How to Fix It, Part I

Rufus challenged me to create a Nobel-level treatise on fixing the health care system. We’ll start from a simple premise: Health care in America is fundamentally broken.

New England Journal of Medicine reports that “Health care spending represents a growing share of our national income and is projected to increase from 16% of the gross domestic product today to 20% by 2018.”

Regular readers will remember that we built our current Health Care system pretty much on the Johnny Cash model for his 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70 automobile. It is an amalgam of rubber bands, reams of forms, and television advertising all held together with sloganeering bumper stickers and Post-It™ glued dollar bills.

The President will address a joint session of Congress in prime time on Wednesday, September 9. He hopes to refocus attention on his own blueprint for ObamaCare.

There is no distinctly native American criminal class
except Congress.

— Mark Twain

Senator Harry Reid and Speaker Nancy Pelosi (D-CA) released this statement to the president: “Our nation is closer than ever to achieving health insurance reform that will lower costs, retain choice, improve quality and expand coverage.”

Remember Mark Twain.

Everybody in this discussion, from the most fervent ObamaCare supporter to the most ardent contrarian, has a good answer for patching up the rusty old car that runs on three cylinders and has two flat tires. It might keep us going to the next exit, but it won’t carry the family across the country on vacation.

The same Democrats pushing patches on the current system want to reinvent the automobile from the ground up but all they want to do with health care is find a few more people to cover and a way to make taxpayers pay for it.

The same Republicans opposing changes to the current system want to keep that clunker but all they can to do with health care is try to divert the money their counterparts want to flow to Washington.

“Foreigners regularly express bewilderment that America may reject reform and stick with a system that drives families into bankruptcy when they get sick. That’s what they expect from the Central African Republic, not the United States,” Nicholas D. Kristof wrote in the N Y Times.

Sorry, Mr. Kristof. You’re w-w-w-w-w-w-wrong. Americans don’t reject reform and Americans don’t want the current system. Americans reject a situation that will drive the entire country into bankruptcy when they get sick.

There are a million great individual programs; most have been reported — in the news, on blogs, and by everyone with a talk show — as the ultimate savior of American medicine. They are not. No one will take on the number one issue: cost. Saving grandmama is a laudable goal but saving grandmama and using the ER as a walk in clinic and requiring nine insurance clerks for every doctor and the thousand other complaints are the reason U.S. health care will cost two trillion dollars this year or more than $6,600 per person for every man woman and child in the U.S. ObamaCare has no (nada, de zero zip) provisions to reduce that $6,600 per person for every man woman and child in the U.S. and we apparently don’t even treat 41 million of those folks. If we don’t take on the cost, health care will cost $13,000/year for every man, woman, and child in America in nine years. Nine years.

Guess what adding 41 million people to the rolls will cost.

Trouble is, programs like Oregon Health Plan ration care to hold down costs.
Trouble is, programs like Whole Foods’ HDHP ignore underlying costs by teaching patients to use fewer services.
Trouble is, programs like Medicare hold down costs by shifting them to Somebody Else.

I’m tired of being Somebody Else.

“What’s your answer?” President Obama asked in Ohio on Monday.

Remember Mark Twain.

“What’s your answer?” the president asked because he didn’t expect a response.

Here’s my answer, Mr. President. Tomorrow, before the President speaks, I will show how to redesign the system from scratch. Do not expect to hear in the hallowed halls of Congress a single word of what you read here.

Next up, How to Fix It, Part II

2 thoughts on “How to Fix It, Part I

  1. What a tease!

    I’m working on a manuscript right now that presents a major system revision. It will be interesting to see whether you and these authors have any common ground.

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