A Modest Proposal to Fix Health Costs

“A Modest Proposal to Fix Health Costs” is a second-place contest winner.

Stand down.  Steven Brill was just the messenger.  Brill didn’t invent the stomach-turning revelations laid out in his 2013 TIME cover story “Bitter Pill – Why Medical Bills Are Killing Us.”  Brill bared the ugly facts via diligent sleuthing, but it’s hard to thank him for an exposé that sickened us, because – and Brill should know this better than anyone – we can’t afford to get sick.  When Brill doubled down during his appearance on The Daily Show our hearts sank again, hopefully not into cost-prohibitive thrombosis.

Brill and Stewart agreed that the U.S. had finally taken up “the second question” (about who should pay medical bills), “but we never asked the first question, which is why are the bills so high?”  By following the money, Brill had discovered that medical expenses are capriciously exorbitant, and that the health care industry basks in financial sunshine on a “prosperous island,” havened from economic turbulence.  Instead of fabbed up bills, Brill asked, “why not require that they be rewritten to reflect a process that considers actual and thoroughly transparent costs?”

Brill’s analysis is clearly on the money, but not the BIG money.  Would he have us believe that institutional obfuscation, creative costing, and a powerful lobby are enough to hold America’s health for ransom?  Here’s the problem:  While Brill tenaciously exposed the supply side of health care’s monetary equation – providers – he failed to address or even acknowledge the demand side.  Why do we passively pay?  Surely, collective American ignorance isn’t the sole accomplice to our bamboozlement.

The coconspirator, it turns out, was right in front of Brill, hiding in plain sight within paragraph three of his own article.  Stephanie, Brill’s very first case study, pointed directly at the culprit.  Stephanie was informed by a billing clerk that the estimated cost of her husband’s visit, just to be examined for six days so a treatment plan could be devised, would be $48,900 due in advance.  Her husband’s condition was potentially life-threatening, so Stephanie got her mother to write a check.  Then Stephanie fingered the guilty party.  “You do anything you can in a situation like that.”

And right there is the demand side.  Whereas you should avoid nonessential tests and procedures, when health issues afflict moi, cost is no object.  Providers can charge what the market will bear, and when it comes to me and mine, and especially when it comes to life and death and me and mine, we go all in.

Surgeon General’s Warning:  If you experience queasiness when reading bad news, or are still taking antidepressants to recover from Brill’s article, or suffer from acute political correctnessitis, do not continue reading unless you have an airplane sickness bag within arm’s reach.

Brill correctly touted the relative efficiency of Medicare in bridling supply side providers, but despite the preferable rates they receive, it’s old people who blithely and recurrently siphon off our health care dollars.  And I’m as qualified to say that as the next guy, unless the next guy happens to be Barack Obama during his 2013 State of the Union address:  “The biggest driver of our long-term debt is the rising cost of health care for an aging population.”

On the one hand we’ve got more people, living longer lives, facing the inevitable afflictions of age.  On the other hand we’ve got inflating medical costs funded by a diminishing percentage of taxpayers.  The years bring fears, and we protect ourselves from the specter of death by throwing our wallets at it.

The medical industry has no interest in letting go of us until our life’s potential (some would say ability to pay) has been exhausted.  One reason is that medicine is obliged to operate under the Hippocratic Oath, but the main reason is that medicine is glad to operate on the Golden Goose (you and me).  Meanwhile, religion and law stand on the sidelines cheering the sanctity of life, fully prepared to rush onto the playing field if the contest gets rough.  For the upcoming generations who’ll spend their earnings keeping old-timers alive as long as possible:  Good luck trying to live.  And for those nearing life’s end:  Good luck trying to die.

It took political guts for Obama to call out the elderly.  But talk, unlike every other item on health care’s pay-to-play bill of fare, is cheap.  Even if Congress were to miraculously get on board with an action plan, what really could be done?

Medicare is already relatively efficient.  We can’t turn back population demographics.  As oldsters shuffle toward to the finish line, most have little interest in and virtually no support for completing the race.  And for those warhorses who’d like to say “no mas” to a life of impoverished quality and incessant pain, the lone stark option is cold, messy, and illegal.

The United States faces a seemingly unapproachable no-win situation.  We don’t have the political will (or the aesthetic inclination) to dress-down seniors, yet we must.  Conventional mechanisms have failed, which is why we need a bold new idea, a maverick solution.  So thank you Sarah Palin for envisioning the way out:  death panels.

Call it reverse psychology, political jiu-jitsu, pity for a struggling commander-in-chief, or just plain nonpartisan patriotism, but Palin did her best to hand the blueprint over to Obama.  The Governor and her camp, utilizing the power of suggestion, strove to shepherd the President in the right direction.  That’s why Palin ceded him ownership of her invention right from the start.  “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’.”  Palin was assisted in her cause by Betsy McCaughey, the 72nd Lieutenant Governor of New York, and by Senator Chuck Grassley.  Palin and her allies tried desperately to encourage Obama by giving him credit, before it had even occurred to him, for wanting to “pull the plug on grandma.”  And though Obama missed the point, not all within his administration turned away.

“Car Czar” sounds like a shill you’d see on late-night television, but it also happens to be the nickname of the lead auto industry advisor within the U.S. Treasury Department.  In February 2009, Obama appointed Steven Rattner to that position so that Rattner could oversee the federal bailout of Chrysler and General Motors.  Following his successful five-month tenure, Rattner returned to his regular job as a Wall Street financier – a guy who knows money.  Here’s how Rattner began an op-ed piece in the September 16, 2012 edition of The New York Times:

Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently – rationing, by its proper name – the exploding cost of Medicare will swamp the federal budget.  But in the pantheon of toxic issues – the famous “third rails” of American politics – none stands taller than overtly acknowledging that elderly Americans are not entitled to every conceivable medical procedure or pharmaceutical.

A few brave realists in the international community, facing similar circumstances, have also spoken out.  Japan’s Finance Minister, Taro Aso, in 2013 told his national council on social security reforms:

I would wake up feeling increasingly bad knowing that [treatment] was all being paid for by the government.  The problem won’t be solved unless you let them hurry up and die.

The handwriting is on the nursing home wall.  Old-timers, via multitude, longevity, and innate self-interest, will bankrupt the United States at the expense of young people and future generations.  Medicine, technology, law, politics, and religion are on Granny’s side.  There’s only one viable solution:  Palin’s.  So snap out of it America – desperate situations require desperate measures.

And stand down.  I’m just the messenger.