Bandolero is going to take an opportunity here to be more serious than usual. The insanity that had been tightening its grip on the pre-Harvey nation had become a source of burgeoning perplexity to El Bandolero, not to mention a source of rare confusion. Radicals on the left behaving like neo-nazi stormtroopers, radicals on the right behaving like neo-nazi stormtroopers, fascists and antifascists with no distinguishing features, monumental insanity, the silent majority holding its hands over its mouths in a hushed yet deafening “oh my! oh my!” And then Bandolero stumbled upon an article that took the whirlwind of bewilderment and incertitude from his mind and crafted a paen to reason and rationality. And here it is: A Nation Gone Daft, by Ronald E. Yates. You should read it. Twice. At least. If you can’t read, ask a family member, neighbor, friend, pastor or other spiritual advisor of your preference, or interpreter if you don’t know English, to read it to you, unless you’re deaf, in which case you’ll need to find somebody who can sign it to you in your language.
El Bandolero, as you all know, is a conservative among conservatives. But, we watched Ted Cruz on Face the Nation this morning, and could only stand up and shout, “You goddam sleazy fuckwad!” He was trying to defend the Senate health care bill, and made a big deal of saying that it’s unfair to saddle young people with the cost of other people’s pre-existing conditions. This simply, and most clearly, shows that the politicians in D.C. are still lying to us and still not doing anything constructive to actually fix the problems that permeate the health care industry.
Insurance, Mr. Cruz, is the means by which the risk and cost of something are spread over a big pool of participants, so that everybody can be covered when risk becomes reality for a few. When you allow insurers to segregate groups based on what each group’s anticipated medical cost is going to be, and then set each group’s premiums based on its anticipated cost, then the people who need insurance the most will be the people who can’t afford to have it. You aren’t fooling Bandolero with vague assertions that you’ll have some sort of credits or allowances so people with pre-existing conditions can still get the treatment they need.
Consider the logical end point of Mr. Cruz’s argument. Logically, why stop with creating subgroups (such as people with pre-existing conditions) of the big group? Why don’t you just say that each person’s premium should be based on his/her personal risk? Set their premium for this year based on what their medical expenses were the previous year. Now, that’s fair! You stay healthy, your premiums will be next to nothing. You get sick and become a burden on the system, you pay for it! Of course, that’s not “insurance”. The idea behind insurance would be, for example, to spread a person’s $10k of medical bills over a million people. When you start creating “high risk” groups to make them pay more so the larger population can pay less, you’re perverting the concept of insurance.
Of course, if what you’re really after are the voters in that very large group of young healthy people, well, you’re obviously going to be working on ways to show them how you reduced their premiums. Not enough sick people are going to suffer and die to affect the election. You goddam sleazebag!
Bandolero now finds it necessary to support the concept of single payer coverage. The fairest approach for EVERYBODY is to have EVERYBODY covered by ONE policy that covers EVERYTHING. That way, the cost of paying for EVERYONE’S health care is spread over the LARGEST possible number of people. Why is this fair to young people, you might ask? They may very well be paying more in premiums than what their own health care would cost if they had no insurance. Well, dumb-ass, it’s fair because down the road, when they turn 50 or 60 or 70 and suddenly find themselves diagnosed with leukemia or dementia or whatever, they will have the coverage to pay for it.
The challenge with single payer is the administration of it. Bandolero cannot imagine entrusting it to a government agency, whether at federal or state or even municipal level. Frankly, Bandolero often finds himself looking back fondly at what was, once upon a time, AT&T’s monopoly of the phone system. Bandolero suspects that a similar capitalistic health care insurance monopoly subject to appropriate government regulation may be the way to go. It may have been a monopoly, it may have had power to squelch competition, but everybody had a phone, we took them for granted, and we had the best phone system in the world. Aside: Remember TPC (The Phone Company) in that terrific movie, The President’s Analyst?
If you want to penalize certain groups of people and make them pay more because they are a higher risk, then penalize the people who create their own higher risk. For example, make smokers pay more. Make sky-divers pay more. Make people who consume alcohol pay more. Bandolero has no problem helping to pay for medical care for people who have cancer. Bandolero has a problem helping to pay for people who have cancer because they preferred cigarettes over health; or paying to set broken bones for people who get drunk and crash their cars. (Although, statistically, it’s the drunk person who’s more likely to walk away uninjured, leaving sober victims mangled or dead)
What Mr. Cruz hasn’t done is ANYTHING that addresses the ANTI-TRUST and PRICE-FIXING practices of the pharmaceutical industry, the insurance industry, and the medical provider industry. These are the NEW BIG 3 who conspire to make the big decisions that screw the health care consumer. Fifty years ago the BIG 3 consumer-screwers were Ford, General Motors and, um, who was #3, anyway? Chrysler? It wasn’t American Motors. We know what happened to American Motors. If Cruz, et al., are unwilling to go single payer, they’ll never get a handle on insurance premiums until they get a handle on the NEW BIG 3. This failure is primarily why Obamacare didn’t work. And it’s why your plan won’t work; aside from the fact that the needs of the citizens are not the focus of the politicians; their focus is on getting votes in next year’s elections.
No, Cruz and his ilk (by “his ilk” I mean virtually every elected politician in Washington, D.C.) are not making any good faith effort to fix health care. They are making every sleazy effort to create sound bites that appeal to the people whose votes they are focused on for the next election. YOU ARE A SLEAZEBAG, MR. CRUZ! You have an opportunity to convince us otherwise. We can only hope you will take advantage of that opportunity. But we’re not holding our breath.
Sen. McCain was also on the same show this morning. Good lord, he needs to retire, soon. We supported him back in his presidential bid, although we were already starting to see the signs then. The signs now are quite clear. He is far more dangerous than Donald Trump. But that’s a topic for another post.
So the Republicans scramble to deliver their replacement for Obamacare but all they’re doing is cobbling together a bunch of talking points instead of creating a plan that will actually improve the delivery and payment of medical services. They have not addressed the deep rooted anti-trust issues that infect the entire system. The triad of Providers-Pharmaceuticals-Insurers will still rake in the bucks at the expense of the consumers. There is still no transparency that will enable consumers to make informed “free enterprise” choices among the various insurance policies that will be offered under the “new” health care plan.
Everyone knows that Bandolero is a strong proponent of free enterprise, and a strong opponent of government regulation. But unfettered free enterprise leaves the door open for abuse. This is because free enterprise at its roots is fueled by self-interest that easily becomes greed. Anti-trust laws make the free enterprise players responsible for abusing the liberties that make the system work. Self-regulation has rarely proven up to the challenge of keeping participants in line. Those that become more “successful” should be rewarded for their success, but not rewarded for abusing the power that success confers, particularly in regard to shutting out the less successful and disabling their ability to play on a level field. Unfortunately, there’s no oversight that can work other than oversight by government. Consequently, this is one area where Bandolero can support a role for government regulation. And, appropriate government regulation has to be a primary ingredient of any new health plan. Nobody other than government has a chance of breaking the triad’s grip over the health care industry and its ability to manipulate the system to assure that they will continue to get rich at the expense of the health care consumer.