Explaining USA Health Care Debate: Repairing Humans and Our Systems

USA Health Care debate is clearly about the allocation and distribution of cost. I keep hearing it expressed as a poor health care. Most instances where USA death tolls are higher could be attributable to relative affluence (affordable illegal drugs, affordable guns, affordable sugar).

Take Cancer. USA's system developed the best responses in the world, and help explain not just the increased rates of survivorship in the USA, but actually floats a lot of other boats as well.

The hypothesis being debated by politicians is not that cancer rates would be lower in a single-payer system, or that treatment of injury would improve, but that costs would be distributed differently. Right now you get very affordable health care if you have Medicare (are over 65) or are eligible for Veterans Administration hospitals, or perhaps are poor enough for Medicaid (I know less about that). But under those systems, you are better off if you have an extremely expensive ailment (like cancer) but not clearly better off (red tape) than if you go to the emergency room of a private hospital.

This blog was developed after a conversation with one of my kids who attended United World College in Bosnia y Herzogovina. All 3 of my kids have lived as ex-pats and wind up trying to explain a system that most people don't even understand in their own countries. If a nation can't even manage its own appliance repairs, how can it manage human bodies?

The answer is as complex as the question is simple. In the USA, people who are the smartest in their class go to Med School or get employed by pharmaceutical research firms. Those people are not available to fix laptops, the money is in fixing hearts and livers. In Ghana, only a slight fraction of smart people have the opportunity to go to med school. I means there are more smart people available to repair laptops.

Cost - Benefit of Biology Repair

At a meta-level, the debate is about repairing the system we have for repairing health. The debate over the USA Health Care Insurance not about USA treatment of illness, vaccination rates, or gunshot trauma, or the root causes of those risks. It is "given this person needs health care, how does the system calculate those costs, and how do they get paid for?"

One of the best reviews of the complex conundrum is Adam Ruins Everything (TruTV) episode "The Real Reason Hospitals Are So Expensive". I don't agree with everything Adam Conover says, and think he has a predjudice for oversimplification (probably driven by his editors), but have empathy for his Wikipedia quote.

That episode gets to the crux of the matter... how much is this repair (treatment) worth? We can objectively tell whether a car or laptop is "worth repairing". We know that that objective decision is arrived at differently by people in different supply-demand economies (Adam Smith). But what is human life worth? And how do we make rational decisions while surrounded by loved ones driven instinctively by a million year old evolutionary principle (fear of death)?

In certain places, even rich people understand the economics. "You have to step over the bodies" is the training advice given to medics on battlefields. If you stop to treat a dying man with 4% chance of surviving his would given an hour treatment, 6 others who had a 50% chance of living with 10 minutes of treatment will die. If a wound is so big that 9 pints of blood are lost every minute, you cannot empty the blood bank to give the person another hour of life. At least, not until you solve the supply problem for blood. That problem - cheap artificial or substitute blood - is most likely to be solved someday in the future in the USA Health Care system, This is because someone obscenely rich will create a market for it. Perhaps NASA or the US Military Spending (cost of soldier) will play a role. For geeks, think of it as "free RAM"... it would change your repair diagnosis decision for a number of machines (as Chromebooks changed the market around hard drives).  The excess in health care expenditure per capita includes both more expensive costs and more available expensive treatment. Think of it as an average cost of a car, in a country where more people buy a Tesla.  That doesn't mean that Chevy is or isn't more affordable, but you can't really tell from the statistic exactly how the income is being distributed.

US Political Debate

Skeptics of single-payer systems point to the red tape and inefficient costs and exploitation (double testing, prices gouging). I have witnessed this in Medicare. Skeptics of the current system point to people who have "cheap" private insurance that excludes things (like cancer or pre-existing conditions) in the fine print and who wind up with crushing bankruptcy when the treatment they require is not covered.

My dad's doctoral thesis professor, William Stephenson, wrote a book called "Play Theory" after developing a really profoundly deep-diving polling system called "Q Method". Based on his research, the discussion above is too complex for most people to follow, and they will naturally adapt the opinion that is the most "familiar" (the most likely to have been heard expressed by a friend or family member). That leads to tribalism and divided Congress, and it can be exploited (weaponized) by foreign powers over social media. I think the way the nation votes for BernieCare, ObamaCare, TrumpCare has less to do with the understanding of the cost distribution system and more to do with finding a simple motto or slogan ("Socialism doesn't work" or "US Health Care System is Broken") than with improvement of the system.

Under the USA system of Medicaid and Medicare, young healthy people are taxed to pay for the cost of elderly and poor and veterans. Unlucky young people (cancer, accident) wind up with bills they cannot pay after they are treated. The bills don't get paid and hospitals put the unpaid expenses onto Medicare patient bills. It provides evidence for both skeptics. But economically, the cost is distributed.

In small countries like Holland, it's pretty easy to distribute the excess health care cost onto a tax on gasoline. In oil rich nations like Norway, its even easier. It's pretty hard on Texans (who have the longest driving commutes), not hard at all on Manhattan residents (who tend not to own a car because of the cost of the garage).

Under Q-Method, I'd ask 100 subjects to rank the following 2 questions in the order they most agree with each. I wouldn't be concerned with how strongly you agree or how violently you disagree, I'd find out the order you'd put them in, even if you agree or disagree with each. This would divide the 100 interviewees into two groups. Their opinions would most likely be predicted, under Play Theory, by the amount of time they spend every day with people who express one of these opinions.
  • Politicians who say they have a simple solution are lying.
  • Politicians who say it's too complicated avoid taking a stand on a difficult problem. 
  • The system is rigged
Reporters who write short blurbs leave it to bloggers like me to explain things to people overseas, who understand that USA health care is different but who mistake election year press controversy for a health care crisis. Most people are healthy and most people don't like to pay taxes, but most people want to be treated if they become pregnant or injured and the health care costs suddenly arise.

My solution would be to make everyone under the age of 25 eligible for Medicare, But even that's far more complicated than it sounds. There are people who believe that every life, even the babies who come to term with a critical congenital brain defect who will never be capable of consciousness (born with a brain stump) who would insist that it's moral to tax everyone to keep that body alive forever (and to imprison the mother who was told about it and ends the pregnancy in the first trimester).

And thus we enter another uncomfortable democratic election debate people prefer to oversimplify, and treat via slogans... yes I will type it. a b o r t i o n s.
For most of us, ability to think is a software problem, not a hardware problem.
Primum non nocere - first do no harm.

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