It’s a healthcare shipwreck!

Some people that know how I spend my days asked me if I built the model of the USS Gerald Ford that was in my last post. I did not, but I just finished this after one year of work. It’s a hobby not a job!

 

It is a model of the English Navy Royal Ship Revenge built in 1577. The original construction plans still exist so this is a faithful reproduction. Its race (we would say razed) built construction method revolutionized warship construction and was used for the next 300 years. She displaced about 400 tons (rating her a galleon), was originally fitted with 46 guns and was crewed by about 250 men. For a time it served as the flagship of Sir Francis Drake after his return form circumnavigating the globe. He called it the most beautiful ship in the world. It took part in defeating the Spanish armada in 1587, but was ultimately captured by the Spanish in 1591 near the Azores. As defeat became inevitable, her Captain, Sir Richard Greenville shouted:

“Sink me the ship, Master Gunner—sink her, split her in twain! Fall into the hands of God, not into the hands of Spain.”

The officers refused the order and she was given over to the Spanish who wished to take her to Spain. She was heavily damaged and thus was unable to survive when a storm hit soon after her capture with, it is thought about 70 souls aboard. The Spanish were immediately able to raise 14 guns and in subsequent years several more guns were driven ashore with the last gun being raised in 1625. Lord Tennyson described her final battle in the poem The Revenge: A Ballad of the Fleet.

…The sailors say Brandie you’re a fine girl what good wife you be, but my life, my lover, my lady is the sea! Enough about my weird hobbies.

There are two institutions in America that I have spent my entire adult life trying to avoid, the criminal justice system and the healthcare system. Through my own decisions, endeavors and perhaps a little luck (been some dubious Friday nights), I have successfully side stepped any contact with the criminal justice system. I have no idea how it works, but as a casual observer of American life it would appear that once you become entangled in its web, your ability to pursue happiness is greatly impaired.

Back in the olden days, when my wife and I got married, the great state of Tennessee required that you get a physical prior to obtaining a marriage license. Now that I think about, I wonder if that is true or just something my wife told me. I should look that up. Anyway, after I got that physical, the next time I saw a doctor was when I turned 50 years old. (that’s 27 years) This time it definitely was at the insistence of my wife. I reluctantly agreed to go mainly because we went to high school with him and I hadn’t seen him in a long time. He put me on some blood pressure pills and told me to quit smoking and lose some weight. Brilliant!

Turns out I was right to try and avoid America’s healthcare system, it’s a serious mess and any day spent at the doctor’s office also greatly interferes with the pursuit of happiness. I wish I could say that my clean living was the reason I never got sick or needed the services of medical professionals. The truth of the matter is, I suppose, that my forbears, being of hardy stock and possessing the indomitable American pioneer spirit endowed me with working parts that have served me very well for 60 years. No idea how long they will hold up but eventually the healthcare system gets us all.

My family has always had health insurance from one source or another. For most of my working life, we like most Americans, have had health insurance through the workplace. After my last employer retired me and my wife had no access to employer provided insurance we signed up on the healthcare exchange. It seemed like a blessing, it was so easy. The first year our premiums and deductible were, I thought very reasonable; last year we saw a significant increase in both and this year we will pay over $17,000 in premiums and have a deductible of about $13,000. This is more than we pay for our mortgage and because we have worked hard and attained a decent middle class income we do not qualify for any subsidy. (do I sound like a conservative?)

In effect we have catastrophic insurance that just so happens to pay for two or three healthily visits per year. Brilliant! My conservative friends have had a good chuckle over this and remind me that they told me at the time the whole Obamacare thing was a bad idea. Very helpful. How did we get here?

You can see why I have been watching with great interest as the Republicans have promised to fix this mess. I am very excited that somebody is finally going figure this out. I have my fingers crossed – go Republicans!

Here are some things 45 said on this

Sept 27th, 2015 on 60 minutes

“I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.

