Cake or death: health care edition

What is the purpose of the healthcare system? the answer seems pretty straightforward, to provide healthcare to people who need it. That looks simple enough.

The affordable care act, the ACA, Obamacare, Romneycare — since that is what it was based on, was an attempt to provide a means for 50 million uninsured Americans to afford health insurance. The situation prior to the passage of the ACA was, if I can borrow a phrase or two from Eddie Izzard’s comedy bit , something like being offered cake (health care) or death.

“Cake or death?

“Cake please.”

“You can’t afford cake. Cake or death.”

“I’d really like the cake.”

“You can’t afford it. Cake or death. “

“Why can’t I have cake?”

“It’s too expensive. Cake or death.”

“So my choice is “or death”. “

“No, your choice is cake or death.”

“If I can’t afford cake, it isn’t really a choice.”

“ —

Cake or death?”

The ACA was an attempt to make cake affordable to that 50 million. Sign up for the ACA and you can afford cake. Twenty million people have done so. Unfortunately for premium prices it’s largely the 20 million who most needed cake and hadn’t been able to afford it before, meaning insurers were on the hook for a lot of health care costs, so premiums have doubled and tripled. If we could get a lot of the 30 million people who have not signed up, who are largely healthy and don’t have significant healthcare costs to sign up, it would reduce costs per person insured and would reduce premiums.

This rise in premiums is a problem, but the Republican solution is to change the rules so that the 20 million sicker people who signed up are forced to drop out of the health care market.

Their solution to fixing the healthcare system, to providing health care to people who need it, is to make it affordable for people who don’t need it and making it unaffordable for people who do. So their solution to reducing premiums is to see to it that people who need healthcare can’t get it.

That’s not a healthcare system.

It’s an affordable premium system for cake, for people who don’t need cake. That’s not a health care system.

It’s a health insurance company subsidy system, it’s welfare for insurance companies. It’s a way for companies whose function is to provide cake to those who need it to keep all the cake for themselves. That’s not a health care system.

It’s a way for politicians to deal with a problem by punting it away for someone else to deal with later, to look as if they are doing something, because it’s important look busy even if they don’t know what to do, when they aren’t addressing the actual problems, which is “why are health care costs rising so much faster than inflation?”

Is it new technology, technology that actually improves the health of patients? Is it drug prices? Is it malpractice insurance? Is that insurance companies acting as middlemen and taking a cut? Is it something else? Is it some combination of all of these?

What’s the source of the problem?

How can you solve the problem if you don’t know where it comes from? Pain pills might make you feel better, but they won’t cure a tumor. Offering pain pills to people who don’t need them and leaving everyone else with tumors isn’t a health care system either. It’s sticking your head in the sand.

Premium prices aren’t the root problem. Prices are a symptom of healthcare becoming more expensive. But “fixing” premium prices is easy if you allow only healthy people to buy insurance by kicking sick people out of the market. That’s not a health care system. It’s just — callous.

Not that it would work anyway. Does anyone really believe that insurance companies will magically and benevolently reduce the rates to what they were 10 years ago once 20 million people’s cake is taken away? That’s not a health care system. It’s fantasy.

The damage is done, the horse has left the barn, the ship has sailed, the toothpaste is out of the tube; Elvis has left the building. Eliminating Obamacare isn’t going to reduce premiums. The only way to deal with healthcare is to move forward, not try and reverse course on a one way street. To fix the problems with the ACA, not make things even worse than they were before. And while you’re doing that, to figure out why health care costs are rising so quickly, so that the root problem can be dealt with.

But that would take hard work and making unpopular decisions. It’s so much easier to grandstand.

That’s not responsible government. It’s a return to:

“Cake or death?”

“Cake please.”

“You can’t afford cake, it’s too expensive for you. Cake or death.”

“I’d really like the cake.”

“You can’t afford it. Cake or death.”

“But I can afford it, you made it possible. Why can’t I have cake now?”

“Well we’re taking it away, so your choice is back to cake or death.”

“If you take away my cake, all I have left is death.”

“- Cake or death?”