Opinion | Ted Konnerth: Rethinking the politics of health care
We can parse the preamble to the U.S. Constitution as, “We the people, in order to … establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare … do ordain and establish this Constitution.”
It’s straight forward: justice, tranquility, defense and general welfare — the basics of a new experiment in governance. On Sept. 17, 1787, the Constitution was approved by the delegates. On Sept. 25, 1789, the First Federal Congress proposed to state legislatures a set of amendments that would eventually become the Bill of Rights.
So 232 years later, we’ve got justice well defined, defense is 11% of our annual budget and tranquility is a bit subjective in my mind, but I’m good with it.
Then there’s general welfare. Somewhere on the long road of history, health care became a product of capitalism. We have to pay for general welfare directly, as it’s not part of our governmental budget if you are not on Medicaid. We currently have about 75 million people on Medicaid, 60 million on Medicare, 178 million on private insurance and 30 million using the Affordable Care Act or Obamacare.
That means we have about 30 million uninsured people. As we have only 331 million residents, there are some issues with definitions and interpretations. But the real point is why do we need insurance in the first place?
I have dental insurance, which costs me and my wife $1,600 a year. Each of us has a $2,000 stop loss for the insurer, which means Humana will not pay anything above $2,000 in a calendar year. This was my year, with a bill for an implant over $5,000, of which Humana has paid around $600. I spend $1,600 per year to buy $2,000 of insurance. My first question should have been, “Why am I doing that?”
Why can’t our medical needs be considered general welfare? There is nothing more pertinent to general welfare than health care, so how or why have we allowed our individual health care to be co-opted by insurance companies whose primary role is collecting profits? Why have we encumbered our doctors to craft insurance-classification schemes to order tests — covered by insurance or Medicare — that will enable them to diagnose us? Years ago, I offered to pay my dentist whatever the insurance rate was in cash if I could drop my insurance. He was offended and thought it was an ethical breach. I could have asked him why he submits bills to my insurer that are 50% or higher than my insurer will cover, knowing he will accept whatever the rate is already in place, but that seemed impertinent.
Health care will consume $4 trillion in 2021, roughly 18% of our gross domestic product. We do not have the best health care system in the world. The U.S. ranked 30th in the Health Care Index in 2021. But we do spend the most amount of money, about $10,500 per capita, of any country in the world. None of these statistics are new to most of us, but they raise the obvious question: Why are we so politically stymied to provide quality health care to every resident in the country?
The answer is bumper stickers: “Socialized medicine! Don’t touch my health insurance!”
We’ve moved from rational, critical thinking to supporting our politicians’ reelection strategy with over-hyped, misleading slogans. Health care is too large of an issue with too many well-financed supporters that have no desire to make our system better. Examples of excess in recent years are frightening: the Purdue Pharma OxyContin lawsuit, the $900 EpiPen (which has maybe $2 of epinephrine in it but was patented as a medical device with no competition), opioid distributors that knowingly addicted thousands of people, prescription drug prices that are twice the cost of other countries and more.
To those of you who aren’t well informed, Medicare is not free. It is paid for, among other mechanisms, by each subscriber based on income and is managed under a separate federal budget that is immune (we hope) from the general budget. It is also well managed and very efficient. I call it my socialized medicine, and I wish all of us could share it for the benefit of our general welfare.
Ted Konnerth’s column “Centricity” publishes biweekly on Thursdays in the Summit Daily News. Konnerth is the founder and CEO of an executive search firm and author of a monthly newsletter for the electrical industry. He lives in Silverthorne. Contact him at email@example.com.
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