Cutting health care expenses: two approaches

1) the GOP APPROACH. Cut expenses by putting the burden on those who cannot pay: sick, old and poor people. I wonder if they have underestimated how much they will save with their approach, because dead poor people don't need expensive medical treatments, and wealthy living people tend to be a little healthier, so overall eventually you'll save a lot by killing off the sick poor ones. There's lots of hidden financial goodness in the Senate bill. Like, the absence of maternity care might lead some women to end their pregnancies, rather than having expensive births in the hospital. Not sure what the going rate was for DIY in the 60s, but with Pence's influence the country will probably find that out.

2) the COMMON SENSE APPROACH. Focus on "LESS EXPENSE AT MORE VALUE" such as

A) PRICE GOUGING. After a hurricane or other emergency, there are certain laws against jacking up the price of water, food, gas or hotels -- against "price gouging". But if a person has a life threatening illness and needs a little pill to save or prolong their life, the sky is the limit. *Pharmaceutical companies charge what the market will bear.* in some cases, a single medicine can run $60,000 or $80,000 per year. Drug prices are based on patient desperation, monopolies, deceptive advertising, and pricing that depends on who is paying for it.

B) MULTI-LAYER PROTECTION RACKET. Insurance companies make profits by promising to protect you from illness and by delivering the minimum required to avoid damage to their reputation or prosecution. They may pay $8,000 for a hospital bill with a sticker price of $16,000; while walking in to the ER as an uninsured patient will cost you the full $16,000. If you only pay $10,000 of it, the rest of your debt will get turned over to a collection agency who may hound you into bankruptcy. And the collection agency may "buy" your $8,000 debt from the hospital for $100 or $200. Protect me from disease, protect me from out of control hospital bills... and to protect my credit rating, is better pay those deductibles and 20% coinsurance. Unless, of course, I've bought a more expensive policy, to protect me from THOSE.

C) COMPLICATED RULES AND BUREAUCRATIC INEFFICIENCIES. Did your doctor fill in the right "insurance codes"? The lump that he removed from your arm may be billed at a different price based on whether it was less than 2.5 mm, between 2.5 mm and 5.0 mm, or greater than 5.0 mm. When you first get the hospital bill and the separate doctor bill and the separate lab bill (and hopefully not an ambulance bill), the insurance company hasn't processed the claim yet. Month later, you get a new bill, and you may have to file an appeal to get it right. To recover $19 coinsurance on some lab tests, there might be 6 people touching it. Even worse, the doctors may know you need an MRI to diagnose the limp in your knee, but they're going to do an X-ray first, because the insurance rules don't like the MRI. Extra tests get done for the sake of checking the boxes of how to "troubleshoot the symptoms".

D) FRAUD, BRIBES, AND KICKBACKS. Some doctors get CHECKS in the mail from pharmaceutical companies for prescribing their medicines. Some clinics or doctors' offices file claims on services never rendered. Referrrals go to doctors at an affiliated business. Organizations like the FDA or the AMA are not immune to bribes or political pressure. The level at which a person will be labeled as having "high blood pressure" or "high cholesterol" have been lowered, under the influence of pharmaceutical companies that profit from the resultant dramatically expanded market.

E) ROOT CAUSES OF ILLNESS, INJURY, AND DISEASE. Exercise, healthy eating: Trump destroys Michelle Obama's program to encourage healthy eating in the schools, and Congress says nothing. Gunshot victims: how much money is spent on trauma wards, multiple surgeries, rehabilitations, or lifetime care of shooting victims? Stress: life/work balance is promised to some college graduates in demand, but inever to low-wage employees. Stress contributes to the absurd gap in life expectancy of rich versus poor. So do environmental factors, like lead in the water of Flint Michigan, or breathing in toxic Chinese drywall installed in lower-end housing. Lack of prenatal care, self-medicating with alcohol, sedentary lifestyles are all costly. Do green spaces actually make a difference in the health costs of a community?

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If our congress wasn't half-bought by pharmaceuticals and insurance company CEOs, AND HALF-BOUGHT BY THE OWNERS OF STOCK IN THESE COMPANIES, the issues above are what they'd be tackling.

Many of these things START with the idea of a "COMMUNITY". Investing public money in green space makes no sense to a person whose worldview is libertarian, because why use perfectly good land that could otherwise become someone's Gunsmoke ranch, or luxurious seaside villa, and turn it into a public park or walking trail? In "you're-on-your-own-istan", survival of the fittest will take care of these old sick poor people, or else the private charity of "rugged individualists" will "save" them, after they differentiate "worthy" recipients of charity from "unworthy" ones.

To which I say, let every libertarian billionaire have an MRI machine in his own basement, and a staff of doctors; let them be followed by a perpetual privately funded ambulance, and let them pay the full expense of the initial development of that pharmaceutical that they consume, all on their own. While they are at it, be sure to have them pay for a good portion of each doctor's and nurse's medical education, too, and for the education of dentists and specialists and lab workers. Let them each be their own little billionaire "island". Because it's the VOLUME of humanity that has enabled the development of modern medical miracles and the proliferation of facilities and capabilities. Developing a medicine to treat every ailment, or the techniques to most effectively treat burn victims, or the imaging and surgical machinery to do brain surgery wasn't a cost that was eaten wholly by 100 rich people. It was a century of technology, medical trials, scientific study by tens of thousands of individuals, successes and failures.

But the "Medical Monopoly" properties have mostly all been sold, and the board is mostly in the hands of just a few, and when we land on their property we'd better be prepared to pay $16,000 or $160,000 or whatever they want to charge us, because otherwise we will be out of the game. The rules are pretty complicated, and the big owners might do some little trades to keep us afloat, to keep us in the game a little longer, hoping we are lucky enough to survive another lap and collect a measly $200. The important thing to them though is that their built-up properties don't get devalued. If you start talking about price controls on pharmaceuticals, their stock will plummet. Any move toward single payer is going to destroy the insurance companies or transform them into mere "utilities" -- low grade administrators. Kickback schemes will be screaming as they go.

But if you open up the Wild West for new insurance plans that discriminate and don't have to cover EHB's, well, you've just opened up a whole new monopoly board for all the same players to exploit. Add in a database of DNA, with which your likelihood of having certain diseases can be much more accurately predicted, and the schemes can include insurance policies that protect you from a lot of diseases you aren't likely to get but maybe not the one disease you are predisposed to develop. Get an illness that's a precursor or marker for some more expensive illness, and find yourself dropped.

If you think these things can't happen, we can point to a list of evidence of what CAN and HAS happened.