Health Insurance and Murder

The head of the health insurance division of UnitedHealth Group was assassinated in public in New York City this week; shot in the back by some deranged coward.  A father of two, a classic success story, a young man who grew up in a small town and worked hard to create a better life for himself and his children.  His crime apparently was that he worked for a health insurance company.  His murder has been widely celebrated by the left-wing whackos who unfortunately inhabit this country and they are pleading for additional assassinations of those business persons in health care and other sectors.  Their words and acts are despicable, disgusting, appalling.  But the open expression of these views is not surprising, because this is what the leftist whackos are at their core–violent and irrational.  They persist because they are tolerated, no, not just tolerated, but encouraged, even celebrated, by the vast bulk of Democrat party members and officials.  Antifa represents what the pro(re)gressives really want to be–a totalitarian force that obliterates any opposition by whatever means necessary.  You will think, say and do what the Party tells you to.

The level of ignorance about the nature of business and health care in this country is high and leads to misdirected anger.  Most large American corporations are publicly owned.  The shares in those companies are in turn generally held by institutions–pension funds, mutual funds, index funds, exchange traded funds.  Almost every working American, certainly any who have a 401k plan or are covered by a pension plan, and all those who have any form of investments, have at least an indirect ownership of American corporations.  Americans are counting on these investments to provide supplemental income while they work and retirement income later.  When these large public companies do well, so do the shareholders, which includes all those average working people and retirees.  These large public companies also employ the majority of working Americans and typically pay high wages and offer good benefits, including health insurance.  And many Americans have become at least modestly wealthy due to profit-sharing and equity-sharing plans at public companies.  Government does nothing like this, quite the opposite, it just takes from most people, giving little back and certainly not creating wealth.  Those who think government-run economies are good for the people who live under them are literally insane; living in a fantasy land when there is an immense body of practical evidence over centuries to the contrary.

There are issues with governance at public companies.  The boards that supposedly oversee the performance of management are typically filled with current or former managers from other large public companies, along with a few professional board members who have the right skin color, gender or other desired characteristic.  Those boards rarely challenge management or exercise actual oversight.  Executive compensation is excessive, because the boards have a personal interest in seeing a high level of executive compensation, since the board members typically benefit from that.  My personal belief is that stock options should be banned and replaced by required stock ownership of purchased shares.   Stock options are the basis for the vast majority of excessive compensation.  Management has nothing really at risk so they are a weak tool for ensuring good work.  But these programs exist because the government not only permits them but encourages them.

Large public companies also have an undue influence on public policy, largely through campaign contributions and huge lobbying efforts.  Politicians, who run your US and state governments, have no interest in changing this, in fact, it is good for them.   So if you don’t like health care policies or programs, don’t blame the companies operating in the system, blame the politicians who make the rules and who do so because they want big campaign contributions or love being wined and dined by lobbyists.  The number one thing that needs to be changed in the United States is the absurd notion that campaign contributions are a kind of speech and that entities other than individual persons have first amendment rights.  We will get a lot better policies that benefit everyone when the private money goes out of the election system.

Most people similarly have no sense of how much the health care system we live under is shaped by federal and state laws and rules.  Medicare, Medicaid, and other government programs account for over half of all health spending.  Those programs use their influence to force doctors, hospitals and other providers to behave in certain ways and the regulations and requirements of these programs raise costs for providers and ultimately consumers.  This is classic government at work–restrain freedom, impose costs, lower quality.  When those programs use private health plans to deliver benefits, another layer of regulation and costs is added.

Obama without any thought to the consequences passed a massive law which regulated every aspect of how Americans receive and pay for health care.  Another huge source of expense for employer-sponsored and individual health insurance plans.  Benefits have been mandated that are often unnecessary but drive up costs for everyone.  If private health insurance was so bad, why did Dems try to mandate that everyone had to have it?  But that law, the woefully misnamed Affordable Care Act, layered immense additional cost into the health system.

