Amendment I

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

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Saturday, October 20, 2012

Solving the Healthcare "Crisis"


Let's skip the wordy preamble, shall we?  I've thrown these ideas out countless times to those who should understand, and I'm always told that I'm impractical.  Then again, I worked with people for several years who thought that new business ideas comprised dredging up the same vomit they spewed two years earlier, and pretending like it was something new under the sun.  So maybe I'm not the impractical one:




  1. Euthanasia.  And to think, we had Kevorkian to help us out with this...wasted.  If you don't get this, then get on a plane, fly to Holland or any other country where people have a fucking clue, and talk to some of  their doctors.  Then read the book Love Life, which is supposedly fiction but really isn't (just like a lot of fiction).  If you don't cry near the end, and perhaps have a change of heart, read the first word of this paragraph and think of how it should apply to you.  
  2. Just another example of how stupid our government actually is, is that we spend tax dollars on public service announcements that encourage people not to smoke, drink, do drugs, engage in risky sexual activity, etc.  Generally, all the fun stuff.  But the real issue is that all this healthy living is keeping people alive WAY TOO LONG.  Let's fight longevity, people.  Legalize it all, and change those PSAs to encourage risky behavior.  As an added bonus, if everyone is busy getting high and fucking each other, we may have less violence.  Which is a bit problematic for my overall theme, now that I think of it.  
  3. Old people.  Hey, parents, grandparents, I love you all, but you know we're spending the vast majority of healthcare dollars on the last couple years of your lives.  I'm not about to encourage a Soylent Green solution, but seriously, could you maybe check out #1 above, you know, when you're not feeling so hot any more, before the chronic, expensive to treat ailments kick in?  Secondly, old people freaking love free shit.  So if you go to Denny's and have the skillet special, and you are old (and by old, I mean older than 47, which coincidentally is my age - go figure), you should get a free pack of cigarettes, a cigar, a coupon for free skydiving lessons, hang-gliding lessons, and some free spermicidal lube.  And some Viagra.  Women outnumber men in the older age groups by about 10 to 1, so let's give Pops a little pick-me-up.  And while we're at it, let's not forget cocaine (see #2 above).  I'm figuring if the women can't stop a guy's heart, an eight-ball probably can.  Strippers?  Just thinking out loud here.  My only concern is that if all the  old men die, the old women will live longer as a result of being significantly happier.  
  4. Stop eating fatty food.  Fat is killing us, and it's taxing the healthcare system.  Which brings me right back to #2.  There's a reason why models, smokers, and celebrities are thinner than their non-model, non-smoking counterparts. Which is ... they spend all their time snorting coke and smoking, rather than eating.  Duh.  (Note:  You can use rock star in place of model, in case you have some sort of gender issue with this - that's not really the point, but whatever makes it easier for you to digest.) 
  5. Killing the Agency Problem.  Sometimes even I miss a beat.  So I had to go back and add this in, since I forgot it the first time. Considering that this is critical to my plan's success, and doesn't represent immediate political suicide for anyone who tries it, it could actually work. First, a quick explanation for the 99% of the population who didn't study economics and don't subscribe to The Economist.  
    • Agency is when one person/entity represents another - simple enough.  The agency problem arises when the agent and the entity the agent represents, have conflicting rewards and penalties that are not aligned with their actual behaviors.  This is also sometimes referred to as the "free rider" problem, though that's typically viewed as more of specific instance of people using scarce resources excessively because they are free.  This, however, is a fairly apt description of healthcare delivery at its extreme.  
    • An example of the agency conflict that should resonate with most readers is when banks make loans on homes, then sell all the loans, making a quick profit while retaining none of the loans, and thus retaining none of the risk.  Why is this a problem?  Because the risk managers underwriting the lending risk work for the bank that is selling the loans, so they have no incentive to limit risk so long as they can profitably sell the loans in the secondary market.   
    • This is a critical distinction, because if no one will buy, then the agency problem may not exist.  The reason it existed in the single-family loan market most recently, is because rating agencies failed at their job, that is, correctly rating things, and gave ratings that buyers considered to be quite safe, while in fact those were just lies.  Or perhaps they weren't actually whores to the investment banks who paid them, but rather their employees are just REALLY FUCKING STUPID.  Take your pick.  That's another example of the agency problem - being paid, either directly or indirectly, by someone other than the beneficiary of your work, when the person paying you has different motives than that beneficiary.  
    • Which gets us to the last part of this particular circle of greed: CEOs who get paid for their company's stock price going up, but who don't have a real penalty for the stock price going down, or for leveraging their company with so much debt that any small error will bankrupt it.  For the record, getting fired by the Board and collecting a gigantic golden parachute does not qualify as a penalty.  Consider Robert Nardelli if you will, the former chairman of The Home Depot, who collected a $210 MILLION severance package for running the retailer into the ground and getting fired.  He was from GE, by the way.  His replacement, Frank Blake, also from GE, appears to be about 10 million times better at running a company than Nardelli was.  Which is hyperbole for "a shitload better than Nardelli."  By all accounts, we can consider the Nardelli compensation structure an agency problem.  
    • Which gets us to the point of this little exercise, with regard to healthcare.  Americans use way too much healthcare, because they don't pay enough for it.  WTF?  I can't be serious, right?  Let me rephrase it - Americans don't pay enough for healthcare DIRECTLY, and don't pay at the time they use it, so the connection to pay and services is less clear.  That is an agency problem, and to a certain degree a free rider problem.  Your company pays the majority of your healthcare premiums, and you have some tiny copay so you can visit the doctor every time you prick your finger on a rose.  What if your copay was $200?  How judicious would you be then?  What if for silly things like that, you could see an RN for, say, $50 instead?  If you actually had to pay the entire amount out of your own pocket each time, and it was a big enough number that it wasn't trivial, as it often is now, your use of healthcare services should go down dramatically.  This is happening to some degree - copays are going up, discretionary accounts with money you get to keep if you don't use it, are more commonplace, etc.
    • But my proposal is much more radical.  Make it illegal for companies to provide healthcare for their employees.  They can still create a buying group to help drive down premiums, and to negotiate the terms of the coverage, but they CANNOT pay the premiums.  Instead, they increase the pay for all their workers by the amount necessary to provide after-tax pay equal to the premiums they had been paying, and workers pay the premiums directly.  The increased salary would be tax deductible for the companies, and to make it really easy, that portion of the employees' salaries would be excluded from taxable wages, making the computations easier.  There would also be options for true major medical indemnity plans, where you have no coverage other than preventive care such as checkups, and major medical, like a tiger chomping your arm off, and you're therefore bleeding to death.  Such plans would be much cheaper than paying through the nose for unlimited doctor visits, for those people like me who rarely go to the doctor, and if I have to I try to convince him that Skype is a legitimate way to visit the doctor.  And employees are free to get insurance anywhere else they want, with other buying groups (this is in large part already possible, most employer-sponsored plans let you waive out of them).  And like safe driver discounts, everyone should have a pool of money to draw from, but if they don't use services, they get that money, or it rolls over to the next year and gets even bigger, giving people a financial incentive to NOT use healthcare.  That's my solution to the agency problem.  
There isn't a politician alive with the balls to try even a fraction of what I've put above, including the most obvious one (#1), since we live in a country where people think they have a right to tell others when they can live and die.  Now who's playing God?  If Jesus wasn't just some insane freak wandering the desert (and for the benefit of the doubt, let's assume he wasn't), I think he would be pretty fucking pissed right now at the hubris of those who think they have a monopoly on bodies and souls.  And I don't even believe in a vengeful God.  Then again, I don't believe in any God, so I suppose I'm simply being redundant.

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