More Thoughts on the Health Care Debacle

“A really big shew,” said Ed Sullivan, back in the day. Like the Watergate hearings, the Comey testimony, and that white Ford Bronco, traipsing along on Los Angeles freeways, this health care mess transfixes me. For sure, the outcome worries me. More though, the stupidity captures and hold my attention.

Take Donald Trump: please. He covers a big chunk of the stupid straightaway. A situation years ago comes to mind, to describe just how little he contributes here. Late in a drawn out mess, I sat with several lawyers and consultants, trying to find a resolution. Hours along, a principal—young and pampered—piped up sternly to let us know we needed to focus on a win-win outcome. No details; just win-win. Helpful! Like Trump here!!!

Then there’s the Senate majority. They rocked along, headed toward a 51-50 outcome … when along came the Congressional Budget Office. Now they’re all shocked, rushing around like I don’t know what. Sorry, Rs, but what did you think you’d get from the CBO.

Health care does not lend itself to simple solutions. Complications aside, though, when you suck more than $75 billion a year out of a system, you will get dislocations. Lots of people will lose Medicaid. People with subsidized insurance will pay more. And insurers, getting payments to protect them against entirely new models for selling health insurance, will raise prices.

The Senate, or course, got previews when the House bill got scored, twice, showing 24 and 23 million people losing coverage. So, take the same amount of money off the table, tweak the mess a little differently and, somehow, this crowd thought it’d turn out differently? Really?

I hear plenty of “CBO always gets it wrong” talk. Poppycock, in fact, unless by wrong they mean anything other than a perfect match of outcomes to projections. Here, the CBO gets a ton of variables, puts them through their paces, and offers projections. The projections make sense, by the way, because when you pull out a bunch of money, you’ll have less coverage, higher costs for consumers, etc.

Who knows, in fact, how many people will be uncovered. Maybe only 20 million people. Or, maybe, 28 million. Either way, that’s not “CBO got it wrong.”

My recent posts generated some commentary. I heard a fair amount of “we need market-based, get the government out of health care remedies.” From, in several cases, people receiving Medicare coverage. (The “Keep the government away from my Medicare” brigade.) Some worked for large, institutional employers. No insurance or market worries for them. Hard to credit comments from people with no skin in this game.

And about market-based remedies? By definition, markets depend on knowledgeable buyers and sellers, acting freely. Ever try to figure out what a medical procedure costs, from the Explanation of Benefits your very transparent insurer sends you? (Ever try to just read one of those things?) Know how to measure the quality of one provider’s service, as against that of another? Can you really evaluate recommendations when you’re seriously ill, and can providers explain complex issues in ways which will allow you to make rational, sound decisions? As for acting freely, sure, so long as you’re not sick and needing prompt treatment.

Lots and lots of stupid in this debate. In and amongst it all, though, we’re dealing with the most important, immediate issue of our times. (Long term, climate change matters more, but it’s a creeper. Think frog in warm water, with someone’s hand on the burner knob.) Sadly, one side exhibits no interest in solutions. Instead, its plan involves a tax cut for its patrons, a philosophical victory, and meeting a stupid promise to repeal Obamacare. Sad. Bigly sad.