Multiple times I have stated my fixes for the health system, all of which address issues created by government.  Drug prices are high because of a patent system that grants an unrestricted monopoly.  That monopoly should be conditioned on low initial prices and limited price increases.  Consumer-directed advertising and in-person detailing of providers should be banned for all health care products and services; it raises costs to the providers and manufacturers who advertise and increases requests for unnecessary care.  Any information consumers or providers really need is and can be found on websites and provided in mandatory printed material.

Large health systems should be broken up, vertically and horizontally.  That would result in more competitive health markets, which means not just lower prices, but better quality.  Individual providers would have more job satisfaction once freed from being a small cog in a huge wheel.  These massive health systems waste immense amounts of money on marketing, excessive administrative staff, fancy buildings and management compensation.  Since most of these systems are supposedly not-for-profit, these practices are particularly abusive.  The same goes for health plan markets which have excessive levels of market share or concentration.  These levels of concentration occurred because government looked the other way and declined to exercise either its legislative power or antitrust enforcement to keep markets competitive.

Our providers pay a fortune to get a medical or other degree, work long hours, deal with difficult patients, often have to make complex diagnostic and treatment decisions; and expect to be well-compensated for that.  That high compensation raises spending.   Do you really want them to be paid less?  Hospitals, as I suggest above, on the other hand are grotesquely overpaid, largely because they are incredibly poorly managed and due to lack of competition have excessive cost structures.

Consumers rightly think health care is too expensive and often have to make difficult decisions about accessing health care or doing without for financial reasons.  But administrative costs are high because of government regulations and failures to act.  And health service costs are expensive for the same reason.  Profit margins in health care delivery and health insurance are not particularly high, outside of drugs and medical devices.  The total of profits and administrative costs is limited by federal law and every state.  Almost every other product and service you buy or use has a higher profit margin than health care or health insurance.  I understand health is different; it is very emotional, it is literally life and death, but use your brain and get some facts instead of expressing irrational hatred.  And don’t parrot nonsense about denied care; there is almost none, and when it is denied, it is usually because it is inappropriate.

You want lower costs for health insurance?  You have to have lower prices for health care.  So limit drug prices when the drugs are covered by patent monopolies.  Same goes for medical devices and equipment.  Dramatically cut regulations that drive provider costs up.  Force providers, especially hospitals to compete and to be efficient.  Make them cut administrative staff, but not care-givers, and put limitations on non-profit providers’ compensation for management.  Force the breakup of vertically integrated health systems.  Limit health plan market shares.  If you are willing to fight for those steps, I guarantee you will have a far more competitive, lower cost, better quality system.  But many people benefit from the current system and you might be one of them.  Everyone is for change until it affects them negatively.

Want to get really radical?  Once more I make the obvious suggestion based on facts.  An incredibly small percent of the population accounts for a massive proportion of all health spending.  Half of the population accounts for essentially no health spending.  Why do we have health insurance?  We should change the system back to essentially fee-for-service.  Everyone pays out of pocket for most care.  Pre-tax sums could be set aside, as they are now, into in-essence a savings account for those health care needs.  If you have an expensive care episode, one requiring a hospitalization or other care above a certain cost limit, make providers or health care-arrangers or whatever you want to call them, bid to handle your episode on the basis of cost and quality criteria, and be paid from a government fund supported by the equivalent of Medicare payroll taxes today.  Total administrative costs and spending would be far lower in this kind of system.

So please get the facts about the health care and health insurance system and think about what the problems really are.  Don’t demonize large companies in health care or their managers–they are doing what the government wants them to do or permits them to do.  If you think a government-run system would be better, talk to Canadians or the British; and ask yourself why Medicare and Medicaid now largely rely on private health plans to deliver and manage benefits.  Government really is almost never the best solution to any human need.

Now back to those despicable morons celebrating the death of a person because they worked for a particular company or in a particular industry.  This won’t stop unless and until there are severe consequences.  These people should be identified and shamed in the most public way and their employers or schools if they are students should be forced to fire them or expel them.  The notion that this is at all acceptable has to stop.  But as I said at the top, it persists because the core, the base, the animating force of the Democratic party believes this is acceptable and sees violence as a necessary tool to crush dissent from that party’s obviously insane and ineffective policies.  Until that party recedes into oblivion or ejects that radical base, expect more of this abhorrent behavior.