Nov 13th, 2016 on 60 minutes

“It will be repealed and replaced. And we’ll know. And it’ll be great health care for much less money. So it’ll be better health care, much better, for less money. Not a bad combination.”

February 27, 2017

“Now, I have to tell you, it’s an unbelievably complex subject,” nobody knew health care could be so complicated.”

He is so on this!  45 putting people above politics!  Can hardly wait to see this brilliant plan!

But wait!

On March 6, 2017 Speaker of the House of Representatives, Paul Ryan, publicly unveiled the American Health Care Reform Act

Here are some things he said about it on March 7: bold is mine

“Our goal is to give every American access to quality, affordable health care. For families, that means lower costs, more choices and greater control.”

“Next, and this is important, our plan ensures there will be a stable transition. As we move from a Washington-driven system to a more vibrant market, we will make sure no one has the rug pulled out from under them.”

“Republicans have long said that we have to empower patients as consumers to spur competition and bring down costs.”

“Ultimately, we need a real marketplace for health insurance. Currently, the tax code discriminates against those who don’t get coverage through their employer.”

Everybody calm down. 45 didn’t really have a plan he had talking points. Paul Ryan apparently had a plan, although since its release, it seems to have been developed in a vacuum. Nobody likes it.

It is definitely a Republican plan. Note the references to competition and free market principles. Free markets work well for most aspects of a capitalist economy. Transactions are executed between private parties (sellers & buyers) without interference from a central authority. You should try it Vladimir. What do they mean by access? I have access to many things in our economy.

I might decide to go shopping tomorrow for a Cessna Grand Caravan, it’s a hell of an aircraft. The salesman will probably be nice to me (I have many choices of airplanes to buy, its a vibrant market) until he figures out I’m just a poor Tennessee boy. Having access is not the same as having capability. I have heath insurance, I don’t have an extra $13,000.

Do these free market principles apply to the American healthcare system? Can they ever apply or are the Republicans trying fit a square peg into a round hole, while the Democrats try to transform us into some sort of weird socialist country like France? Anything but that! Please!

About the time Hillary was trying to reform healthcare in the 90’s, my son cracked the top of his head open. He came running into the house, his head a gooey mess. It’s off to the nearest emergency room. I did not ask how much it was going to cost to close his head back up. What if I did? What if I said I couldn’t afford it and we were going to have to shop around or I’ll just have to take him home and see what happens? It probably would have healed up OK, who knows?

My guess is they were not going to let me leave with this child and his busted open head. They may have even called the authorities on me and I would have then been entangled in the dreaded justice system. It’s all connected.

Not exactly a free market transaction. We can’t decide in this country if healthcare is a right or just another free market exchange. Until we do, I fear we are not going to figure this out. Repeal and replace, no matter what form it takes, is only going to swat at the edges. Throw in the complicating factor of third-party pay and all of sudden nobody knew how complicated healthcare was. Brilliant!

Don’t get me started on pharmaceuticals. If you are sick and the doctor says there is a pill you can take, do you ask how much does it cost? No, I don’t either. This violates the fundamental law of a free market economy, supply and demand. Theoretically, all transactions are negotiated between the buyer and seller and over time the market establishes the correct price based on the supply and demand for that product at any given point in time. Drug companies know you will demand their product no matter the cost, so guess what? Again, not exactly a true free market transaction.

This is the Tennessee headquarters of Blue Cross Blue Shield. Nice building, and they have nice buildings like this all over the country. I could not begin to guess what buildings like this cost but I bet it takes some serious coin. Looks like a comfortable place to spend some weekdays. Wonder if they are hiring. The wife could use another job, these healthcare premiums are interfering with my lifestyle choices.

AIS Health is a publishing and information company that provides the healthcare industry with relevant and focused information. Here is a recent report:

“Thirty-three people who served as the CEO of a Blues plan for some or all of 2014 collectively earned more than $26 million in salary and about $102 million in total compensation, which includes bonuses, 401(k) retirement contributions and other incentives.”

