The One, the Only . . .

Healthcare as the Moai

A recent article in the Strib said the annual cost of healthcare that a company pays for a family is now about $20,000/yr - which somehow reminded me of something totally different, the Moai.

Are you familiar with the Moai?  They are those statues with giant heads that made Easter Island famous. It seems that the early Eastern Islanders were so fascinated with them – inexplicably – that everyone on the island did nothing but build statues. Perpetually. What, you may ask, does this have to do with healthcare and, more importantly, you? Bear with me.

In addition to the company's $20,000 the employee is on the hook for about $10,000. Wrap your head around that!  Along with Medicare, Medicaid and VA it all adds up to about $3.8 TRILLION/yr or almost 18% of the entire economy – and growing 5% or more each year (while the economy is growing around 2%.) That's about 50% more than the whole manufacturing industry and equal to the entire housing industry. It’s also twice as much as any other advanced country in the world spends (not to mention that we still have tens of millions of under/uninsured and with worse results.) Why is that? Maybe this explains it - compare US costs to Australia:

Cost of MRI - $1100 vs $215

Knee replacement - $28,000 Vs $16,000

Hip - $29,000 Vs $16,000

Personal favorite:

Colonoscopy - $3000 Vs $370

And don’t even ask about pharmaceuticals.

Back to the Easter Islanders. They became so consumed with building Moai that, giving all their energy, they used up every tree and resource on the island and ended up eventually destroying it and killing each other. For statues.

Healthcare is not a Moai, healthcare is important – but, like the Moai, it doesn’t add any new value to the economy. Economically it is essentially the same as repairing your house or your car. So, what does it mean if the company is paying $20,000 for something that doesn't help them build a single car or create a single app? Let’s see, wages have not increased much in last 30 years at the same time that healthcare went from 6% of the economy to 18%. Hmm, I wonder why would that be. And how much less have companies invested in their business? Don’t know but a lot - and it is a terrible competitive disadvantage for American business versus other countries. Of course, another delightful "benefit" is that, again like no other advanced country, almost 50% of all bankruptcies in the US are because of medical bills. Nice. Finally, health benefits are not taxed for either companies or individuals costing the US Treasury about $300 BILLION per year – budget deficits anyone? 

Bottom line: we pay too damn much for our healthcare! We have great health care but a crappy healthcare system. No one designing a system today would choose to make one as complex and inefficient as the one we have. Which, of course, is why every administration in the last 50 years has proposed some sort healthcare plan to make it more affordable and available to everyone - with zero success. There are no simple answers to this. Why? Because the healthcare-industrial complex is as protective of its profits as the military-industrial complex and the education-industrial complex. Insurers, doctors, pharmaceuticals, hospitals and medical device makers all see us a huge, bottomless wallet that they can take advantage of - remember, OUR spiraling costs are THEIR incomes . . .  or stock options. I’m sorry to speak so poorly of an industry I worked in for ten years but the truth shall set you free.

In a perfect world we wouldn’t have insurance for healthcare but it’s not a perfect world. So what do I think? Glad you asked! First, NOT single payer, at least not until we get costs under control. (BUT if we don’t do something soon you can absolutely count on single payer coming anyway in the next few years because people are already rebelling.) And it’s not free market mumbo jumbo; healthcare is not now nor ever will be a consumer product like a car or stove – try shopping for a doctor or hospital after a heart attack or before starting chemo (especially since you can't compare prices anyway.) It certainly can’t be totally free either, part of the problem now is that WE all expect everything all the time and paid for by someone else i.e. insurance. Skin in the game, baby!

So baby steps? Perhaps make ALL health insurers non-profits; it’s been the rule in Minnesota for many years and has served us well. Won’t do much to stop price gouging but it will take profit and Wall Street out it which has to be a good thing, right? Another option; treat healthcare like a utility - no more of this charging whatever the market will bear, it’s cost plus. I’m sure there are lots of other ideas but it’s all about the will to get it done – which means WE have to push it.

There is one other option I might offer, the Moai Option: let’s just keep building those healthcare Moai’s until we transfer all our wealth to them and then, like the Easter Islanders, hope the gods take care of us.