Sunday, October 19, 2008

Painful Socialization

I've been doing a lot of thinking about the recent socialization of the financial market. Couple that with the thinking I've been doing about the upcoming elections and the related issues being discussed. Something very near and dear to my heart is health care. It's dear from a couple of angles. I work in the industry and as a father of two – provide health care for my sons.

The “crisis” is very real to me. I have a very good job in the health care industry and have probably the best insurance this side of being a US senator. Still – I can barely afford to provide health care for my kids let alone myself. I'm still paying on a 3 day hospital stay that my son had 2 years ago and I haven't been to a doctor (other than emergencies and serious illness) in years. Granted, part of that is my loathing of doctors but a huge part of it is that I simply can't afford to spend the money for something as seemingly frivolous as a checkup when I feel fine.

In case you have any doubt where I stand on the issue – I'm a very firm believer that the only real answer is a single payer system. Similar to what you find in England, France, Norway, Denmark etc etc. If you aren't yet convinced, and the word “socialized” makes you think of the USSR. Here is the one fact that you need to know. Only four governments in the world spend more money per capita for their citizens health care than we do 1. And yet we have a system where we, each individual is supposedly paying our own way! The average government spending in countries that have single payer systems (socialized health care) is much less than what the US spends in a system where the government only pays for a small portion of it's citizens! Just to drive home the point. Health care bills are the number one reason for personal bankruptcies in the US!5 On top of all that we still rank 37th in the world in the quality of our health care.2

Unfortunately, I also must believe that a single payer system is not possible in the US under conventional political means. In the US we have to hose with everything. Look at our tax system for example. A simple idea of paying a percentage of your earnings. We have mucked around with that until the tax code has to be hauled around in a Mac truck and there is a multi-billion dollar industry built around paying your taxes! Absurd!

This fall's events on Wall Street got me to realize what we are facing and what, ultimately must happen in the US for a single payer system to come to pass. You wont like it. But it just might be happening anyway.

To get a handle on what I think might happen you first must understand a couple of things about the US health care industry that most Americans don't. You see, in the world of health care there are really only a few ways to be profitable. When you are talking hospitals it's all to be found in one area really. Elective surgery done on individuals that are relatively healthy to begin with - and have really good insurance or are wealthy enough to pay the bill themselves. That means things like back surgery, orthopedic surgery, and even cardiac bypass surgery on fairly young, healthy, people like me and better. If you can pay the bill and won't stay very long – you my friend are what hospitals (and surgical centers) want. Medicare / Medicaid pays about .30 on the dollar and it takes around 6 to 12 weeks to receive payment. Everyone else is either written off as charity, simple bad debt or is reimbursed by the local government on some level as “indigent care”. Usually at much less than .30 on the dollar.

What is happening in our country's population centers is this. Surgical specialty, and private hospitals are opening - or have been for years in the major cities. They are private enterprises that do not have to take anyone but the best patients. Healthy, wealthy or healthy and well insured are the name of the game. These are often hospitals that resemble nice hotels.

Who wouldn't want to be treated there, and great if you can afford it. Since 50 million of us or more 3 don't have health insurance that means at least 1/4 of us go to the local "county general" hospital for our primary health care. Those hospitals are increasingly finding that 30 cent on the dollar mark to be the best they can get. How long do you think that can go on?

I live in a small city where this is just now taking place. It's been going on in major population centers for years in some cases. The hospital I work for is just shy of doing ¾ of a billion dollars a year in revenue - with an annual operating budget somewhere north of 50 million. The city has an annual budget of about 25 million and the county, even less. How long do you think they can support a failing county hospital?

Health care is a $2.26 trillion dollar a year business in the US.4 Plus it's run by large companies and paid for by large insurance companies. The very ones being bailed out. When health care fails, who do you think will step in? Your local government - not likely. Not even likely to be your state government with these numbers. How many lives will be lost in that socialization? How many will be stock brokers or congressmen?

Update: Maybe it's already happening.

Friday, October 17, 2008

If `Joe the Plumber' is like my plumber, he can go pound sand

Eric Zorn of the Chicago Tribune had a hilarious take -
If `Joe the Plumber' is like my plumber, he can go pound sand