Health Care’s Game of “Let’s Pretend” – Rearranging Deck Chairs on the Titanic?


 Health Care’s Game of “Let’s Pretend” – Rearranging Deck Chairs on the Titanic?

The game of health care consensus and “let’s pretend” continues:

Consensus view #1: We have the best medical system in the world, for those who can afford it.

Consensus view #2: The “best” is unaffordable, or almost unaffordable, for most people.

Consensus view #3: The U.S. is the only advanced economy without a National Health system.

Put that all together, and you get an inkling of an unexpected consensus among big business and big labor:

Consensus view #4: Unless the U.S. gets universal health care, U.S. businesses, already paying huge health care costs for their employees, will be non-competitive with Asian and European companies in any (every?) nation where health care costs are paid from general governmental revenues.

What’s the fix? As almost always, a real fix must be preceded by a long string of pretenses. Consider these:

Pretense #1: At least current employer-provided insurance is workable. Really? The employee-paid premium shares, plus deductibles, plus co-payments, are growing to the point where “coverage” is becoming a sham, and at the tipping-point the young and healthy will opt out, leaving the system unaffordable and therefore unsustainable if it only insures the bad risks.

Pretense #2: Let the poor pay for themselves -- the emergency room, or medicaid, or other state-financed benefits, are “free”. Really? Look at any hospital bill and pretend that the huge number for each item is its real cost, and then recognize that this is just cost-shifting to the payers from the non-payers (the poor). The payers pay for everyone else.

Pretense #3: Fix it with tax deductions? Really? Tax deductions for the lower paid, who don’t take deductions – indeed often don’t pay taxes – is trading one sham for another.

Pretense #4: Solve the problem by mandating benefits, instead of enacting national health. Really? It’s just shifting the burden to employers who are already non-competitive because of the current burden, or to employees, many of whom cannot afford what we have now.

Bottom line: The consensus, stripped of its pretenses, will eventually force something like “national health.”

Is National Health a “fix”? National Health has its own pretenses:

Pretense #1: National Health is a “good” health delivery system. Really? Please! It’s terrible. Only it’s better than anything else that’s feasible, except for those who can afford completely private top-of-the-line medical care.

Pretense #2: Good private medical care would be wiped out by National Health. Really? Not so in Britain (the “Harley Street” alternative).

Bottom Line: Sooner or later (and sooner is a better bet) private insurance will not be provided by employers (in which case the private system itself may be non-viable), and will not be affordable by employees, and at that point, like it or not, “let’s pretend” gambits will run out, and National Health will run in.

Not a happy prospect, but then, rearranging deck chairs on the Titanic is the ultimate pretense. Rearrange them or not, sinking is still sinking.