Politics: Health Insurance is not the issue

Can we stop talking about it already? The insurance industry is not actually the problem with our health system in the US.  It’s a symptom. And not even the worst symptom – it’s like the rash that it super-annoying-but-in-a-super-difficult-spot-to-scratch-so-you-can’s-scratch-anyway.

I have talked about this with a lot of people. From “I hate everything ACA because it ruined everything” to “Medicare for everyone! Yay Bernie!” the people who actually want to solve the problem can be brought around that health insurance companies are getting screwed too.  And yes, they are making a sick profit and we can talk about the evils of capitalism – but insurance companies are in a terrible place where they are taking on risk and financial burdens with (theoretically) no hope of a 100% positive lifespan.  I mean, what percentage of people never go to the doctor until they fall over dead? Oh, and then death is hardly free – so…. yeah, they will pay something I’m sure.

My best (and newest) argument is the another insurance most people will probably have (at some point in their life):

The Car Insurance Argument

The best graph I saw was here (https://www.confused.com/car-insurance/price-index):

Yes, it’s in pounds not dollars, but it stacks up with what Consumer Reports, CBS, and others are saying (but they don’t have a pretty graph). But look at this – huh, since 2012 it hasn’t actually changed THAT much, and it isn’t just a “steady uphill.” Much less a “damn those are some big jumps up in price” that health insurance has seen.  Also, if you read these articles I linked – almost all of them cite higher payout amounts.

It’s like when people get claims against bodily injury…. healthcare is damn expensive.

So why aren’t car insurance companies gouging the public like healthcare? I would argue because: they can’t.

It’s all in how car insurance is calculated.  My car insurance is calculated by value of my car. And the car industry is relatively competitive (or at least we can argue about that industry another day. Let’s keep the assumption “competitive”).  So if my car is worth $25k to replace, the car insurance quote will be significantly lower than if my car is $65k to replace, the 1st care will pay less in insurance.  Equally, if there are 2 cars which would each be worth $25k to replace but one averaged $1800/body repair and the other is $600/body repair…. 2nd car is cheaper insurance.  The insurance industry takes a lot of factors into consideration, but at the end of the day they aren’t drastically raising prices because it is tied to the value of the car they are insuring.

I don’t think it is entirely that simple, but let’s talk about the value of human life. If I am insuring my child – just what is my child’s life worth? My spouse. My parents. Myself. What is the value of my life? There is no ceiling. There is no competitive market. I can’t buy a cheaper life instead or a more reliable body (God, wouldn’t THAT be nice!)

Profit on Health

This leads to the second argument I have against insurance being the problem. When you compare similar procedures, they are unequal.  You can Google other sources for yourself (seriously – LMGTFY) but I liked the Investopedia article I found that talked about comparing procedures.  Here is an example:

For example, the average cost in the U.S. for an MRI scan is $1,119, compared to $811 in New Zealand, $215 in Australia and $181 in Spain. However, data showed that the 95th percentile in the price of this procedure in the U.S. was $3,031, meaning some people are paying nearly $3,000 more for a standard MRI scan in the U.S. than the average person in Australia and Spain.

Um. What?!? Why is an MRI over $1,000 in the U.S. and $200 other places?  Supposedly it’s a “cost of living” issue – which is BullShit.  New Zealand is damn expensive to live and THEY pay 20% less that the average American.  Hell, can you imagine how difficult it must be for a hospital in New Zealand to order an MRI machine? Somehow I don’t see that being a huge industry on the island… they have to import that super-specialized piece of equipment and they they pay less than I do?!?!

As fancy as MRIs are – they have been around since the 70’s.  Why is 50 year old technology still so expensive? It’s not like it’s Ford Pinto and not producing new ones any more…

Oh, and the US has more MRI machines per capita that any other country except Japan. (like 36/1m people): https://data.oecd.org/healtheqt/magnetic-resonance-imaging-mri-units.htm

There is something WRONG with prices for care in the US.  I couldn’t find a single example where the US pays less for a procedure than any other country.

Access, Choice & Insurance

This leads to an absolutely red-vision-inducing part of the argument and where I tend to lose my conservative friends. And by “conservative” in this sense I mean Randian – lost-in-the-love-of-Capitalism-can’t-see-other-systems’-benefits friends (of which yes, I know a few people.)  Healthcare is not a market in the capitalism sense.

