When the Cubs Win the World Series

And then there is that question about what bears do in the woods. With the exception of a morning sunrise, nothing appears to be more consistent that the annual escalation of “everything healthcare,” from medical procedures to the cost of healthcare insurance. That we are a toxic nation of fatties, accelerating our way into heart attacks, strokes and heart attacks, doesn’t slow this process at all. But we are more likely to see the Cubs win the Series than a year where health insurance costs recede or even stay the same.

The Affordable Care Act – Obamacare to many – alienated hordes of Americans with unkept promises (“you can keep your existing policy”) or clear-as-mud coverage options or the infamous failure of the implementing cyber architecture. What we forget is the 2010 twisting and turning to get the law passed that made major concessions to private industry just to get enough votes to squeak by. The original proposal suggested that there might be a direct government option, much like Medicaid for pay, to extend coverage to just about everyone resident in the United States who was not already covered or could not afford the new alternative options. That got killed totally in a trade-off with the insurance industry, who smiled as the bill that passed literally pushed 100% of the new coverage through private hands, albeit with a reduction in administrative costs.

Likewise the cheaper option – the ability to buy less expensive prescriptions from Canada – died as a private industry sacrifice to allow American pharmaceutical companies to continue to charge some of the highest prices on earth for their prescription products. The ruse was that we could not check quality control in another country, even though Canada and the European Union apply the same or more stringent standards on drug quality as/than we do.

What could not pass, despite support as early as the Nixon administration, was any notion of automatic and universal healthcare, a process that has had a downward pressure on cost increases wherever that system has been implemented. And yes, Mergatroid, Canadians today would rather give up their addiction to ice hockey than forfeit their universal healthcare system. And Canadian businesspeople smile a competitive grin, knowing that their per-employee healthcare costs are dwarfed by the per-employee costs that apply to American wage-earners on average.

In an interview with the Wall Street Journal, Health & Human Services Secretary Kathleen Sebelius speculated:

"I think premiums are likely to go up, but at a smaller pace than what we've seen since 2010," …adding that she thought the likely increases would be less significant than they had been in the years before the federal health-care law was enacted.

“Of course, Sebelius is only speculating. No one knows what health insurance premiums will look like on the exchanges next year… The relatively small number of younger (and presumably healthier) people who've signed up so far is a cause for concern that mostly sick people bought this coverage, and that they'll run up big medical bills. That would lead insurers to raise rates for 2015 to make up the money. There are guardrails built into the law to mitigate this problem, so the effects on premiums may be modest anyway.

“Even health insurance companies don't know what's going to happen because they don't yet know how their new customers will behave, and won't have much time to figure it out before they propose next year's rates to federal and state regulators.” Huffington Post, March 13^th.

In addition to insurance companies and pharmaceutical providers, another constituent in this system of continuing high medical costs has to include plaintiffs’ counsel in the malpractice bar, opposing every attempt to limit the size of malpractice awards, a factor resulting skyrocketing malpractice insurance premiums imposed on doctors and medical service providers. And there is evidence that these lawyers are succeeding in their push-back: “Caps placed on how much money people can receive in cases where a doctor’s mistakes led to a patient’s death were declared unconstitutional by the Florida Supreme Court on [March 13^th].

“The lawsuit limits were part of a law pushed by then-Gov. Jeb Bush (R) in 2003 in an effort to lower the cost of malpractice insurance rates and to keep doctors from moving out of state…Thirty-five states have some type of cap on medical malpractice awards, according to the National Conference of State Legislatures.” Associated Press, March 14^th.

Old world incumbents have clearly struggled against the tsunami of change in healthcare systems, but you don’t have to be a mathematician to figure out that as costs constantly go up as average consumer buying power continues to decline (as it has for average Americans for well over a decade), health insurance will eventually hit the tipping point of general unaffordability unless something big changes. So I know I’m out-of-step with mainstream opinion, but the biggest problem with Obamacare might not be the obvious. It just may be the litany of concessions to private industry to moderate any competitive pressure from a lower cost program. Maybe we need more care, not less. What we need less of is costs!

I’m Peter Dekom, and this is going to be a very long road with an ultra-slow fix based on Congressional gridlock and grandstanding.