Is it safe to assume that the money for these fancy buildings and executive compensation packages come from the premiums we pay for health insurance? Blue Cross is only one of many of these insurance companies and I am sure that they employ many thousands of good, hard working Americans. They deserve to work in nice spaces and I do not begrudge anyone for making a good living. But!

 This has to contribute (even if it is just a little) to the rising of premiums and deductibles and I think we ignore this at our own peril. The healthcare third-party pay system is a relatively recent development in American life and it evolved out of accident insurance policies that were offered in the late 19^th century. At that time health care was a fee-for-service system. People paid out of pocket directly or bartered for the medical service they received. Sounds like a free market system. Just like buying an airplane.

My wife’s great-great grandfather, Dr. Jasper Newton Tabler was the doctor for a company building a tunnel in King’s Mountain Kentucky in 1874. There were 400 men working on the tunnel and each single man had 50 cents per month deducted from his pay and each married man one dollar. This money was turned over to doctor Tabler who was then obligated to treat any man and his family that needed treatment.

As technology began to improve and costs began to rise, many doctors and hospitals began to adopt a similar system as the tunnel company and encouraged people to pay into an account to cover future costs. It was this system that ultimately evolved into health insurance. The only other prevalent third-party pay industry I can think of is restaurant servers and very few servers think of it as a career. Strange bedfellows!

Health insurance as we know it today, an employer provided benefit, was developed during World War II when the labor market was tight (where have all the young men gone?) and the government imposed wage controls. It turned out to be a good way to attract workers.

The problem now is more and more people are losing employer provided health care especially since the economic downturn of 2008. We come back to the issue of rights versus obligations. Today for the most part, if you can’t pay you get service anyway (think gooey head) and that has to drive costs up for everybody involved, you and me, your boss, the doctor, the hospital and even the insurance companies.

 It is not supposed to be this way!

 I hope both my liberal friends and my conservative friends will agree that the status quo cannot be sustained. I hope they will agree we need to change the discussion and focus on the underlying issue. Is healthcare a right or not? If it is we have to figure out how to pay for it, if it is not we have to refuse service to those that can’t pay. That’s a free market. (no money, no airplane) Not a good choice. Not a good place to be, but here we are.

Until we figure this out, until we decide at last what kind of country we want to be this is not going to get better. We are going to continue to argue and bicker over changes that fundamentally change nothing. Some people can pay, some can’t.

I believe that healthcare is different. Free market rules cannot apply, if they do people die. Are we really going to be OK with that? I come down on the side that in a country as rich as America, a country whose founding principle is the free pursuit of happiness that we must declare once and for all that every American has a right to the best healthcare in the world.

If that means a single payer system, so be it. I don’t see how it could possibly cost me anymore than I am paying now. I am certainly open to suggestions; I have no interest in turning our country into another France but neither can I be comfortable telling good hard working Americans they only get the healthcare they can afford. What kind of country do you want to live in? If wanting to live in a country that values compassion and realizes that charity extends beyond the grave makes me a left wing radical, then it’s a label I can live with. I wonder if this might apply?

They that go down to the sea in ships, that do business in great waters; These see the works of the Lord, and his wonders in the deep.

For he commandeth, and raiseth the stormy wind, which lifteth up the waves thereof. They mount up to the heaven, they go down again to the depths: their soul is melted because of trouble.

They reel to and fro, and stagger like a drunken man, and are at their wit’s end. Then they cry unto the Lord in their trouble, and he bringeth them out of their distresses.

He maketh the storm a calm, so that the waves thereof are still. Then are they glad because they be quiet; so he bringeth them unto their desired haven.

Oh that men would praise the Lord for his goodness, and for his wonderful works to the children of men!

Psalm 107

We have to find a way to calm the storm.

Thanks for letting me vent, thanks for your kind words of encouragement as I try to sort it all out and above all thanks to my conservative friends for disagreeing with me with loving hearts!

Love to all!