California Road Trip, Day 15, Claremont

Speaking with medical students

Full of fire and insights, Dr. Katie Ottaway, from Port Townsend, Washington, joined us for the duration of our Road Trip.   We’re  no longer  just a bunch of old white men.  Our daytime Claremont event was well attended.  In the evening, we met with some medical students… Pop Quiz! Do you agree or disagree with the following statement?   “If we can’t have Single Payer, the public option would at least be a step in the right direction.”

Yesterday, upon hearing someone say that Medicare is an example of a single payer, I had an epiphany, but not the kind that requires a change of shorts. Grab a cup of coffee and settle in for an important discussion that is key to understanding our health care conundrum.

“Single Payer” does not mean that only single people pay.  It means that we pool all the money we are spending,  put everybody in the same “risk pool” and prioritize our resources to maximize  “our” health and minimize “our” suffering.    If you have been reading these posts, you may remember that we are all paying for everybody anyway (through taxes, tax subsidies and cost shifting).   Truth be known, we waste 20-25% of all of our health care dollars servicing the insurance industry which prospers by carving us into risk pools. I’ve been told that for every dollar an insurance company spends figuring our who NOT to cover, they generate five dollars in profits.  Insurance companies are gamblers. They win by stacking the deck to avoid excess risk, aka adverse selection.

Albeit  publicly owned/operated and truly not-for-profit, the public option would be just another insurance company.  We would insist that it behave ethically and accept all applicants. Unfortunately, as Dr. Mike Huntington is fond of saying, it would be “like a baby swimming in shark infested waters”.   The other insurance companies will use every loophole in the law to legally (and illegally) ensure that all the sickest, most expensive patients gravitate to the public option… which will predictably struggle then fail, NOT because of inefficiency, but because it was designed to be subject to adverse selection.  What’s worse, sometime in the future, when Congress takes on substantive health care reform again (because they didn’t fix it this time),  the insurance industry will point to the failing public option and state clearly, “See! The Government can’t do health care.  Single payer would be a disaster.”  Wrong lesson.  Public option is a trap.

In reality, our senior citizens today already have a public option, Medicare.   So do poor and disable people who qualify Medicaid/MediCal.  Vets use the VA System.  They are all high risk, expensive “risk pools” financed by the taxpayer.  Meanwhile the insurance industry uses taxpayer subsidies to cover those who are least “at risk” (employed people and their children).   It’s insane.

Back to my epiphany.  Medicare is the epitome of a public option that is designed to fail. It’s no wonder Medicare pays providers so poorly and future deficits look so bleak.

Want to fix Medicare, stop wasting $400 Billion dollars, and accomplish true Universal Health with one swing?  Create a single risk pool.  Then expand Medicare’s sleek infrastructure and make it the single payer.   I guess that’s two swings.

Gotta go.  Running out of shorts.   Laundry, two week’s of it, needs my attention.