WHAT IS IT THAT “WE” DON’T GET ABOUT HEALTHARE?

The Author began a long and vainglorious career as a healthcare attorney in 1991. Blessed with the heart of an economist and the firm belief in never underestimating the other guy’s greed, he quickly saw that something was amiss.

The Author was first tasked with trying to collect money. There was a hierarchy of payors, or more properly, a list of better positioned suckers. Collecting money to pay for patient care was a game to find other people to pay for healthcare. For all this talk about “personal responsibility,” and keeping “gubmint” out of healthcare, Americans have an entitlement view of healthcare.  It goes like this:

A.   Insurance, which employers, or former employers, should pay for, must pay the healthcare bills. That system worked well until about 1980, when the unexplained “decoupling” of American healthcare costs from the rest of the developing world began. Before 1980, US healthcare costs were on the high end of the healthcare costs paid by other countries, but moved in the same curve as our world partners. But something happened in 1980 that ran the train off the tracks. US healthcare costs decoupled and began dramatic rises. The graphs on the linked sources, demonstrate this “decoupling”, as the Author calls it.

 In and around 1980, most Americans had health benefits. The poor, through Medicaid, the elderly through Medicare, and the workforce through their employers.  That last source started to change and American workers began losing coverage, especially those in lower-wage positions and in temporary positions. And we have not looked back.

 

      B.   If insurance does not pay, the government should pay. In regards to this point, the     Author is not talking about government paid health benefits for employees and retirees. The Author is talking about needs-based welfare in the form of Medicaid and entitlement welfare in the form of Medicare. Many poor, but nowhere close to enough, have Medicaid. Anyone over 65 or who has received SSDI for more than two years receives Medicare.

 C.   The payor of last resort, the poor sucker herself. The individual that is finally “responsible.”

So in collecting money, the Author discovered, that you worked the hierarchy, hoping to avoid the last resort, the patient himself. And one can understand the natural desire to stick someone else with the bills for the bills that most Americans still see as a god-given entitlement.

WHAT IS IT THAT THE STATE OF INDIANA DOESN’T GET ABOUT HEALTHCARE?

In the next installment of this article, the Author will take a look at Indiana’s decision not to expand Medicaid, a decision that the Author believes may be reversed.