- In healthy life expectancy: #24, just ahead of Cyprus and Dominica. Not very impressive. (One really awful statistic that’s unrelated to this conversation: there are fifty countries on this earth where a person’s healthy life expectancy is less than 50 years old, thirty countries where it’s less than 40, and three where it’s less than 30.)
- The overall rank of the U.S.’ healthcare system: #37.
Moreover, unless we adopt a total indifference to the poor in this country, it’s hard to argue that the system is anything close to fair-minded. Put simply: if you’re poor in this country, your chances of dying early are massively higher than if you have money. Life, liberty and the pursuit of happiness, indeed. One of the arguments I’ve heard proffered as an explanation for the above, in fact, is that the U.S. ranking is sinking because we have more poor people and more unemployed people than before. I sometimes wonder if people who say things like that listen to themselves: this is an argument against reforming our system? Seriously?
3. Our current system has a severe perverse incentive. Let’s review how this all works: if you get sick or hurt in any severity, you visit a doctor. Because visiting a doctor is simply too expensive for most people (even, probably, you and me — to say nothing of the truly poor), it is unlikely that you do that unless you have insurance (or at least, if you are uninsured there is a very serious debate going on in your mind). The insurer approves of your doctor, and often in advance of your doctor visit. They approve or disapprove of medications, tests, and procedures. You and I are unlikely, again given the cost, to obtain medication, tests or procedures that are not approved by the insurer. Let’s not mistake this: your insurance company controls your access to healthcare.
Now, let’s not go crazy about insurance companies and paint them as devils or as awful people who want you and I to die. I doubt that happens much, if at all. I’ll bet that they think of themselves as pretty darn good people, and they’re probably mostly right. But let us admit this much: not as individuals but as companies, their incentive is as follows: extract as much from us as they can in premiums, and pay back as little as they can get away with. Insurance companies get revenue from our premiums, and payment of claims are an expense category in their accounting. There’s not much room for debate about that.
I’m not saying that the people who work there think of it that way. But at the corporate level that is really the incentive, isn’t it? Let’s now do the conjunction of the two conclusions to reach an absolute truth: Your access to healthcare is controlled by entities whose fundamental incentive is to deny you that access. This is, umm, a pretty bad thing.
4. Lobbyists are killing our chance to get something that Americans want. Let’s not cast aspersions here. Let’s just lay down a few facts:
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- For every member of Congress currently in office, there are six full-time healthcare lobbyists.
- The bill currently sits with the Senate Finance Committee. Over the past twenty years, the current members of the Senate Finance Committee have received over $50 million in campaign contributions from the healthcare industry.
- The chairman of that committee, Max Baucus, has received $1.5 million from the healthcare industry just in the last few months.
- In total, Congress has received about $380 million from the healthcare lobby in the past few months alone. There are 100 senators and 435 congressmen, so that adds up to a little over $710,000 per potential vote. Since you can bet that they didn’t waste money on people who clearly don’t support their agenda, it’s easy to conclude that the healthcare lobby put somewhere around $1 million in the coffers of every amenable senator or congressman.
- Ergo, shocker alert: Sen. Baucus’ bill will massively increase the number of customers for insurance companies (through insurance requirements, a la car insurance), and does so without introducing any new nonprofit competition (i.e., the “public option”). In short, it’s an awesome deal for insurers.
Perhaps I should illustrate the above with a picture:

Anyone super-surprised that the bills coming out of Congress right now (and most egregiously, Sen. Baucus’ version) are almost unbelievably favorable to insurance companies? The New York Times refers to the groups of people influencing our healthcare reform bill as “organized interests.” They are too kind: what they mean by “organized interests” is “healthcare lobby.” And, just to be clear: you and I, no matter whether you agree with me on what we should do or not, are not an “organized interest.”
5. The cost side of the healthcare equation is a little nuts. I’m a turnaround CEO. My job is to come into companies that are maybe performing at a level that is less than what their board and investors were hoping, and try to make it better (grow revenues and make the company more profitable). This problem is similar: we have to ask, where is this cost coming from? What areas are contributing value to the system, and what areas are more costly than they’re worth? What adds value, and what is value-subtracting?
