Sunday, November 22, 2015

Medical Protection as a Commodity


As this NBCnews.com article points out, the pot has been stirred again in the arena of medical care costs, and who foots the bill. United Health Care, the nation's biggest provider in overall terms, is sending up a "we may not continue participating" balloon into the political atmosphere.

I couch this in such terms because you have to take such statements with more than a grain of salt; not only as it comes on the verge of the final leg of another campaign season (getting longer just as the number of black days for Christmas consumption expand out beyond Thanksgiving), but also because there are caveats to how much impact their pulling out may or may not have. They are big as insurers go but they don't have a huge stake in the exchange markets yet and, as the NBC piece points out, they were late in getting into the exchanges, and may not have done a very good job in preparing for their entry (other insurers, like Aetna, say that things are going as planned) .

What we need to keep in mind here, however, is this one simple fact. Health insurers are not really in the business of paying for health care. They are in the business of capital formation. They use the payment of health care bills as an incentive just as content providers use entertainment to get eyes, ears and brains in place for the reception of messages to consume. The whole point of their business model is to limit payouts, one way or another, so that capital can, in fact, be accumulated and invested in other areas. And, as these things usually play out in the world of Big Money, the more payouts they avoid the better they look to other players in the game.

As ridiculous as that may be, in terms of how best to provide a fundamental social need, it gets even worse when we also consider that the other side of the health care coin, the doctors, nurses, hospitals and pharmaceutical companies, are also purveyors of a commodity. However well intended they may be (and most of those in the trenches really are), the fact remains that making money is still the primary enterprise here, with actually helping people in distress a bit of icing on the cake.

The primary difference here, however, is that, being a monolithic, and hardly ever a competitively exposed, market they can set prices pretty much as they please. A cost increase history one need only compare to general inflation over the past few decades to see how out of proportion they have been. Only higher education (understandable as it relates to the imparting of information, our real gold now) of late compares. As with other fundamental social needs that go begging now because we can't figure out how to equitably balance who should pay and who should benefit, this is no way for any society to not only grow, but to flourish. No way for us gain our destiny in stepping off this rock and begin reaching out to the stars.

The affordable care act was a well intended reform and, for the most part, it has done surprisingly well in getting more care to those who need it; however you may disagree on the complexity it may or may not have created, or whatever cost dislocations it may or may not have also created. That it probably does fall short in one way or another only illustrates the fact that it, as well as most Liberal efforts to reform, did not really get at the primary problem; which is precisely the fact that a cost based, commodity economy, no longer makes any sense in a comprehensively electrified, information environment. You need only consider that everything to do with health care, its quality, its efficacy, and whether it is applied cost effectively, relates to the movement of information. But if information itself is a commodity, and whose movement then depends of the assumption of net gain, how can it possibly move freely enough to attain the goals just mentioned.

Fundamental change, not piecemeal reform, is the only way we are going to get real solutions to most of the pressing problems we face now. The sooner the rest of you accept that the sooner we can get to actually doing something about them all.



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