Health Justice NOW (II) What We Want

Timothy Faust’s philippic against the US healthcare continues with what we (everybody but the private-insurance infrastructure) really want.

The bloated, impenetrable ACA was originally intended to massively subsidize private companies and hope they’d consider insuring sick people in exchange. Instead, it’s being used to massively subsidize private companies without guaranteeing the insurance afterward. This is the natural consequence of compulsive compromise and the fetishization of incomprehensible “data-driven” policy. It is a murder at the hands of a legion of prissy policy people, a death by a thousand paper clips. (page 79)

That health economics is a hard science is a fantasy peddled by health economists. Even the greatest text in the field, Pricing the Priceless by Joseph Newhouse, is as much philosophy and theory as it is mathematics. Forecasting the utilization of healthcare is as precise as forecasting the weather. But I don’t need to know what happens tomorrow to know what’s happening today, and what’s happening today is fucked. (page 90)

Traditionally, healthcare in America has been rationed according to care and one’s ability to pay. (page 91)

Standards for what care is covered have to set at the federal level, and all payment must come from federal dollars. Medicaid shows us why: when states are permitted to determine what kind of care they cover, and when they’re on the hook for the costs of that care, even a small economic slump can trigger state Medicaid programs to restrict services or find ways to recoup the costs from the patients. (page 94)

But single-payer heatlhcare doesn’t erase jobs or make them redundant. If it wants to get its work done, a single payer has to create jobs. A lot of jobs. Meaningful jobs.

States are inadequate to the task of single-payer. (page 107)

ERISA is a fascinating and very opaque law that has, not by original intent by by modern interpretation, handcuffed states that want to more aggressively regulate healthcare in their state. It’s not possible to even create a state-sponsored resource pool for insurers (like a database of how much different procedures cost), because self-insured plans can’t be required to participate. (page 108 footnote)

I have to reckon that the powerful national figures who push for “state-based solutions” to the healthcare crisis are just shirking their responsibility to confront the same powerful donor class who profits from our market-based problem in the first place. (page 109)

These determinations of illness and their resulting insurer bonuses are made using diagnoses on a patient’s medical records. Now, these medical records have two purposes: tracking patient status, and bringing in cash. Aetna and friends are thus interested in making sure every possible diagnosis that can be on those records gets on those records, regardless of whether it’s a necessary or even true diagnosis. This is known as upcharting, and Medicare Advantage insurers are more interested in the data-heavy business of upcharting than the business of insurance. (page 113)

Whenever we hand over Medicare to private companies, they rip us off for billions and billions of dollars. The money we give is given at the expense of the American public, and it’s money that’s stolen from rural hospitals, public schools, or infrastructure. Medicare Advantage is a theft from the future of America. (page 114)

Then of course, there is the more cynical reason CAP and other centrists advance such tepid, useless policy: they actively benefit from the donations of the insurance industry and hope to see its continuation. When meeting with Blue Cross executives, an aide to Democratic House Majority Leader Nancy Pelosi assured the insurance titans “not to worry” about single-payer, before asking for their financial and institutional support. These organizations invoke the language surrounding the single-payer movement but neuter the policies to keep corporations happy. (page 116)

In real life, the fundamental myths upon which the insurance and healthcare industries insist reveal themselves to be smoke and deceit. But truth does not matter to the powerful. They hold our mediocre insurance plans hostage for government subsidy; a subsidy that lazy lawmakers would rather grant than interrogate the status quo of fear, profit, and domination in American healthcare. (page 121)

This is ridiculous: we are engaging in a titanic nickel-and-diming of doctors in order to cover for the innumerable massive healthcare corporations that are extorting us. (page 124)

Our money is wasted by the unworthy and uncaring, wasted on insurer advertising and administrative costs, and it can be won back only by switching to single-payer. (page 125)

The market won’t solve this; the market caused this. So we use single-payer to allocate the money the private market has taken from us to do what it refuses: pay fair wages for essential care, which we guarantee to every person who needs it. (page 127)

No private insurer has seriously invested in population health; none have invested in compassionate labor, or paying those laborers justly. And they never will. (page 129)

8 responses to this post.

  1. Posted by NJ2AZ on March 29, 2020 at 12:31 pm

    I’m not saying we should keep the status quo, but i’d take it over what seems to be the prevailing ridiculous proposal (Bernies M4A), which apparently makes no consideration for the fact that $0 cost sharing juuuust might overburden the system or that lower reimbursements might lower the number of providers.

    and healthcare will always be rationed in some way, the only question is how.


    • Posted by Tough Love on March 29, 2020 at 1:21 pm

      Health Insurance Companies have long understand the importance of the insured having some skin in the game via deductibles, coinsurance, copays, coverage limitations, etc.

      And the larger the insured’s share the lower the healthcare utilization rate.

      That’s likely one of the reasons NJ’s Public Sector “Direct-10” Plan is so VERY expensive. With VERY low out-of-pocket costs for those seeking healthcare service, the utilization rate is assuredly much higher than in Plans with higher insured cost-share amounts.

      Sanders is nuts if he thinks a $0 insured cost-share in a Medicare-for-all Plan is viable from the cost standpoint ……… unless coverage itself is very restricted.


      • Posted by NJ2AZ on March 29, 2020 at 1:51 pm

        and i’m inherently against any system where i have no control over what i pay into it outside of actively choosing to earn less income.

        i get some..even many people have bad health luck, but a whooooole lot of it is choice too. i should be able to pay less by living a healthy lifestyle


        • Posted by Tough Love on March 29, 2020 at 2:04 pm

          Quoting ……….. “i should be able to pay less by living a healthy lifestyle”

          That’s the purpose of underwriting in the Private insurance market. E.g., some Life Ins Cos have a super-preferred (VERY low premium) risk class for those who regularly compete in marathons.

          In privately purchased insurance, the premium should (to a large degree) reflect the “risk” being taken on by the insurance company. Similarly, in Privately purchased health insurance (outside of Obamacare) the sicker you are the more you pay, and the sickest are not offered coverage ……. keeping in mind that morbidity and mortality risks associated with a specific ailment may differ considerably in the determination of insurability for Health Ins. vs Life Ins.


          • Posted by NJ2AZ on March 29, 2020 at 3:45 pm

            i always thought they should start small. socialize like…. prostate and breast cancer treatments…..or something where there is general consensus that its a ‘bad luck’ sort of malady. see if they can make it work. if yes, grow the socialized medicine portfolio in a manageable way.

            “Well, we’re just gonna take over everything” seems like an obvious recipe for disaster.

  2. Posted by geo8rge on March 29, 2020 at 3:44 pm

    “States are inadequate to the task of single-payer. (page 107)”

    My understanding is Canadian healthcare is delivered at the provincial level.


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