26 January 2014

the one where you think i'm talking politics but i'm really talking business.

obamacare is a debacle in both its primary objective and in its attempts to meet that objective.

universal affordable health insurance is the incorrect target. universal affordable health CARE is what we should aim for. pluswise, the tools to reach this incorrect target (from the plans proffered to the website through which plans are accessed) are incomplete, broken, insecure, and expensive.

the reason insurance is the wrong target is because insurance is a means to care. care itself is the end and to aim at a means instead of its end -- in the best case results in perfected means and in the worse case results in convoluted, bureaucratized means. either way, you're still left with having done something around means and you haven't addressed the end.

universal affordable health care.

wouldn't THAT be grand!

what if we had clinics which were supported by public money and were open to the public. these clinics could offer all the basics like immunizations, well child checkups, mammograms, dental care, prescriptions, pregnancy care, basic preventative care of all types... all this on a sliding scale, where all persons are served regardless of their ability to pay.

oh. wait. WE ALREADY HAVE THAT.

that's right. we have public health. it's generally served up in relatively dingy rooms in relatively dingy parts of town, and to access the services, you'll inevitably wait a few hours and might even have to come back the next day. i know how it works because i've used it myself. i mean, it wasn't yesterday. it was like, 25 years ago, we went there to get immunizations. we had to wait a while, and everything there was a terrible shade of green, but it worked, and it was affordable.

obamacare is a convolution where we need a solution.

one complication with universal insurance coverage is that for it to work, people have to be covered for things they'll never need, services they'll never use. to simplify: in order for my mammograms to be covered, the 80-year old man who lives next door needs to have mammograms in his policy, too.

another complication is inherent to insurance. insurance is a middle-man who manages a pool of everyone's money and doles it out to the folks in the pool who need it. managing the pool and doling the funds out requires a bureaucracy which in the case of medical insurance has grown to the fill thousands of office buildings with millions of people who do nothing but move information around.

yikes.

why do we even need a pool? why don't we just pay outright for medical care? because it's gotten so damn expensive, no one can afford it. why has it gotten so damn expensive? i'm not going to say i understand it 100% but i know it's got something to do with our litigation-happy society that forces doctors to carry expensive malpractice insurance, and it's got something to do the way medical insurance companies negotiate network pricing.

we could start with tort reform and with enhancing existing public health services. we could take a look at medicaid and medicare, maybe restructure those. we could take a good hard look at medical insurance. but instead of any of that, we get another layer piled on top of what was already there, and the sad punchline is that the insurance companies are getting paid from both sides.

that's right. the big winners in obamacare are the insurance companies. the means. why? because we aimed at the means and so what we got were enhanced means. means on steroids. but, still the ends are no better off. are we closer to universal health care? not yet.

it's not about old men having to pay for mammogram coverage. it's not about needing a celebrity-filled communication system to get the word out. it's not about sub-50 employee companies or part-time versus full-time. it's not even about if you like your plan, you can keep it.

it's about the winners being stockholders of insurance companies and losers being the rest of us.

we lose when coverage and care are conflated.

it's like that giant boulder rolling down on indiana jones, and it seems too big stop, and maybe it is. i know i can't stop it by myself, but i'll be damned if i won't go down swinging.


WE LOSE WHEN COVERAGE AND CARE ARE CONFLATED.





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thanks to descartes for assisting me to pull my thoughts together.

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