There are two Americas. Half of America brushes their teeth, takes their vitamins, exercises, eats healthily, gets almost enough sleep and is blessed with "average" health. They consume, on average, $236 of medical care per year.
The other 155 million Americans consume, on average, 100 times more medical care per year.
I have four children. Imagine going out to lunch. I give two of them $1 for lunch and the other two I give $100.
The government has a solution. They passed a law that requires everybody to buy a $12,000 per year health insurance plan. Then, they pass a law that subsidizes the costs for low income families so it only costs them $400 per month....
Not much of a favor if you belong to the half of America that incurs only $236 per year in medical costs per year.
To be really plain-spoken about the government solution, they did not address the costs. They played a shell game to make it look more affordable. They moved much of the cost from Peter-to-Paul and they moved the out-of-pocket from the individual transaction to a monthly bite.
We are all going to die.
It is not a choice.
It cannot be avoided. Even trillionairs will die.
The best we can hope for is to be at peace with our Maker, our family and to leave an enduring legacy.
Some people have far more "skin" in the game than others.
About 9% of Americans are diabetic and you can bet that nearly every one of them thinks the current system is way better than what it replaced. ($14,000/year)
0.3% of Americans are HIV positive ($25,000/year drugs)
About 0.1% of Americans are on dialysis. ($80,000)
And we wear out as we grow older. Like a 100 year old house, the wiring and plumbing are marginal at best, rotten and decayed at worst. Plumbers hate quoting work on old houses. There is just no way to know the scope of the project because you cannot know how much pipe you will have to replace before you get to sound piping.
Dilution of responsibility
Clarity is difficult to achieve due to the diluting and clouding effects of sharing risk. It is easy enough to remove this distortion.
Suppose one had enough money to set up each grand child in a profession, be it welder, hair cutter, accountant or thoracic surgeon as bet fit their abilities. Now suppose you are on your death bed and the Grim Reaper offers you a deal: he will allow you one more agonized breath if you hand over your grand children's future. Would you do it?
I propose that most people would opt to protect their grand children's future at the cost of one less breath in this mortal plane.
Furthermore, I believe that most people would be willing to give up six months at the end of their life provided they have come to terms with their mortality and made peace with God and their family.
Martha (not her real name) was the mother of my closest friend in high school. In her late eighties she was in slow decline due to a heart condition. Her doctor projected that she had six more months. It would not be painful. She would sleep more. It would be harder to wake up in the morning. It would be harder to keep her extremities warm. He anticipated that she would be lucid right up till the end.
But there was a procedure...it was risky for somebody in their late eighties but it would probably add two years to her life.
Her response was, "What the heck. Why not? Let's go for it!"
The operation was a success. A success, that is, as defined by the surgeon. She did not die on the operating table. She died in recovery.
It was a success from the stantdpoint of the accounting department. The surgery created billable events so they could amortize assets with excruciatingly high fixed costs.
Herein lies much of the problem. The world is filled with plucky eighty year olds who figure, "Why not?"
The medical industries ability to create "billable events" at will creates much greater return-on-investment than any other industry. Go down to your local car dealership. Ask them how much money they could make if they could conjure up customers at will. Ask them how much money they could make if every department was fully scheduled around-the-clock.
That unwordly return-on-investment attracts more money which is sunk in......more fixed cost. Which requires more Marthas and more "successful" surgeries. The true cost of healthcare will not abate until enough Marthas opt for the graceful, 6 month coast-down at the end of their life. Enough Marthas such that the return-on-investment sags below alternative investments and the sick-care industry stops attracting hot money.
Only then will fixed costs attrit out faster than new capacity is added. Only then will sanity return.