OK, I’ve owed this article for a long time. I was able to successfully avoid it by posting a guest article and by continuing to post reviews of podcasts on my other blog (The Podiwan – Comedy Podcast Reviews) and, truth be told, just by ignoring it. I’ve sat in the bathroom and imagined the progression of this article; talked to myself about it and had some remarkably good sentences stream through my consciousness. But avoid writing it,.. I’ve done. Now that I’m here, finally writing it, I’m still stalling with a preamble.
Fixing health care is hard.
I’ve had lots of ideas about how it could be done and each and every one of them has attached to it some hangy bits called “likelihood of happening”, “what is more likely to happen” and “the end result of such a solution”. Here are some of the possible fixes.
1. The Health Care Industry Grows a Conscience
The health care industry may be a gigantic monolith in terms of how we talk about it, but truth be told, each of the companies involved is made of people. Real humans with families, pets, health problems, loved ones in trouble, etc. They’re all the same as all of us because they are, in fact, all of us. Health care, as an industry, employs five or six million people depending upon who you count as part of the industry. In a country of 350 million people, that’s a sizable chunk. They have more people on the payroll than anybody else except the government; more than the auto industry, more than food or transportation, more than anybody. But here’s a group that’s bigger than the health care industry; the people who have zero access to health care.
What if the people in the health insurance industry started to give a shit about the rest of us? What if, as a block, the people who sit behind desks, or run the printing office on the third floor, or the math whizzes who set the actuarial tables started to care about the rest of us like we were people; like we were their family… their brothers, sisters, mothers, fathers, cousins with AIDS or kids with pediatric diabetes? What if, one day, they all decided to change the way they did business? They could still make the game profitable for the stock holders. They could still keep dancing around federal regulations and coming up with new and amazing ways to get around rules that seem obvious and moral. They could even continue to write off loses so long that they become profits. All they need to do is lower the price to something where the profit is a reasonable 20% (instead of a completely unreasonable 88%). That would let us all in, or at least most of us. They’d still make enormous profits, they be seen as altruistic humanitarians, we’d be mostly covered as a country and everybody could feel better about themselves.
If the 2 million people in health insurance decided tomorrow that they would not be the ruthless cut throats that the overlords in the boards rooms required them to be… if they all did it at the same time, they couldn’t all be fired. They couldn’t all be sent packing. The industry couldn’t just replace all of their functional people machine parts in a day or a month and boom, just like that, the world is a better place. The same is true for those other 2 or 3 million actual health care workers. They could just one day decide to care about us like we were related; Close relations. Not like creepy 2nd uncle Fitz who gets drunk at the new years and makes inappropriate jokes in front of the kids, but people you care about and don’t want to go through bad stuff. Instead of double billing or even single billing according to the outrageous billing menu they’re used to, they bill by what’s right, what’s normal, what’s appropriate. They could bring it down to what plumbers and mechanics charge and still make a killing. (Have you had a plumber out to the house recently? Those guys are doing fine.)
Or what if, at the very top, the CEOs and the Boards of Directors just decided one day to fix it themselves. They’d get together and upon starting the meeting, a person would rise and say, “I know we were all gathering today to figure out new ways to avoid human responsibility and legal regulation but I thought I’d put this bug in your collective ear. What if we fix the problem ourselves? What if we stop trying to fuck everybody just on principal and start to have some real principles that both we and our customers can respect and admire (as opposed to just having commercials that say we have principles and then we do the complete opposite).”
The other suits in the room would sit quietly for an uncomfortable moment and then their leader would begin to laugh at the absurdity of the joke, “Oh, Jenkins, you’ve still got it. You’re still the funniest insurance man we’ve ever met. Seriously though, have you lost your fucking mind?”
Jenkins would continue, “No, Schmitty, I’m serious. We could do this. We could fix it, include everybody, make ten times more money and keep the government off our backs for the next 40 years. I’ve worked out all the details. You all have a copy in front of you. It’s doable and we could start right away.”
Schmitty, being the senior man at the long shiny table, touches a small button on the arm of his remarkably comfortable chair and Jenkins is instantly immolated by a magenta beam of laser energy. There is the slightest odor of ozone in the air. Schmitty motions to Hoover across the table, “OK, let’s get back to business.”
Likelihood of Healthcare as an industry growing a conscience? 0/0
Likely outcome if they did: Nothing,… they won’t
2. The Government Forces a Solution that Works
They’ve been trying for 3 generations to get health care in this country for the least of us. To some degree we have a program that works insofar as it is illegal for a publicly funded hospital to send you away if you can’t pay. Of course, what they can do is attach your pay for the next 2 million years and try to collect. But mostly they don’t get the money and the rest of us pay for it.
But we’re not talking about a system to catch the least of us. We’re talking about a system that includes all of us, at least those of us who want to use it. Nobody is saying we have to lose private health care insurance and hospitals. We’re just saying there should be a system in place for the average person who lives in one of the richest nations the world has ever known to get some insurance they can afford and that actually did something.
