::RUNS AWAY SCREAMING:: It’s almost enough to make you give up. (Which might be the point.) But WHY IS IT that EVERYONE talking about “the rising cost of health care” starts out from that premise and goes downhill from there when they take up … (Are you ready for this?) INSURANCE.


Explain to me in clear, no-nonsense term WHAT the FUCK insurance has to do with “health care.”

Does it have to do with paying doctors, nurses, pharmacists, phlebotomists?

Really? You think so?

What percentage of your “health care” dollar actually gets to the provider? Do you even know? I do. I don’t have insurance. I pay providers directly. Cash (well, checks). I get “discounts” ranging from forty to sixty percent. Trust me, they’re not doing that out of the goodness of their hearts. They’re doing that because they A) don’t have to jack up their list prices as a negotiating tactic against insurance company pressure and B) don’t incur the INCREDIBLE cost of maintaining staff to handle all the paperwork. I get services. I pay cash.

Simple. Neat. Clean. Cheap. Easy.

A pharmacist, who remembers the day before the relentless “insuring” of medicine in America, once told me that half of all money spent on medical care in this country goes to insurance company.

Robert Heinlein once wrote about engineering that “you don’t put a propeller on a bathtub just because one is handy.” Which is a colorful way of saying “form follows function.” (Or should.)

The conflation of “insurance” with “medicine” is a propeller in a bathtub. Worse: it’s an outboard motor, mounted with its propeller IN the bathtub — in the water. It doesn’t improve the situation; it aggravates it. It increases costs both by adding cost centers not necessary to the medical good and by muddying market waters. It muddies the market waters by decoupling pricing signals from buying decisions. This decoupling reduces the downward pressure that competition exerts on prices in any market. And insurance — any third-party payor, really — induces a pathology in the medical field whereby people who ought to be “buyers” — the ultimate consumers of medical goods and services, become “clients” or “beneficiaries” of some benevolent other and come to perceive the goods and services they receive as “free.”

It shouldn’t take much thought to perceive clearly where this will/has/does lead. Shouldn’t take any, really, since we have a crystalline example ready to-hand.

What America needs is to stop thinking of “health care” in terms of “insurance”…

(Which, by the way, isn’t really insurance — but that’s become like the old carp of Winston’s grammatical error in its “Winston tastes good LIKE a cigarette should,” which actually means that Winston tastes like anything BUT how a cigarette should taste. Nobody ever listened all the way through the lecture, and nobody ever really cared. Teleport that forward to the present day and you get: Yeah, yeah, yeah. We know: health coverage isn’t really insurance; it’s cost-pooling. That’s what we call it; get over it).

What America needs to do is tell the government to get out of the business of telling us how we may/must/should pay for our medical care, and let us make our own purchasing decisions without regard to state lines, political fiefdoms, and the spoils system that rewards narrow pressure groups for narrow pressure group tactics, when it should take care for — in the constitutional phrase — the general welfare.

Which. It. Does. Not. Currently.

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