We Don't Need No ***** Health Care Reform

Insurers, pharmaceutical companies, advertising agencies, national hospital associations, and other trade organizations whose influence with Congress now dictates America's response to proposals for health care reform are correct.  The system we have works and our ranking in the mid-30s of the worlds nations for our health care quality is adequate since anyone who is truly rich, employed, worthy and well-connected can get all of the health care that he or she needs (provided it is approved by insurance company bureaucrats whose pay and bonuses depend on their success at limiting care and retroactively canceling sick customers' insurance).  If Obama's health reform is defeated, as insurers, pharmaceutical companies, advertising agencies have determined is best for the country, the following will be just little bumps in the health care road.

1. Choose to have your heart attack, auto accident or fall from a tall ladder when the hospital emergency departments are not chock-full of those pesky uninsured people who can't afford to get health care from doctors during the day.  If you get there in the peak uninsured persons' time, you might have to wait for service for just a few hours.

2. Tell your kids to stay home in front of their computers and TV sets, rather than play with the neighborhood kids because one of those kids might have a cough from infectious tuberculosis which hasn't been treated because his mom and dad aren't working and they don't have health care insurance any more.

3. Fire your babysitter, your gardener, your domestic help and and anyone else who comes to your house because with these low-level jobs it is unlikely they have health insurance and who knows what diseases they could be incubating?

4. Home school your kids so that you can limit their exposure to infectious diseases from some of their unworthy uninsured classmates.

5. Don't ever eat in a restaurant because the kitchen help or the waiters serving you might be sick and might pass the sickness on to you when the food is prepared or served.

6. Never take public transportation (trains, subways, buses, airplanes, ships, ferries, elevators, shared taxis) because the uninsured person sweating and coughing next to you, who couldn't afford to see a doctor about his fever, might have influenza, cancer, cholera, diphtheria or some other awful disease that he contracted but remains undiagnosed and untreated and maybe you'll catch.

7. Be sure to be nice to that woman whose child has just been diagnosed with leukemia but can't have a life-saving bone marrow or stem-cell transplant because the child is uninsured and mom and dad haven't sold off all of their assets yet to qualify for Medicaid.

8. Be sure to avoid that person who mutters to himself and threatens passers-by because he has paranoid schizophrenia but no supervision of his medications and no insurance to pay for them. Soon the police will be along to taser or shoot him, but their services don't come from the health care budget.

9. When they close the hospitals near your home or workplace in the interest of "efficiency" and "saving money,"  your new employer-provided health insurance may provide a perfectly satisfactory substitute hospital on another continent. staffed by people who might speak your language.  On the other hand, your insurer may offer a nurse call service which can tell you how to set a broken arm with stuff your husband has in his garage workshop.

10. When new drugs, devices, technology and procedures are developed they will be available to politicians, bankers, financial people and CEOs under their insurance policies, but unfortunately, not to you and your family.

11. Your new employer-provided health insurance policy may provide for regularly scheduled office visits to the doctor. The new standard visit may be 3 minutes long, of which 2 minutes will be spent by the doctor entering stuff into the computer terminal.

12. Your doctor works from 9-12, 1-5 PM in the office, will not see you in the hospital, and knows nothing about the people who will see you in the hospital including their names, qualifications or experience.

13. All of that money you spent on life insurance will be very-much appreciated by your family.

Underwriting Is Not The Only Way To Get Rid Of Sick Patients

I was not overjoyed to read that insurers have agreed to abandon underwriting any more than I would be happy to read that terrorists have replaced plans to explode dirty nuclear devices in the subways of our major cities with plans to engage in biologic warfare.

There's more than one way to exclude expensively sick people from an insurer's risk pool: here are several. First, limit the drugs on the plan formulary to make drugs, for people with diseases which are expensive to insure, not covered, very expensive or inaccessible because of bureaucratic requirements. Second, have a network of doctors and health care institutions which doesn't include people or institutions with particular expertise in caring for people with expensive diseases. Exclude providers in certain geographic areas with "undesirable risk exposure." For instance, if a particular occupation (i.e., school teachers and educators) is believed to involve increased insurance coverage risk, don't provide facilities (or solicit business) where teachers and educators are significant population component. Fourth, avoid marketing to "high risk" clientele. And fifth, have an 85% "customer satisfaction" rule: if 85% of your customers are content, ignore complaints from the other 15%: they are not worth the administrative overhead to deal with, they demand too much, and they may be the sick expensive ones.

Finally, a "pool" which is available to individuals who can't get insurance any other way will encourage the strategies described in the last paragraph. It's just another reason to cost shift.