Tuesday, August 1, 2017

Intro to Ben's Care

If you are young, reasonably healthy, have a decent job with employer-paid health insurance, you may well wonder: why is health care such an important political issue in the United States?  But you may know the answer anyway: 1) too many Americans have no access to health care because of poverty or bad health, and 2) over-all, health care costs our economy way too much (17.8% of the GDP on its way to 20% by 2024).

But before I begin my pitch, may I ask you about your last doctor visit.  Do you know how much your doctor billed your insurance?  Do you care how much he or she billed your insurance?  How much would you care if you had to pay for the visit yourself?  And knowing how much he or she charged, would you have made the appointment in the first place?  No, really, answer these questions honestly before reading on.

Onward.

The state of health care in the United States today is that the Republicans have sworn to repeal and replace Obamacare, and the Democrats are committed to defend the Affordable Care Act.  There is some irony here as the philosophy behind the ACA / Obamacare is honestly more Republican than Democratic.  Indeed, ask any activist Democrat, then or now, what health care in this country should look like, and all of them will say “Single Payer, Medicare for All.”

I am not here today to defend the ACA or Single Payer.  I believe there is a better way; call it Ben’s Care (“Ben’s Care” is merely a place-holder name; it will be replaced with a real name by those who take ownership of it.).  I am not naïve enough to believe that Ben’s Care might be proposed and approved by a Republican White House, a Republican Senate and a Republican House of Representatives.  But, if Democrats wait for politically perfect conditions, they will not be prepared when the time is ripe.  They should begin to prepare now.  Imagine if Democrats had their own proposal to replace Obamacare!  Wouldn’t that make an interesting 115th Congress!  But Ben’s Care is not just Democratic thinking, and I am sure that we could get some Republicans to co-sponsor it.  If only because it is the best idea for health care in the United States that has been advanced so far.  And because Republicans don’t want to look bad with no replacement for Obamacare.  And Democrats would get the lion’s share of the credit for the plan if they propose it first.

So, let us now talk about Ben’s Care.

There are two premises that underlie the thinking of the health care paradigm that I call Ben’s Care.  One is that the cleanest way to cover every American’s health care is to make it a government program that is paid for by general taxes.  No one has to sign up for anything, they are just covered.  Everyone is covered.  This is Democratic thinking.  The second premise of Ben’s Care is that the reason that the cost of health care in the United States has exploded from 5% of the GDP  in 1960 to 17.8% of the GDP in 2015 is, in a word, health care insurance.  It sounds like I am building a case for Single Payer, doesn’t it?  No, because Single Payer is health insurance, too, just government insurance rather than private corporate insurance.  Imagine for a moment if people had to pay out of pocket for their health care!  Imagine what would happen to the cost of Lipitor, a cholesterol Rx drug that goes for $320 / month.  If patients had to pay out of pocket for this drug, can you imagine that its price would remain $320?  Who would buy it?  If a glaucoma patient was billed $800 for a 30-minute visit four times / year, can you imagine who would stay with that specialist?  When insurance pays for everything, no one cares how much anything costs; and costs inevitably increase until reality sets in and no one can afford the insurance anymore.  When we have to pay for our own health care, it won’t take long before medical providers and drug manufacturers begin to charge reasonable prices that regular people can afford.  I hear you asking, “What about those medical emergencies that few people can afford, what about them?”  I did say the government is involved.  The government will help pay for medical care when individuals begin to suffer financially from the expense.  The Republican part, where Supply and Demand are in control of health care costs.  But the government comes to the rescue before disaster strikes.

Any questions so far?

Now for the gory details of Ben's Care!