Obamacare Deductibles: Sticker Shock! A Central Payer and the American Center

An article in the Chicago Tribune http://articles.chicagotribune.com/2013-10-13/business/ct-biz-1013-obamacare-deductibles-20131013_1_health-care-overhaul-health-insurance-health-coverage points out the increasing deductibles on health insurance policies and indicates that they are occurring as a result of Obamacare.

Did anyone expect anything different to occur? Did anyone think that the health insurance companies were going to lower premiums, deductibles, co-pays, and lessen the existence of other dollar garnering mechanisms? Did anyone think that the health insurance companies were going to expand their coverage, i.e., what they pay for, without a reflex increase in consumer price to cover that expansion? Health insurance is a money-driven business, whose goal is not to enhance the health care of individuals who buy their services though the purchase of insurance policies. Its goal is dollar profit, and its sole function is to administer payment of the policy holder’s medical bills. This American goal of dollars has lead to the creation of a business empire with elongated, sinuous tentacles, which are unnecessary for the fulfillment of its one simple clerical function. Note, I do not believe that the function of assigning individual risk of getting sick and then designing insurance payment to and from the insurance company based on that risk and on profit expectations is a necessary task to be accomplished for the health care system of Americans. I believe this leads to direct interference with the sound, ongoing, non-conflicted functioning of the doctor patient relationship, which is the essence of health care.

Yet, Obamacare seems to have given this business the keys to the kingdom. The Obamacare rhetoric of new insurance regulations and rules, although they might sound good for the American people, are simply assimilated into the health insurance corporate algorithm, which then spits out new formulas for dollar garnering to maintain its profit. Thus, the rhetoric of Obamacare rather than enhancing one’s medical care actually inhibits this individual endeavor for many people.

The third paragraph of the Chicago Tribune article begins with, “I believe everybody should be able to have health insurance…” But the rest of the article goes on to explain why this hope is just not feasible in our current system. It’s not feasible because what it really says is, I believe everybody should be able to have a business relationship with companies that withdraw every last dollar from their wallets and, in return, give as little as possible of the product back to them. Health insurance companies operate this way to enhance their dollar profit, and Obamacare has made the situation much worse.

Shouldn’t the sentence be, I believe everybody should have clear and equal access to health care, i.e., to sound, ongoing, non-conflicted doctorpatient relationships, and that our politicians should have the common sense decency to set up an administrative payment mechanism for the work accomplished within these relationships that doesn’t bankrupt individuals and their families. I believe the American center would agree with this.

Until the ethos of our health care system changes such that clear and equal access to sound, ongoing, non-conflicted doctor patient relationships becomes the primary goal to be achieved for everyone living in America, i.e., until the medicine of medicine outweighs the importance of the business of medicine in the minds of our compromised politicians, healthcare business leaders, doctors, and the general American public, true health care reform for the benefit of everyone living in America will not occur.

Ask yourself these questions: When the Affordable Care Act was voted on by our Congress and made a law, which created all these insurance exchanges and health insurance mandates, etc., why didn’t the majority controlling democrats just create a central payer mechanism instead? Do you really think the effective meaning of socialized medicine (interference with sound, ongoing, non-conflicted functioning of doctorpatient relationships) and its occurrence comes only from public 3rd party payers and not from the private health insurance 3rd party payers as well?

An astute observer, who reviewed this essay before I posted it, said that I was missing the point: The Affordable Care Act is just the first step in the complete takeover of our health care system by the government. The people in America will become so completely disgusted with the health insurance industry that they will en masse beg for a government takeover of the entire health care system. This deeper layer of thinking about the Affordable Care Act may be supported by the existence of H. R. 5808 http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.5808.IH: which was introduced in July 2010 just after the Affordable Care Act was passed in March 2010.

“Complete government takeover” is indeed a scary term. In the past and now, I have advocated a central payer system, which is constructed such that the medicine of medicine, the clear and equal access to sound, ongoing, non-conflicted doctor patient relationships for everyone, becomes the primary goal and the business of medicine, dollar profit, becomes a secondary goal. I say a central payer can be structured such that it satisfies both goals and still lowers the amount of money spent on health care. Health insurance companies would eventually fade away and employers would no longer be in the discussion as providers of health benefits.

Many, I expect, believe that this could/would be catastrophic because too much power would exist in a central authority, and, given what human nature is, this would lead to total control over a very important aspect of our lives and completely defeat what I am trying to accomplish. Britain and Canada are examples of the pitfalls of central payers. In addition, the current implementation of Obamacare, which has turned out to be nothing short of a debacle, must give us further pause regarding deliberation over the concept of a central payer.

Can we not do better in America? Are there not real people, who possess enough knowledge and experience and who would work in government with moral integrity and sensible philosophical underpinning, to create a system of payment which frees the doctor patient relationship from the influence of the payer and concomitantly satisfies the need of ongoing, sensible profit for necessary health care businesses? I say there are and that we need to find these people and place them in a structure, which allows them to create the best system of health care payment in the world and which shelters them from politicians and business people in a similar manner as the Supreme Court is sheltered. This is the basis of the central payer system, which I support.

Some, perhaps many, would say that what I am espousing is socialized medicine. This is only partially true: I am indeed saying that we need to bring the business of medicine under control with proper, profitable assignment of payment to necessary healthcare businesses from a central payer. However, I am unsocializing the medicine of medicine, the doctor patient relationship, by removing influence from that payer upon its functioning. Regarding the strict economic definition of socialized medicine http://economix.blogs.nytimes.com/2009/05/08/what-is-socialized-medicine-a-taxonomy-of-health-care-systems/?_r=0 it is not true at all because I am not changing the ownership of any health care businesses.

I must be more explicit in how I see this central payer functioning, and I will do this in future posts. I will introduce these future essays by noting that a major expenditure in our health care system is for hospitals and addressing the dollars we pay to these 6500+ independent business fiefdoms is of vital importance.

R. Garth Kirkwood, MD