You’re Solving the Wrong Problem

Patriot Musket

Obamacare, Trumpcare, Ryancare, Medicare, Medicaid. So many names for healthcare, each an attempt on their own to “solve healthcare.”

None of them solves healthcare, rather each is a shuffling of the decks in managing how healthcare is paid for. The main problem of course is that virtually every healthcare-related good or service has a price attached to it that is set not by the market, but by the Centers for Medicare and Medicaid Services, or CMS. How? CMS has a code for every single good or service that is consumed within the realm of healthcare, these codes are called HCPCS (Healthcare Common Procedure Coding System) codes. And there are literally thousands of them. Each of these codes comes along with a price, known to all of us as “allowables.” Every single insurance company follows CMS’s lead on allowables. If CMS says that the allowable for, say, an x-ray is $100, then that’s what every insurance company reimburses for an x-ray. A healthcare provider may bill whatever they want for that x-ray, but $100 is all they’ll ever get, and there is no incentive for them to charge less when every insurance company will pay that price.

Yes, we have an entirely government price-controlled healthcare system. By attempting to bring order to the marketplace with a common coding system, the government has shattered the market it intended to simplify. Every few months, after being lobbied by various healthcare groups (doctors, hospitals, big pharma, etc.) the head of CMS rolls out updates to the allowables schedule, which always go up. It’s an impossibly complicated issue, and these codes and the automatic increases in price that come every year are the heart of the problem, and thereby the home of the solution. Reforming the allowables system, the pharma patent system, tort reform…they all take time, but no one’s working on those because they’re too busy trying to “fix healthcare” by shifting around who is going to pay the premiums.
Until that happens, until something is done to reform the actual cost of healthcare, insurance is the only answer. Until the day comes that a patient can shop for goods and services on the healthcare market and afford to pay cash for it, insurance is the only answer.

I have type 1 diabetes. My daughter has type 1 diabetes. 1.25 million Americans have type 1 diabetes. This is not your grandmother’s diabetes. We can’t scrape by with testing our blood sugar once per day and take one shot of insulin or anti-hyperglycemic drugs. It’s an impossibly, ghastly expensive disease to treat. And we are not alone; millions more suffer from chronic illnesses for which there is no cure but there is an expensive treatment regimen. Without insurance, we would be bankrupt and on Medicaid within months.

The battle cry among conservatives right now is to repeal Obamacare in full and then start over, delivering on campaign promise after campaign promise to repeal it. I am not in that camp, and my views on the issue are colored by something more than my political beliefs. They are colored by my experience. Many of you reading this know about my political activism, but few know of my activism in the world of type 1 diabetes. I have been there in hospital rooms with parents whose small children were just diagnosed with this dreadful disease. I have seen the genuine, very real fear that my self-employed friends with type 1 are experiencing at the thought of losing the only decent private health insurance plan they’ve ever had access to. The chronically ill are literally enslaved by insurance.

I don’t love Obamacare. I don’t love Trump/Ryancare. I don’t love government being involved in healthcare at all. But until reforms are enacted that drop the price on a vial of insulin from $300 to $20, insurance is the only answer for people who face challenging chronic illnesses.

Reform the patent system that allows big pharma to tweak a patent every few years and extend it for another 20. Reform the never-ending, irrational increases in allowables. Reform the ambulance chasers. Reform the rebate system paid to pharmacy benefit managers.

Until such time that pricing in healthcare becomes full market-driven, transparent and truly affordable, put the pitchforks down and help people find a way to pay for the only option they have, insurance.

Long live The Republic.