More on Health Care … and We v. Me-I

I got into it with a guy I don’t know the other evening on Facebook about Obamacare. (We have a few mutual friends.) I shouldn’t have, but I do so many things I shouldn’t; falling into an FB encounter of the less than kind sort falls outside my top 10.

A mutual friend posted about her insurance frustrations. This fellow labeled himself—Conservative—and expressed his “HOPE [that] the GOP does not screw this up,” referring to House passage of the bill on Tuesday. I wrote:

They already have. The insurance markets don’t like uncertainty, and this crew just created a boatload of it earlier today.

He went off on Obamacare. (Non-sequitur.) I noted the fact that it has allowed me to work as a solo practitioner, and make substantially more money than I was making. Then he stepped in it, stating: “You are just lucky to have other people paying for YOUR coverage.” And down the hill it ran! (The words “bugger off” came, left, and returned again to my fingertips … but in my defense, the plane was boarding for London.)

A few brief facts before we go forth. The ACA does involve subsidies for low-income households. I don’t receive such a subsidy. And, because our tax code favors people based on status and activities, the government takes most generously from me. I am single. No dependents. Not a homeowner. And I work for a living. (If I was married, owned a home, and made my money from investments? Much smaller tax bill.)

I don’t complain, ever, about paying taxes. This country provided the structure which allowed me to succeed. But, somewhere, valuing a shared existence jumped the track. From We, we became Me and I.

We all have an interest in a healthy populace, and “populace” includes those who are among us without appropriate documentation. (Viruses and bacteria don’t know from immigration status!) More, though, than that, too many among us fail, consciously or not, to appreciate the shared underpinnings of our society. What can be identified out of a checking account becomes “I paid” and everything else gets ignored.

So, as long as we’re focused on health care, let’s scratch the surface an inch or so. We all contribute to health care provider education. How? Medical schools receive receive National Institutes of Health grants. Students receive financial aid. Government programs help pay for medical school, in return for public service.

We also contribute directly to hospitals. Many of the NIH-grant recipients operate hospitals. Non-profit community hospitals pay no income tax, which represents a shared cost we all pay. Without these (and many more) benefits, you’ll see shuttered doors, and lots more people dying in the streets.

Then there’s Medicaid. Yes, those of us who work for a living contribute to its coffers, but many of us will never get back what we paid in. But, then there are those whose expenses will exceed by orders of magnitude what they pay in. Some will recover; others won’t. Fraud and poor judgment, because of bad incentives, exists. (The ACA does much to align finances with outcomes, quietly.) And even without fraud and poor judgment, money gets spent without achieving outcomes, because we don’t often know, up front, what will work and what won’t. But still we march on, because alternatives—think people just dying—don’t reflect our values.

Plenty needs fixing with the Affordable Care Act, and with health care delivery systems generally. With 2X cost, relative to our peer nations, and .5X outcomes, room for improvement screams from the rooftops. What passed in the House of Representatives on Thursday improves nothing. How do I know? OK, I don’t, really, but when people pass a law in a hurry, because they can, before the Congressional Budget Office can score it, I know they don’t know, either.

Beyond fixing health care, though, we need to fix the Me-I mindset. So long as people move about blithely, secure in the belief that if they can afford something—never mind all of the parts of whatever it it is that they don’t pay directly—they can have it, and not pay for anything else, we don’t really understand our problem. And if we don’t understand our problems, fixing them becomes a matter of chance at best.