The health care debate is fundamentally fucked.
What Obama and the Democrats propose is a major fix to a severe symptom of our failing health care system. The Republicans argue that a public option will corrupt the markets,leading to more runaway spending costs as the government remains the sole health care provider. Indeed,a poorly-constructed government provided public health care option would result in less incentive for people and small business to buy private coverage. While the Right never acknowledges the details or possibility of a government regulatory role that would work,the media and the public remain stubbornly ignorant of a real debate about a public option,and worse yet,completely unaware of the larger problem:
A patient goes to a doctor for colitis (inflammation of the colon). The doctor perscribes a new drug called Asacol HD. Asacol HD is an extended release version of the previous drug Asacol,made by Proctor & Gamble. The patient can’t get the Asacol HD because the Insurance Company doesn’t cover it. Why? Asacol is about to go generic,allowing cheaper versions of the drug to be available. Proctor & Gamble is going to lose revenue when it does,and they’ve released Asacol HD coincidentally around the same time. Asacol HD will now hold the exclusive patent. The Insurance Company knows this,and they’re about to make money by no longer covering the expensive Asacol in favor of the cheaper generic drug.
That is how the system works. There are only two actors in this story: Proctor & Gamble and The Insurance Company.
There is the obvious: Proctor & Gamble is a pharmaceutical corporation whose business it is to make money. They make money by making drugs with exclusive patents. You and I are not biochemists; yet it seems devious that Proctor & Gamble should release a better,extended-release version of Asacol right about the time Asacol is about to go generic. So the Insurance Company will sell you the common-sense notion that what they are doing is keeping Proctor & Gamble in check: they won’t let Proctor & Gamble rip you off by charging you more for Asacol HD just because Asacol is going generic. Because Proctor & Gamble is a big,scary,evil pharmaceutical corporation.
That is what the Health Care Debate is based on today. Not on doctors and patients,but on Insurance Company and Pharmaceutical Company.
Let’s get back to the two people who aren’t in the story.
There’s the doctor who prescribed Asacol HD. The Insurance Company will sell you the idea that Proctor & Gamble sends out well-paid salesmen with unlimited expense cards to woo the Doctor into prescribing Asacol HD. And they do,and it has only been recently that the Government has put restrictions on what they can buy Doctors in an effort to sell their drug. This seems to appeal to our common-sense ideals and our individualism – we the Patient don’t want Protcor & Gamble selling drugs to our Doctors with fancy cars and dinners. And that is exactly what The Insurance Company wants you to believe. That they are doing the right thing.
Some doctors argue that government-run public insurance option would hurt their income. This is true in many cases,in terms of Medicaid. But accepting that means there are only three possible solutions to the current debate: A) The government runs out of money,growing its deficiet uncontrollably while our markets weaken. B) do not take Medicaid or a government-run option, leave the weak to live or die on their own. This includes ER visits: have hospitals turn patients away. C) doctors will make less money, removing the motivation for innovation and progress – the elements that do represent the current best aspects of our system (remember,our actual health is not one of the things this system is good at).
Lastly, we come to the last and least actor in the story: The Patient. While Insurance Company fights Big Pharma on behalf of you and your employer’s premiums convincing the American Public that they’re on our side,The Patient is getting sicker and can’t afford the Asacol HD the Doctor prescribed. The Doctor’s hands are tied. Maybe the Doctor can go back to Asacol. If it will work for the Patient. Maybe the Patient wasn’t responding to the Asacol. Or Pfiser’s colitis medication that is covered by the Patient’s Insurance Company. But only until the Doctor’s professional opinion is vetted by the Insurance Company. None of this is important in the American Health Care Debate.
And herein lies the fundamental problem with the American health care system. The problem sits right in plain site of the Republican Conservative mantra that gets blind and dumbly repeated out of the mouths of people who rarely understand it. If you’re going to tout the free market as the solution to so many problems,it’s important to understand how it works first. And,more importantly in this case,who it works for.
The health care marketplace consists of the two primary actors: Pharmaceutical corporations as the producers and Insurance Companies as the consumer. This market is not so much broken… It is making these two companies more and more successful. We tout the American Health Care system as the best in the world because of what this market has done in terms of innovation and availability of that innovation to the Insurance Company. However,there are the two minor actors that do not participate in this market: Doctors and Patients. And they are not successful. They are not participants in this marketplace,and they are not part of the market. They are not making money,and their prescriptions are not being covered.
What’s being covered is the efficient balance in the marketplace between the Supply of what makes Pharmaceutical Company money,and the Demand of what makes the Insurance Company money.
What’s not being covered is what the Doctor prescribes,and what the Patient needs.
Listen: We have taken the power to tell the Patients – us – what drugs to prescribe away from the medically-trained Doctors and put it in the hands of Insurance Companies who are out to minimize loss and maximize profit. We have given up the power of the marketplace to make us healthy for the pursuit of money.
In a simple way,the Republicans seem closer to the fundamental problem of the health care system,yet understand it the least. The problem is the structure of the health care marketplace,the solution may not be the Democrats’ regulation of that broken marketplace. The solution is to put the real producers and consumers of health care as the main actors in the marketplace: a solution that ought to cater to the right and the tea-party whackos following Sarah Palin. Unless,of course,they are simply true believers in the rising popular American Ideal of fuck the weak. Let them die on the streets outside the hospital if they can’t afford insurance. When the Republican response to the public option is the notion of "Government telling us what drugs we can and can’t take," then ask yourself whether Humana or Blue Cross Blue Shield is in any better position to do the same thing. That’s the system we have right now.
I don’t know how to restructure the marketplace to have the two most important benefactors of the system more closely participating in it. I don’t know where Insurance Company in its current form would fit into that marketplace. The health care system doesn’t work without pooling risk, and that risk is expensive the sicker you get. My feeling is that if Government doesn’t play a regulating role in that market place,the market will be coerced by outside influence from Insurance Companies looking to minimize coverage. Even Friedman wasn’t a market anarchist willing to tout the free market flag until corruption and market manipulation become unrecoverable.
I do know,however,that we are no longer asking our politicians to solve real problems any longer. We’re now asking out politicians to lie to us about what’s wrong,lie to us about what the solution is,and sit back and watch the MTV-inspired entertainment news networks glam up those lies with outrage and speculative opinions. It feels good to be stoked up with righteous indignation and rage at thy neighbor. And politics is hard. Like health care is hard. Eventually the simple majority of Americans are going to realize how enslaved by dumb they have become while living like armchair quarterbacks sucking the tits of op-ed culture.