Socialized health care: HMOs with Guns

Announcer:
"Welcome, everyone, to America's least favorite game show, Let's Make A Health Care Deal! Here's your host, BS Footprint!"

BS Footprint:
"Hello, everyone! How are you feeling tonight? A little under the weather? Health problems got you down? Growing weary of the 'health care crisis'? Not to worry, we've got a deal for you! Actually, we have not one, but three!"

"Behind each of our three doors, we have a health care system. Each has its benefits and costs. Since this is a special occasion, we'll even tell you what's behind each of the three doors!"

"Behind Door Number 1: We have a doctor (or other health care provider). You engage his service as you would any other professional, and pay him directly, out of your own pocket. There are no other parties involved in the transaction."

"Behind Door Number 2: We have a shiny new HMO/insurance company AND a health care provider. You pay the HMO/insurance company a fee, and some or all of your health care costs are covered. You pay the health care provider a fraction of his normal fees (or none at all if you have a really good insurance plan)."

"Behind Door Number 3: A brand new government run health-care system! That's right, you don't pay anything directly! You and some of your fellow citizens may pay taxes, and some taxes (or government debt) are used to pay health care professionals (and the growing bureaucracy required to support the system)."

"Now, let's play tonight's game!"

~ ~ ~

Which door would you choose? And why?

Ok, I'll admit it: the health care reform debate isn't a game show, though some of our fellow citizens seem to behave as if it were.

What's the nature of each of the Three Doors of Health Care? Which leads to the best customer service? Let's take a quick look at the relationships in each form:

1. You and the doctor/health care provider
2. You, an HMO or insurance company, and the doctor/health care provider
3. You, the government, and the doctor/health care provider

Note: From this point forward, I'll use the term 'doctor' to mean 'doctor or health care provider or shaman' to avoid toasting my keyboard and driving you nuts. I use the term 'HMO' to mean 'HMO or insurance company or bookie'. Similarly, when I use the word 'he' or 'his' in reference to doctors, I mean 'he or she' or 'his or her'. So, now that I've got that covered, let's proceed:

While Door Number 1 may be more expensive in some cases, it's the most direct relationship, and the one most conducive to good customer service. After all, the doctor is working for you, you are his customer. Barring malpractice or lawbreaking, he answers only to you.

What about Door Number 2? Well, it's a little more complicated, since you are paying an agent (the HMO) to limit your cost exposure in case of a serious health problem. You're still the doctor's customer, but the doctor has to deal with all kinds of non-health care related stuff, like documentation, forms, etc. in order to keep the HMO happy. So the good doctor isn't fully your customer, because at least some of the time he's working for, and answerable to, the HMO. You are the HMO's customer, and in some ways, you are the doctor's customer as well, though it's an unclear relationship. We'll dive into that muddied relationship later on.

Let's take a peek behind Door Number 3, shall we?

Behind Door Number 3 we have you, the state, and the doctor. So now you have the equivalent of a super-HMO between you and the doctor. Great. Nothing's really changed. Except now you've got an even less-responsive organization between you and your doctor. And it's a dangerous one, too.

~ ~ ~

Ok, I get it – some people aren't very happy with Door Number 2.

What puzzles me is why anyone thinks they'll be happier, better off, or healthier choosing Door Number 3?

Why wouldn't anyone be happier with Door Number 3? More free stuff, right?

~ ~ ~

Let's look at government's track record to date: it's been super-responsive to your needs so far, right? How's that Social Security promise looking to you now? How about that progressive income tax that was only going to be levied on the 'rich'? How about that public school system? Department of Education? The Postal Service? Illegal immigration or border control? War on Drugs? Fannie Mae? Freddie Mac? Banking regulations? Shall I go on?

I might understand (and even share) optimism about public health care if there was ample (or any) evidence that government had its act together, that it can handle responsibility for anything more complicated than going out and blowing up stuff.

But it can't, hasn't, and won't. You're ignoring history, and denying reality, if you think that an American government-run health care system won't turn to shit in a big hurry.

And unlike Door Number 1 or Door Number 2, it'll be tough to seek legal redress if you don't get the service you signed up for. It's damn tough to sue an individual government worker due to the doctrine of sovereign immunity, otherwise known as the “we were just following orders” immunity doctrine. (You may be able sue them if they do something egregiously outside the scope of their jobs, but don't count on prevailing). At least with Door Number 1 you have some ability to sue for malpractice, negligence, fraud, or breach of contract. Same with Door Number 2. I doubt you'll be able to do the same with Door Number 3, and if you doubt me, you might want to consider the success rate for plaintiffs suing Uncle Sham to get their 'promised' Social Security benefits. See: Flemming vs. Nestor. Don't fool yourself into thinking your friends in government won't change the rules of the game on you, out of necessity.

And, best of all, when you go for Door Number 3, you get to deal with a bunch of people who have guns. Just because the guns aren't on the table most of the time, doesn't mean they're not there, backing up every petty official's decisions. People who refuse to acknowledge the 'stuff of the state' and the essence of government may be well-intentioned, but they're no less delusional.

Personally, I'd rather not have all those guns interfering with my health care. Unless I can bring mine to the table, too.

~ ~ ~

A note on the relationship between you and your doctor

When and why did the purchase of health care services become anything other than a private transaction between a customer (you) and a vendor (your doctor)?

How on earth did something so simple become so unlike any other service, like having your house painted or your plumbing repaired? Any differences are purely imaginary.

And has departure from the direct customer-vendor model been a leading cause of the so-called health care crisis? We'll discuss that in a future post.