We came close. About this time last year, the democrats squeezed through a bill that addressed some of the more egregious problems, stretching the activation of those changes over several years. But really, the main problems still exist. The democrats owned congress and the executive branch and they still couldn’t get a plan that the people could use. Republicans across the country immediately filed thousands of lawsuits to test the constitutionality of provisions in the bill that they had forced the democrats to include just so that they could play the constitutional card down the road. What’s more, the republicans, who now (as of Jan 2011) control the House of Representatives, have vowed to wipe away the entire thing; voting as a solid block to do so. The dems still hold the senate and the President will veto and nothing will get done and it will go on like that forever. Or at least until the republicans own both houses and the executive branch and they pass something worse for us and better for the insurance companies.
Chances of the government making a useful and helpful change to the healthcare system any time, ever, at all? Zippo, zilch.. zero.
3. The “People” Force a Solution that Works
The people tried, but the people are too easily fragmented and frightened. Good people I know who are of average intelligence or above were frightened during the healthcare fight in Washington. They heard day after day the right’s constant barrage of lies, half truths and ugly characterizations and they couldn’t help but absorb some of it. If that many people were saying that many things, so often and so vociferously, and with such ardent conviction, they might be right. These things might be true. They might actually create death panels to withhold care to old people with cancer. We might all of the sudden become Nazi Germany or Stalinist Russia, because after all, isn’t this how they all got started, with a black president who is a secret Muslim and wasn’t even born here?
We don’t have the power to force the change. We do but we don’t. We get distracted by shiny things and our attention span is about as long as it takes to get a new American Idol crowned. If we ever did focus for long enough and stayed on the point and kept our congress people on the point and forced them to understand that we not only want this but actually need it and that we won’t vote for them again if they don’t give it to us, we’d have at least a chance of getting it done, but that would still require the political folks to ignore the 50 million dollar contributors from the insurance industry and the 110 million dollar contributors from the medical lobby and the 250 bazillion dollar contributors from the pharmaceutical industry and frankly folks, that just ain’t gonna happen. There’s no point in even discussing the chances.
4. An “Angel” Fixes it For Us
This is really the only one that can work. By angel of course, I’m not thinking of Christian dogma beings with powers. I’m speaking from the financial investor version of the word. In trying to get new inventions to development and then the market, sometimes you need what is called an angel. They put up the money. They’ll get a giant piece of the other end but they may actually be doing the whole thing for mostly altruistic reasons. They’re already rich. Their money is safe and they just want to help new people climb the ladder. If they make more money in the long run, all the better. Angels differ from the standard investment groups looking for new inventions and technologies in that you make be able to retain control of your invention or your company. The standard Investment Capital groups are going to take 99% of your company, product, idea, whatever. You’ll probably still get rich, but your thing is theirs now and you can’t have it back.
How does this connect with our conversation about fixing health care?
How about this:
Bill Gates, George Soros and Warren Buffet represent together as a group in just their personal wealth (just their money, not money they control within companies) about a third of a trillion dollars. You could, if you wanted to, with that kind of money, start a new Healthcare Giant; an insurance company that everybody could afford and whose primary purpose, was not to make money, but to self sustain and provide actual, usable and affordable healthcare for people. In fact it could be done with a small fraction of the money represented by that group. It could be created as a non profit with simplified forms to stream line the medical billing. It could be built with the idea that A) doctors and patients should decide what course of action is appropriate, not insurance companies and B) anybody who is caught cheating is out for life; doctors, patients, hospitals, lawyers, whoever. Fuck with the system and you’re out on your ass… forever.
It could be announced and explained on a two minute Super Bowl commercial. People and Doctors would flock. Companies would, at the end of their contracted periods for coverage with old style companies, migrate their entire employee force over to the new system because it could save a company like GM a billion a year and then they could lower the price of their cars and compete with Korea, China and India (and win because we make better cars and now we can make them cheaper, too).
Best of all, as soon as the other, older companies in the industry saw the writing on the wall, they’d have to fix their plans or die. They’d have to compete which would mean that they would need competitive pricing and competitive products. They’d have to trim the fat in their corporations and find a way to live on something less than 88% profit, but they could do it. Some might not, opting instead to move their money into a different industry. Some might fight it in congress but would eventually lose. But eventually, inexorably, the system would fix itself. In ten years time, we’d marvel at the new system and how well it worked and we’d wonder how we ever allowed the other thing to happen.
What are the chances of this happening? Who knows Bill Gates, Warren Buffet and George Soros? Anybody? Maybe Steve Jobs can be pulled in. He’s really familiar with the healthcare industry, in that he has a great plan for himself called being rich and great plan for his employees called being well compensated employees. See if you can get any of these folks on the phone. Send them this section of this article. Start an email campaign or a facebook tsunami. Create an impassioned plea on video and put it on Youtube. These guys are rich beyond belief. They have so much money that they are actively trying to solve world problems because they can. They have the wherewithal and they have the condition known as rich guilt. They know that so much wealth pooled in one place creates a great inequity in the system and they want to make positive changes in the world. We’re in the world and we need positive changes.
Get on it people. I’ve done the hard part. I thought of it. See if you can get a few ultra rich angels to bankroll our future healthcare system and make the old system change in the process. What have you got to lose? The system couldn’t be worse than it is now. No system at all would at least save money so even that would be better than what we’ve got.
Go for it. On your mark, get set… GO!