Wednesday, June 10, 2015

'No One Would Create A US Health Care System Like The One We Have Today'

No words necessary
We were having lunch with a distinguished health care expert yesterday talking about, what else? health care in North Carolina and America at large.

This person has been in health care over the past 30 years from deep inside the bowels of major medical centers (terrible analogy, sorry), in health care advocacy and in public service.

It is fair to say that this person has seen it all and knows a heckuva lot about health care costs and delivery in America.

We got to talking about the pending SCOTUS decision coming up on the ACA, aka 'Obamacare' and this person said this:

'If we were starting a new health care system in America from scratch on a blank sheet of paper, NO ONE IN THEIR RIGHT MIND would ever propose a system that looks exactly like the one we have operating today!'

The ACA was proposed with the good intentions and political promises of covering everyone in America with 'affordable' (hence the 'A' in the ACA) health care.

The 'promise' that President Obama and the Democrats then in charge of Congress who passed the ACA gave the American people that this would 'save the average American family $2500' has long been blown out of the water. Many families have seen their health care premiums go UP, not DOWN, close to 100% over the past 2 years of implementation. Blue Cross/Blue Shield of North Carolina recently announced that people on the very ACA plans the President and the Democrats promised would 'save them money' are going to see their premiums go up between 25% and 50% in 2016.

Election year. Yippee.

With the pending SCOTUS decision about to come down perhaps later this month, we thought now might be a good time to review some of the facts about health care so you have some frame of reference in which to talk about this when the decision is handed down and all the flamethrowers are ignited from either side of the equation:

  1. Close to 75% of all health care costs* in America today are being paid for by government sources. Whenever you see 'government sources' or 'government-paid'; substitute two words:

    - 'My Taxes' or
    - 'Money Borrowed from the Chinese' or other sources 'that my kids and grandkids will have to pay for one way or another, either directly in payment of interest and principal or, in the more likely tried-and-true fashion used time and again in all recorded history, inflation.
  2. Total health care costs today are expected to be about $4 trillion. Out of a GDP of $16.3 trillion. 1/4 or 25% of our American economy is tied to the health care system.
  3. In 2012, just over 2 years ago now, US health care costs were 'just' $3 trillion. Our total health care costs have exploded over 33% in the last 24 months.

    Maybe some of this can be attributed to the 'woodworking' effect of the ACA and expanded Medicaid coverage where people who were previously treated for free in the emergency rooms or pro bono by well-meaning doctors (who can't turn people away from the Emergency Department anyway regardless of their condition) are now 'officially' counted as being part of the 'paid' health care system.

    Still, costs are going up, up, up. As Mick Jagger would say: 'To live in this town, you must be tough, tough, tough, tough, tough!'
  4. 100% of all Medicaid costs in America are paid by the government, mostly federal from 60%to 79% or so with the rest being paid for by the state government. (Remember to substitute in thw words 'My Taxes' or 'Debt' anytime you see the words 'the government')
  5. 100% of all Medicare Part A (hospital) costs are paid for by the government.
  6. 75% of all Medicare Part B (doctor and physician payments) are paid for by the government.
  7. Almost all or 100% of Medicare Part D is paid for by the government.
  8. Who knows how much of Medicare Part E-Z set up by Obamacare is paid for by the government? Even the CBO stopped trying to figure it out 2 years ago when the goalposts kept moving around under the Obama White House policy changes and exemptions from the ACA were giving out to thousands of allies or groups to whom the Obama Administration was sympathetic.
  9. 100% of all Military health care, both current and retirees, is paid for by the government.
  10. The VA is 100% paid for by the government.
We could go on and on but we think you can see the picture. 

'How may we help you today? We are from the
government and we are here to help'
We do not have a health care system in America today based 100% on private health delivery principles. We are closer to a government-paid system health care than most people would like to admit.

Instead of ours being a 'single-payor' system however, we have something that looks more like a multi-headed dragon at times with all of the confusing and many times contradictory policies, forms, applications, and acronyms from HCFA (now defunct) to CMMS, DHHS, TriCare, ERISA to you name it.

True 'health care reform' would not increase overall costs; everyone's personal costs; make the process of staying well or getting well more arduous or produce more opportunities for litigation as the process matures.

We did not get it with the ACA. Sadly for the nation, all we got was more expense without any of the underlying cost drivers being addressed through thoughtful serious reform.

Something to keep in mind as you hear the talking heads chatter on about the upcoming Supreme Court decision on the ACA.

* see Chris Conover: Government On Track To Make Up 66% Of Health Care Spending which was written in 2012 so we rounded up to our 75% estimate 3 years later

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