Monday, September 30, 2013

The End Is Near!

Yep, it's almost here.  October 1st is tomorrow, the date Obamacare goes into effect.  Some are dancing in the streets, some are jumping out of windows.  So where does 'ol Lowandslow stand on this, you're asking?

I think it's gonna be an absolute mess.  Here's why:  Anything that comes with a 2,700 page users manual, written hastily by a bunch of bureaucrats (who probably have a government job only because they were too inept to get a job in the private sector) and industry lobbyists (who you know are making damn sure their clients are protected one way or another), is doomed to fail.  This is going to be a cluster f__k of epic proportions!

So then I'm for the status quo, right?  Nope, not at all.  The status quo is a runaway train carrying us all in slow motion straight over a 1,000' cliff.  I firmly believe we need some sort of, for lack of a better term, "universal health care".  Consider this:

Only 51% of US businesses (pre-Obamacare) offer health care coverage to their employees.  That is down roughly 10% in a decade.  And of those who do have employer paid / subsidized coverage, more and more are seeing higher deductibles / cash-out-of-pocket maximums ($5K-$10K is not uncommon) and co-pays.

Private insurance?  Fuggetaboutit.  One middle aged friend of mine, for example, who has had two back surgeries and a wife who is a breast cancer survivor, is paying $1,500 per month for just himself and his spouse.  And that's with a $10,000 deductible.  Another friend (with insurance) told me if his wife has any more issues, their only recourse will be bankruptcy.

Speaking of:  There are 1.7 million personal bankruptcies +/- filed in the US each year.  Medical bills and lost income due to illness are responsible for 62% (or roughly 1 million) of those.  That's more than due to crushing credit card debt or unaffordable mortgages.  And of those 1 million filings, 78% HAD HEALTH INSURANCE.

When the average working / insured American has an income of about $50K and gets a medical bill for $5-10K, they're screwed.  Unless it's for use to cover a catastrophic accident or illness, do they really even have insurance?  If they can't afford to use it, is it really there?

And talk about inefficient....somebody explain to me why there are 50 state insurance commissions with 50 different sets of rules and 50 different insurance company and state bureaucracies?  Why aren't insurance companies organized around one giant nationwide group policy with one set of standards? 

Pharmaceutical costs are out of control, too.  Consider this:  In all countries I'm aware of with some form of national insurance, the government determines how much drug makers can charge, and it's always just enough to cover the cost to manufacture the drug.  

All the costs to cover R&D, which can run up towards a billion dollars, are charged to AMERICAN consumers.  That's because our "free market" allows Big Pharma to charge anything they want here.  This is true.  I've had it confirmed to me by a friend in the pharma bidness.  *you're welcome world*

And how about all those not-so-visible costs we pay to cover the uninsured?  Several years ago I heard a spokesman for the Baylor Hospital System admit they charge 150% of cost to INSURED patients in order to cover the write-offs for those who couldn't / wouldn't pay.

Just last week I heard the Dallas County Judge say the County spends more supporting their county (charity) hospital than it does on ALL other county functions combined.  This would include running the jail system, the sheriff's office, the courts, the road and bridge districts, etc.  (I haven't researched that, but I take him at his word.)

So then doctors make too much, right?  IMO, no.  Consider this:  Docs go through 10 or more years of college, med school, internship, residency, etc, and usually accrue $250K or more in school debts, before they can enter practice.  For our best and brightest, I don't think their income is unreasonable.  (Compare this to a Wall Street banker who might make 10-times as much selling fraudulent securities.)

Oh, here's a about getting all the blood-sucking trial lawyers out of the game?  Bad docs need to be removed, no doubt.  But in waaaaay too many malpractice cases it's just a money grab.  The legal profession has become a parasite on the medical profession.  Why are they allowed to do that?  (Because trial lawyers as a group are among the largest political campaign contributors, that's why.)

I could go on and on, and maybe I will at a later time, but suffice it to say the status quo is becoming less and less workable, even for those of us who are fortunate to have insurance and can afford to cover high deductibles and co-pays.  Long term the status quo is simply unsustainable.

Let's review:  The health care crisis is becoming more and more acute and is swirling down the toilet.  Obamacare will probably be a mess.  The status quo will someday eventually fail us.

So what do we do?  Beats me.  It's going to take someone smarter than me to figure it out.  BUT WE MUST FIGURE IT OUT.  Removing the spectre of instant family bankruptcy due to whopping medical bills from the national conscience is bound to be good for the country.  

We need to be concentrating on becoming more competitive, stronger, and more resilient in the new world economy, not losing sleep worrying about how we're going to pay for grandma's festering sore.



  1. Germany has good health care and insurance for it, but we also making the same complaints (meds too expensive, docs under paid,,,,,,)

  2. It'd be nice if instead of throwing a tantrum like a bunch of three-year-olds the House would actually do something useful.

  3. I used to say in Brokerage Operations, the only way to make some things happen and work where one hundred + firms are involved was to MANDATE it!! Instead of just saying something was impossible, once it was MANDATED, smart people miraculously found a way. Obamacare will be a mess, but it is MANDATING healthcare changes, and I think smart people will tweek it, institute good ideas that have floundered for years and come up with new ideas. It is going to hurt like hell, but I think we will get it right.

    The need is to balance fair pricing for Drug firms, doctors, and all providers at affordable costs and reasonable access to users. Clearly based on the experiences of other countries this is impossible, so it needs to be MANDATED!!

    You should work for FOX NEWS Scott, your commentary actually IS fair and balanced!

    OH...Congratulations on number got me by one!

  4. No bill of this magnitude will ever be perfect but the Republicans aren't interested in making it better; they want to kill it before people discover they like it. If Republicans really thought this was a tragedy for America they'd sit on their hands, let Obamacare explode and then ride the wave in the next election. But Republicans have always been against what they call "entitlement" programs, such as Social Security and Medicaid. All these fat cat Republicans in Congress HAVE government paid health care so what does it matter to them?

  5. I have a friend whose breast cancer bankrupted her family - and as soon as they started thinking they could climb out of that hole she was diagnosed with colon cancer. Without "Obamacare" she'd be staring bankruptcy in the face again. Frankly, knowing her, she would have just forgone medical treatment to spare her family.

  6. I just read an article in a German national newspaper today that called the mandatory insurance of all citizens a "given standard in all western industrial nations." They can't understand how a nation of bible thumpers and "God Bless America" patriots of the "nation under God" can oppose something like this.

    This healthcare insurance reform may not be perfect, but it's the law now. It's a big deal and it will come with growing pains; so it will need to be changed, tweaked, and worked out. We pay more than twice as much for our health care needs as citizens of other nations do...but we're not getting better service.

    I agree with you on everything you wrote - except I'm not automatically convinced that "Obamacare" will be an absolute mess. I may be...I'm hoping for better.