Healthcare is NOT a right!

Oh, yes, there seems to be some heat atop the Stoa this day, although and angry Stoic is hard to tell apart from a bored Stoic, but I digress.

I had an interesting conversation with one of my neighbors, a few columns down the Arena. She and her husband own a franchise in our city-state healthcare eventually came up as part of the discussion, since she had to ask about the leach ponds in my back yard and the Delphic servants that come to visit all the time.

She had plenty of good questions. Good questions, however, begin to take you to a granular level of detail that then loses sight of the bigger picture. Context begins to become as important as the topic. So, to keep it big picture and understandable, I used metaphors that directly lined up with the context of her life.


I started out by describing to her how the system used to work, how it works now, and how Obama wants it to work now.

She owns and operates a wonderful fried chicken and fixin's restaurant. A good Southern joint where grease is one of the primary food groups. I love the place.

So, when she opened her business, she had to calculate her overhead, such as utilities, insurance, maintenance, new equipment schedules, produce and product expenses, and staffing costs. To cover those expenses, she planned on selling fried chicken with all the Southern sides. If she sold enough of those, she could cover her material overhead, pay her staff, pay herself, and bank the rest for the future.

Here is how it worked. A man came into the restaurant, went to the counter where a chipper young lady stood in front of a register, hair pulled back and snaked through the back of her baseball cap. That's cool. He would look at a huge board of fare and then pick what he wanted. Two other nice young folks would then rapid fire the food from a hot service line that was just behind the counter. The customer can see the food and see what is going on his plate. People worked in the back in a semi-open environment so he can see how they are preparing the food. The prices are up on the board next to the food item, and when his order was complete, the register rang up and he handed over the money for the cost of his meal.

If he was unhappy about any part of the meal, he told them and it was quickly dealt with, usually with free food or a coupon for his next visit.

That free exchange of goods and services has existed since our non-Sapien ancestors had two rocks to trade among each other.

Now, lets see how this works in a 3rd party provider environment...read Blue Cross, and other commercial insurers. I'll even through Medicare and Medicaid in for good measure.

I will start with managed healthcare from its early stages all the way to how it works today, just so you can see how it evolved.

Now, the big commercial insurance companies work by acting as an intermediary between the customer, you, the hungry person now standing in line for your food, and the restaurant owner, the person covering their overhead and trying to make a living by selling chicken.

Since the Insurance company is able to "pool" customers together, they are able to demand a price that is lower than what is seen on the menu. If BC came to you and said, "Your chicken is great, but at $5.00 it is just too much. How about if we promise you access to 15,000 people per year, you will only charge them $4.00 for the same meal?"

In the beginning, you know, the top of the slippery slope into Hell, you thought, "ok, guaranteed business is better than the uncertainty of hoping that my marketing works and I get people in here in ones and twos."

So, they sign on to BC and other entities like them. Now, some of those entities are able to negotiate different pricing based on the number of "people" they can pool together and guarantee to patronize your chicken establishment.

Since it is too time consuming to explain this pricing to each and every customer in line, you pull all the prices of the menu. Most people are not going to understand when they find out what and how their carriers are paying for their services.

At first, this new system seems to work ok. The restaurant is able to budget and plan ahead since it knows about how many customers it may have in any given year. They buy new equipment and upgrade their services to attract more of these carriers.

Over time, costs for everything go up. Just talk to your grandparents and ask them what a loaf of bread or a gallon of milk cost when they were young.

Now, people being people and business being business, if it is not illegal, people will take advantage of a system and extract the most they can out of it.

So, in 1980, our same guy goes into the chicken joint and asks for a chicken lunch. The harried woman behind the counter is not as well dressed and certainly not as polite as the young, chipper woman that was there 10 years ago. Instead of looking at him, she first asks for his card to see if they accept his carrier plan. Now that that hurdle is out of the way, she then tells him to move on down the line to get his food.

By 1990, the carriers are not making the kind of money they used to. You see, these third party people who negotiated the price in 1980 have to make money for themselves. Their organization grows and gets sued and must lobby the government so that they will leave them alone. So, since they are not making as much money, they negotiate the prices down even further. So far, that the restaurants must now begin cutting back on things to stay competitive with one another.

By 1993, these carriers found themselves under attack by politicians. It was felt that quality and access to care was being denied to people who did not belong to these carriers. The cost of food was not listed on menus any more and those that had to pay out of pocket the old way felt they were being overcharged.

These carriers then began to demand more than just a low price, but proof of the quality of the food that was being prepared and served to their customers.

These added expenses caused most the chicken joints around the country to start going out of business. Those that didn't began to lump together for safety in numbers.

So, in 1995, the same man would stand in line outside to get to the counter where he could order his food. After long wait, he gets to the over worked and under paid, angry woman behind a stack of paperwork. The menu is now gone, and in its place is a list of rights that the business must comply with for each and every customer who wants chicken. The man can no longer see behind the counter to where the chicken is prepared. Instead, a sign is nailed to the door reminding everyone that quality is their highest priority. There is no more hot food out for him to see when he orders.

Instead of ordering, the woman takes his name and his card, punches both into a computer where she reads back to him, "You can have only a two piece meal with one side. Your carrier will no longer pay for two sides." If you ask to pay for the side out of pocket, she declines saying that it violates their agreement with the carrier to do that.

Standing in line some more, you eventually get to the end where your meal comes out on a tray from a conveyor belt. The chicken is bland because the government feels that too much salt is bad for you. It is also cooked in recycled peanut oil and not lard, because lard is bad for you as well. The pop is diet pop because the carrier will not pay for regular pop any more. Your teeth may rot and then the carrier will have to pay out for dental work. No, sir.

So at the table you have chicken you don't like, a side you didn't order, and diet pop. A statement of benefits comes to your house in a few days showing you what services were rendered. The meal that once cost $4.50 now seems to cost $25.00 for some reason. What the.....

Now, by 2001, the number of regulations has grown ever higher and this chicken restaurant owner must comply with them all if she still wants to take carriers.

The meal that used to cost $4.50 now seems to cost $75.00.

By 2009, along comes Congress and the President, who feel that eating Southern style chicken is a right now has decided to make it "Universal". The results?

Where before, co-pays and deductibles used to keep some people from ordering a meal rather than cook at home, now, everyone wants to eat out all the time, since this new "chicken plan" is supposed to cost you next to nothing.

The results?

Well, now that the government was going to set both the price of the chicken and its quality, most of the restaurants simply quit. The ratio of restaurants to customers has become so lopsided that there are very long waiting lists to get that meal. Furthermore, the government mandated training programs that were then created to create more chicken chefs has resulted in sub-standard chefs who are more likely to poison you then cook good chicken.

You must now wait for a letter to come in the mail to tell you when you may go stand in line for your chicken. The line, when you are allowed in, will be very long. The woman in the restaurant will no longer even look at you. She simply scans the card and sends you down the line. No questions are asked, you are simply given what they feel you should get and you had better be happy.

In 45 short years, you went from being able to choose where you wanted to go for dinner and paying $4.50 to being told when you would be allowed, no matter how hungry you were, to go get that dinner. Gone are the "carriers" even. The government has taken everything over and treats the chicken and you as if you were at the DMV.

I could go into so much more detail, but we need to keep this under a hundred pages. The point is clear. Whenever the deal is between YOU and the SELLER, there will always be quality control. If you don't like the chicken, you go elsewhere. That person then fails. The one who does it right, shows others how to do it right. All the government knows how to do is mess stuff up and make sure that everyone else messes things up according to a detailed policy.

Enjoy.

Live well,

--Zavost