Hannah and Papa J

Hannah and Papa J

Thursday, September 17, 2015

Why Republicans deserve Obamacare

Dear Hannah,

I was delighted to find in the New York Times this week that our hospital capitalists are beginning to wonder what their expenses are.  It's nice to finally have some company.  I've been wondering what my expenses are ever since I moved out of my parents' house; and I've been keeping records of it in red and black ink because I don't want to live in the streets.


The black ink, of course, signifies that everything is going fine and that my income matches my expenses; and the red ink is the terrifying reminder that I'm consuming more than I produce.  Even the squirrels and the ants do it, actually -- this budgeting thing; and when they do it well, they live, and when they do it poorly, they die.  And when the animals do it poorly and don't die, it's only because they're living off of something else that isn't doing it poorly.  Our whole existence is economics, and only the worst economists and pirates and public officials are the ones who negligently live in inks of red.  

And this goes to show why the piece in the New York Times is important (if a little discomforting): because all this time the people who have been actually watching their expenses are the people who are going to hospitals for help, and probably watching because they are forced to be responsible because they don't have an unlimited source of income.  And they're usually people who are surprised to find, in very unwelcome pieces of uncharitable mail, that their hospital bills are going to put them into the red.

For the hospitals we have a different story.  The fact that our hospitals are beginning to ask obvious questions like how much are we spending? is indicative of the fact that until now their expenses didn't matter.  And they didn't matter because their profligacy could never outmatch their incomes, because our hospitals (almost like nationalized industries) aren't businesses in the classical sense.   Unlike everyone else's desperate attempts to provide the best services at the lowest possible costs in the face of every possible competitor, our hospitals don't have fiscal competitors and they can't have fiscal competitors, because against everything we know and cherish about capitalism, pricing isn't really an issue.  There is no red ink, because the black ink is flowing not out of superior service and competitive prices, but out of the public's ignorance and helpless desperation -- from which there seems to be no end in sight. 

The ironic thing about the entire defense of our "free market" hospital capitalism is that it has almost nothing to do with the original theory of free markets, which makes the Republican attacks against Obamacare ridiculous.  While possessing the characteristics of private ownership (which results in its defense by Republicans), its success borders more on the economics of monopoly (which results in its condemnation by Democrats).  And I call it monopoly because, if we really consider the way our medical system works, it not only refuses to show us what the competition charges for the same services, but it refuses to tell us what it charges for its own -- until the bill comes in the mail, and we're bound by law to pay it.  In fact, the majority of our bills so disproportionately match the services we receive (my wife was once charged $300 for ibuprofen after delivering a baby), that we're left wondering why we weren't told they were expensive in the first place.  And I think the answer is clear.  All of us are being robbed by our medical businessmen.

Our medical industry is the only business in America that asks Americans what we'd like off the menu and doesn't give any prices until after there's a gun in our faces, which then leads Republicans to complain because the Democrats are complaining about the prices.  And it's one of the only ones that relies upon a customer who isn't only in want of something, but in desperate need of it -- a need that keeps the business coming, regardless of how people are being gouged.  Not everyone needs a tv or a car or an IPhone; all of us will get sick and die.  And they ask us what we value our lives and the lives of our loved ones at, and we answer -- everything.   A blank check.  Every penny.  And they get it, because nobody tells us we could have it for less.


But if there is one thing we can learn from the New York Times with this issue, it's that someone out there -- some brilliant, wonderful person at the University of Utah -- believes it is not only possible to examine the actual costs of our hospitals, but to have them budget accordingly (which the hospital "capitalists" will find beneficial to their businesses).  Now it has only to be asked, if this isn't only possible but good for our hospital capitalists, why someone isn't doing the same for us patients.

Because if there is anyone in danger of red ink, it's the poor and impoverished masses of sick and dying people -- the productive and competitive citizens with mouths to feed and homes to hang on to and inheritances to pass on to their grandchildren.  And if a budget is good for businesses, a budget is good for families as well -- and we have got to find a way to help them budget.  Right now, due to the refusal of hospitals to tell prices before the sale and the inability of the public to compare between competitors, they can't.  Tomorrow, before we get a universal healthcare system and ruin the greatest medical achievements any society ever produced, we can.  We have a chance to break the horrible trend of the animal kingdom -- that most of us will be producers and competitors and responsible economists, and a few of us will succeed by being predators. We can reestablish symbiosis in a system of parasitism; and we can do it in the names of liberty and capitalism.

As a person who never went to school in medical expenses and hospital management, I can't provide that solution.  But now I know, because of the University of Utah, that it is possible.  It may be a governmental program not to regulate anything, but to relate everything.  Perhaps this establishment of capitalism in our hospitals will make good use of the internet; perhaps it will show patients what they'll pay for every service they receive before they receive services, and show them what their neighboring clinics and hospitals charge for it too.  And maybe it will drive down prices when hospitals realize they're in competition, and maybe it will show us that other options, not only in prices, but in services, actually exist.  Hopefully it will drive all our negligent underperformers and purposeful overchargers into an irretrievable red -- or reform them into the black.  But there is one thing I do know with total certainty, and it is that if our Republicans have no ability to recognize when a free market isn't even a market, and simultaneously no pity for the millions of people devoured by the monsters who profiteer off their misery, then it isn't the Democrats who deserve Obamacare.  It's our Republicans.

Your father,
-J

PS: It has been brought to my attention that one reason hospitals may be charging exorbitant prices for their services is because of 1) insurance and 2) laws that force them to give services to people who can't pay.  Regarding the first, I would say that yes -- although insurance does create a disconnect between the buyer and the business, thus making the buyer less discriminatory about the prices, a mandatory disclosure of prices and competition will scare away the majority of people afraid to pay even a percentage of a ridiculous charge.

And regarding the second, if our hospitals are overcharging because they're forced by laws to pay for settlements and the care of people who can't ever pay them back, I would say that the immediate results of my policy would be disastrous -- and the long-term effects would be extremely beneficial.  Some hospitals would be forced to close and the public would be left (in certain particularly egalitarian areas) without adequate medical help; which would force our legislators to take an approach that recognizes the rights of patients only so far as to not harm the majority.  If we have been giving too much, we would scale it back so that our hospitals could function again without gouging the public. 

4 comments:

  1. "... And I think the answer is clear. All of us are being robbed by our medical businessmen."

    Indeed. As I sometimes say, doctors -- at any rate, hospitals -- and ambulance chasers *deserve* one another.

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  2. Like it in general. Going to AT now to read the comments section to your article (I'd been staying away lately due the takeover by Trump love).

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  3. The guy who just fixed my computer can't keep his job because of the Affordable Care Act. He loves the work and has been paid by the piece by his company. He can make full-time wages working only 25 hours a week. He doesn't get health coverage right now, but he said he's okay with that and loving what he's doing.enroll in obamacare

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  4. Thank you for this article. Very frank and brave. If I would say this about untouchable (in eye of my friends) Obama, they would stop hanging out with me. lol. I store such interesting articles as this one in my secure dataroom .

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