There are two sides to this, and the first is this: when there are no options, it’s not a market which the “invisible hand” can assist.  And when I am unconscious, I have no options.  In fact, if you are put in an ambulance, they frequently will take you where they want – to hell with your protestations.  You can’t drive, you can’t really choose. This means there is no “shopping around”

Ok, so take out emergencies and you still have issues.  Let’s take the previous MRI example – I live in Atlanta where there is a plethora of hospitals and “stop shops” where I might be able to get a non-emergency MRI. I theoretically should be able to shop around. This assumes I can get an answer.  There is a huge issue that a lot of places don’t have published prices.  This is there the red-vision starts to happen. They base the price on variables like “what percentage will your insurance pay” and “how many times was this aspect requested this week” and “who is your insurance provider.”  So even though they have a computer program and they just “enter a code”  – it isn’t the same price for everyone because they don’t HAVE a set price.

Yes, for non-emergency procedures I might be able to shop around.  I might not. As much as we have 36 MRIs per every million people, they aren’t evenly distributed between those millions of people.  This isn’t even taking into account the time & effort it might take for someone who is sick to find that “cheap” MRI. Telling someone who can barely drag themselves to the doctor in the first place to “call around” and “price shop” sounds like the kind of drivel spoken by someone who is either (a) never really been sick (b) never had to do the leg work themselves or (c) both!

Oh and all of this assumes choice.  When I lived out in Between, GA (yes, it’s a real place) – the nearest hospital was 25 minutes by ambulance. And there was none of these “shop stops” for things like x-ray and MRI.  There was no choice whether it was emergency or not.  Shopping around when you are ill (ill enough to need an MRI) just might be cruel & unusual in my book.  When I’ve had pneumonia – shopping around to get the x-ray my doctor needed so she could prescribe the medication I needed was impossible. I did not have the energy. And no, asking my mother or my husband or my friend… That is a bullSHIT argument from A to Z – why should someone sick have to do more than “THAT is the nearest source of health, go get it!” is beyond me. Would you really expect your parents, siblings, spouse or child to go through that kind of hell?

No? Shockingly, you think they should get treatment ASAP when they are sick enough to need it?  Shockingly, you think no parent should watch their child gasp for breath with a fever of 104? Nobody should have to suffer through 3 hours of a broken arm? Nobody should wake up after getting hit by a drunk driver to hospital bills the insurance refuses to pay because they went to the “wrong” hospital?

Excuse me while I sit in the corner screaming into my pillow.

Ok, I’m going to take a moment and put this here:

What I want my Legislators to Do!

This is actually simple. I want them to ignore health insurance.  Yes, ACA is broken. I think we can all agree it wasn’t the fix that it’s strongest supporters hoped for (though I never remember hearing anyone saying “omg. this is gonna fix EVERYTHING” – the strongest supporters seemed to say “We think this is better than doing nothing.” which is actually kind of sad).  But whatever the hell the GOP is trying to pull right now – it isn’t a fix either.

I want my legislators – congressional representatives – to stop looking at health insurance and start looking at health care. And I have heard some arguments that by privatizing all health insurance/costs people would begin to see what those costs are and be more consumer-like and “shop around” but this is more BullShit.

If I am having an asthma attack and an ambulance shows up. I can’t argue which hospital they take me to (literally & figuratively). Much less if I am in a car accident and need to go to the only trauma center in a 100 mile radius.  Or if I’m just unconscious. Or if my child is dying in my arms. I’m not going to “shop around” – what kind of cold blooded disgusting human would EVER think this is an argument?

If you can accept that shopping around in an emergency is inappropriate, then our system is broken.  This is not a market which the philosophy of capitalism works with. Much less our duct-tapped version of capitalism. Insurance compounds it, but I don’t think it’s the root cause of the breaks.

I don’t know what “the” answer is – but I know that repealing ACA and just talking about “insurance” is NOT it.  The GOP has had 7+ years to talk to people way smarter than me and come up with answers.  I’m disgusted that they haven’t. ‘Cause they haven’t – they have made it clear with every press conference since Nov.  I expect my legislators to stop blaming ACA – which was never supposed to be a final solution- get off their collective ASSES and FIX THIS SHIT.