Saturday, July 04, 2015

Cost-Benefit Analysis

The only surprising thing about this story is that AOL is still apparently a going concern. Who knew?

We're going to be seeing more and more stories like this in the years to come, of outsized health care costs being spread around to everyone. This is because the numbers are what they are, politics aside. Five percent of the population accounts for almost half the expenditures, and that's just the start of it. Everything is a hockey stick, as far as tracking proportional usage.

Socializing medicine by definition means that the other ninety-five percent who make up the other half of expenditures are effectively subsidizing those five percent. Meanwhile, the usurious charges and rates have been completely unaffected by the ACA or private insurance plans.

The racket remains intact, and that's the real problem. How does an infant rack up a million-dollar hospital bill? Instead of plugging the book and harping (rightly) on the HIPAA violations, the article practically begs for an itemization of services. Of course, looking at the EOB would also constitute a HIPAA violation. But it would be helpful to all concerned to get a look at how much things cost.

Tim Armstrong may be an overcompensated asshole, and he's almost certainly not taking a hit on his $12m compensation package. No, better to engender resentment among the working dogs by making sure they have a good idea of what's affecting their 401(k) plans. But all that still doesn't mitigate the fact that consumers are getting rooked by the health care industry, that healthy people are being forced to subsidize unhealthy people, that people with coverage are paying ridonkulous costs to cover people who can't pay for their care.

The moral argument is separate from the financial argument; obviously the moral thing to do would be to have -- wait for it -- the single-payer system we were promised before Ted Kennedy died, the Democrats ran a terrible candidate to replace him and lost their supermajority, and Scott Brown fucked everything up. But we got what we got, things cost what they cost, and people who are now having to pay into the kitty are having to adjust their expectations.

There is no solution. Much like being patient with what's left of your political system, hanging your hat on dickless incrementalism and the Lucy's football promise of Real Change, you're going to have to dial down your expectations of just how much socialized medicine will make your life better. Yes, if you need health care but have no coverage and cannot get on a plan through your job, it's great. But the problem has been trying to soft-sell the cold fact to people who do have coverage and don't use it that it's going to come out of their end, instead of making the CEOs and HMOs and the rest of these high-toned assholes share the pain.

(Bearing in mind, of course, that the family in the article had coverage through their employer. That's yet another area where we're getting fucked; I work for the gubmint and I got socked with an additional $200/month taken out of my paycheck for the exact same coverage, that I don't use in the first place. There's my student loan payment.)

In another ten or twenty years, with a little luck and a lot of help, the ACA will be a lot like Social Security is now, almost untouchable by politicians. But its biggest hurdle to overcome, ironically, comes from the fact that you need to convince the people who need it least and are least likely to vote in general -- young people -- to support it. The people who need it and will use it -- old farts and boomers, getting ready to retire and scavenge every fucking dime of Medicare and Social Security they paid in and then some -- are the most likely to vote, and to vote against the ACA, figuring that they already have their fucking ladder, the rest of us can just go find another staircase or something.

It's not a matter of blaming sick people for being or getting sick. Sooner or later, that fate and more awaits us all. It's a matter of who gets stuck paying for it all, and what kind of care they get for their troubles.

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