HCR -- Arguing While We Wait...

By John Ballard

It's gonna be a long summer as everyone waits for the Supreme Court to make historic decisions about PPACA. Three days of arguments last week revealed a far more partisan divide among the justices than even the most Conservative of well-informed legal experts had predicted. It turns out that most of those esteemed thinkers reside more in academia and think tanks than the more Machiavellian world of politics. And even though Supreme Court justices are the least likely of all our political creatures to be influenced by politics, when all is said and done they are all still products of a political exercise.

Over at The Health Care Blog the blogmaster reblogged from another site a post by blogger and health policy consultant Robert Laszewski with the whimsical title What If We End Up with a Health Care System Like the One they Have In New Jersey?  That was posted Friday, less than 48 hours ago, and in the course of two days has attracted over seventy comments. Thanks to Google Reader and an opening in my schedule, I was able to get to the head of the comments line.

The current crop of news has several high-profile stories that have captured the attention of the public. The news business, like the weather, mixes excitement with boredom l depending on what's happening next, so like expectant family members in a waiting room a lot of viewers and readers are nervously looking for something to do as they await outcomes.  Five or ten years hence we will look back on this time knowing whether or not the US, Israel or Iran started a war, whether gas prices went up or down or Trayvon Martin's killer got away with murder. We may shake our heads in disbelief that so many everyday folks continued to be in denial about climate change or took seriously the apocalyptic images the GOP is crafting to fan the already hot fires of bigotry and suspicion animating opposition to the country's first and only Black president.

So to pass time waiting to find out what the Supreme Court will decide in the matter of PPACA, individual mandates, severability and such I give you my little essay from the comments thread at another blog. (I see no need to use italics since I am quoting myself.)

After thinking more about the matter, I am coming to the conclusion that mandates, both federal and state, are nothing more than red meat for the insurance business. The law was carefully crafted to allow states to retain a significant measure of control by establishing exchanges, but even then there is no mechanism aimed at capping health care inflation.

The adverse selection argument is easy to grasp. Unless everyone is in the risk pool some will always game the system. If getting insurance is optional but sold with guaranteed acceptance, what�s to stop anyone from picking up a policy after they get sick or on the way to the emergency room?

A smoke and mirrors game is going on to distract both consumers and taxpayers that the real driver of medical costs is not how best to cover the uninsured but at what point to either stop or limit treatments and/or make providers quit putting such outrageous numbers on their bills.

I can hear the screaming already about tort reform and defensive medicine, but sooner or later the only way that real costs will get controlled is that an actual safety net, clearly defined AND LIMITED is going to have to come into existence in the US, same as in most of the rest of the world.

Some countries have a pitiful safety net because they are too poor to provide anything better. Others, like Canada, have a Medicare-like plan for all that only costs about eleven percent of GDP, is tax-supported and the object of well-known spitballs from US talk show hosts and Conservative pundits, and the UK and Germany have a hybrid of both. Private insurance is not allowed in Canada, but private alternatives in the UK flourish.

In all cases those at the bottom of the economic ladder are more or less cared for some kind of way, poor though it be. The best we have come up with in the US is Medicaid, and although states may negotiate rates with providers the national picture is a Duke�s mixture of plans ranging from excellent to embarrassingly poor, all of which are supported more with federal funds than from the respective states.

Even under this plan, states want to have the money with no strings attached. I can�t speak for others, but I have no confidence that in my state that money will be appropriated any better than the local option sales tax or highway tax money� all of which is tossed into the general fund (following the federal example of how our Social Security taxes have been �borrowed� for other purposes, replaced by that so-called �trust fund� that GW Bush called worthless IOUs in a file cabinet in West Virginia).

As the years pass I�m getting closer to the time in view of human mortality, when medical care will be a total waste. When I think about my children and grandchildren my only hope is that they will be blessed with good health and no serious accidents. because absent some serious changes which I have yet to see coming, they won�t be able to afford insurance anyway other than a very high deductible policy.

Why? Because I sure don�t see any evidence that providers are competing to treat sick or injured patients at lower prices. I hear the advertisements (some even disguised as PSAs) trolling for new customers, inviting the public to get screened for all kinds of medical problems of which they may not be aware. Paranoia is being marketed wholesale when demonstrable problems like substance abuse and all those �non-emergency� cases clogging the ED are multiplying in their face. TV ads invite Medicare beneficiaries to call for a �free� motorized chair or scooter, even to get a free something or other for taking that initiative.

I see the private sector flush with success as literally millions of Americans are going without basic care. The system we have now is an economic and social train wreck and the arguments I�m hearing have more to do with how to limit care rather than figure out ways to make it more accessible to those who need it most, most of whom are the working poor and their children.

And all the while the insurance industry smiles in the corner like a cat watching a mouse, knowing that no matter which way the cookie crumbles they will still have a profitable piece of the action.