Overall, the cost side of this equation is stunning. My mother was alarmed whan she learned that pills prescribed for her (post-cancer treatment) that ran nearly $100 per dose, could be had for $4 from a Canadian pharmacy. A tube of cream to treat toenail fungus runs $264 here, but can be had wholesale for $5. It’s the healthcare equivalent of those $1,000 hammers and toilet seats we all made such a fuss about years ago.
It’s a travesty, and it is a thread that runs all through our healthcare system: we recently had an emergency room bill that included charges for unnecessary services, and it included a shot that cost $1000 for the medication. My wife had an i.v. in her arm throughout the visit. I am not joking when I say that I could insert a syringe into the i.v. and deliver medication, and in any case the job takes maybe thirty seconds to perform. We were charged $175 each time someone did this. Not for the medication — just for the service of inserting the needle into an i.v. This works out to a rate of $21,000 per hour. Get paid like that for a week, and you’ve made almost a million bucks. Pretty good work, if you can get it.
Now: let’s get clear about whom we should have an issue with. It’s not doctors and nurses — they are highly trained, well-educated specialists and they should be paid handsomely for their work. Moreover, they are not the reason I was paying $175 for someone to push a needle into a tube. The doctors and nurses receive a fraction of that hospital bill.
It’s a little bit drug companies. To be fair to them, they employ PhD’s and expensive researchers, and their work is really important and really expensive. But, in the same way that Halliburton should not be able to unnaturally profit from the performance of a public service, drug company profits should not be able to rise too high. I know, I know… this seems socialist. But really: let’s say that polio makes a reappearance in the world. Should it even be possible for drug companies to charge whatever they want — let’s say, for the sake of argument, $10,000 per shot — for providing the vaccine? Of course not. That’s not okay. At some level, when you’re providing a public service, you inherit some public responsibility.
Who is it, then? Two groups:
It is partly lawyers. Tort reform, particularly with respect to medical torts, is badly needed. Doctors perform under extreme duress, and some allowance must be made for the difficulty of their position. If you and I were held to the same standard of performance that doctors are held to every day, our stress levels would triple immediately. Because they can be sued at every turn, for the slightest mistake, they pay massive premiums for malpractice insurance. That cost is passed along to you and me.
Allow a little rant: I don’t understand how Democrats can take this off the table, when they want everything else on it. Folks in Washington: if we’re going to address healthcare, then let’s address healthcare. Everything’s on the table. If it injects significant cost to the system with little beneficial result to care, then it gets the ax. Right?
The second group we’ve already discussed: insurers. These folks aren’t like doctors: this is not a “best and brightest” specialty. They don’t improve our health. They don’t…add…value. They simply aren’t worth, in terms of their value to the system, what they’re paid. They’ve been making huge profits, and they don’t deserve it.
The excessive cost in this system comes from two groups that contribute little to the improvement of our health: lawyers and insurance companies.
6. Service denial due to “pre-existing conditions” is a crock. I get the theory. If the subscriber set were small, it would be difficult for an insurance system to handle expensive care for someone who has a known condition when they enter the system. But if the subscriber set is small, it is because insurers attempt to game the system by denying insurance for anyone who isn’t healthy. This is a healthcare version of Vegas’ house rules: If you get to provide great coverage only for people who aren’t sick and aren’t likely to get sick, then it’s not rocket science to make a lot of money.
The mockery of justice goes even further: note that when you are denied coverage for a pre-existing condition, you are not denied coverage for only those issues that arise from the known condition — you’re typically denied coverage entirely. My ex-wife has bipolar disorder, and when her current COBRA coverage runs out, she will simply not be insured (unless serious reform happens in the meantime). The illogic goes this far, then: she could be denied coverage for a broken arm… because she is bipolar? Huh?
I think all of this should lead us to a few conclusions: (a) that serious reform of the system is necessary; (b) that everything should be on the table, including both serious reform to our insurance system and to our tort system; (c) that any decent reform should provide affordable healthcare to every American; but (d) there’s a lot of unsavory momentum that works against any of that happening. Hence, we need to get really vocal about it, if we want anything halfway helpful to happen to our healthcare system.