Obamacare is a part of the problem in health care.

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Ok, so the problem may be Obamacare,  in that it did nothing to regulate, to slow down cost increases. Perhaps a stupid law, which made it illegal for Medicare and Medicaid, to negotiate drug prices came into being during W. Bush’s tenure as President.

The argument that one cannot wait until one is sick to buy insurance is supported with the non-equivalence comparison to wrecking a car and then buying insurance to get it fixed. Maybe if health insurance truly was insurance, this might approach making sense, but humans, with very few exceptions, are not mechanical devices (insert Al Gore joke here).

But it is not insurance.

Once it was—I remember those days, with high deductibles that most people never met in a year and never received anything from the company. This was an insurance against catastrophic health issues, and even then, it rarely cov3ered more than 80% of costs after the annual deductibles were met. Insurance companies made money by having a large risk pool to spread the risk; many large companies served as their own insurance company by self-insuring and paying an insurance company to process claims.

This went away as HMOs and other similar schemes came into the world of the backwards United States health system. The idea was if health was maintained within and by an organization (HMO), that over-all costs would be lower. Small co-pays were instituted for routine office visits.

Eventually, insurance was replaced with a system that collected premiums in advance of paying costs—much like the self-insured plans of larger companies. All well and good, except, everyone—doctors, hospitals, insurers, people—took their eye off the ball and costs rose higher and higher until they reached the current crisis level where health care consumes one in every six dollars in the country.

Yes, the actual cost of health care has risen essentially unabated, but embedded in the cost of water we pay insurance companies are commissions, profits, administrative and processing costs. All would be severely curtailed if we chose to go to single-payer. Estimates of these savings range from 30% to nearly 50%, which means we would pay less without regard to underlying actual costs.

The ideal would be a National Health Service, as exists in every civilized country in the world. This means the providers are employees of the government and suing them would be next-to impossible. Yes, we would need safeguards, but what could come to an end is the practice of excess testing done for no other reason than to avoid potential lawsuits. Malpractice insurance would go away, and even the billing staff of hospitals and physicians would be reduced. The medical practice would change from a fee-for service model to one where profit incentive is eliminated in the provision of health care.

We can do it, but first, we have to focus on the right thing: costs.

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