Saturday, September 25, 2010

Our Health Care Happy Meal


"...health reform would allow for them to receive preventive care services without having to pay anything... Health reform starts at birth -- health plans will no longer be able to refuse to cover children younger than 19 simply because they were born with a medical condition... adults and seniors will no longer have cost-sharing provisions for preventive services... Together this all adds up to more patient protections than we have ever had, and this is just the beginning."

-Kavita Patel, "Will health reform be repealed?", CNN.com

Parents the world over know the magic of McDonald's Happy Meals. There's something about the promise of a Happy Meal - the way it's packaged, the free toy - young families and especially kids find them irresistible. But anyone who's purchased one of these knows the reality: that toys within the Happy Meal are typically played with for no more than three minutes and the plastic tchotchkes are discarded faster than the accompanying 2% milk.

And yet, despite the fact that the toy is worthless, kids clamor for the Happy Meal again and again. It's human psychology - we simply can't help ourselves. Hope springs eternal that next time the next Happy Meal will contain a better, more stimulating toy. It's the possibility of the unseen, the thrill of victory, something for nothing, and all with the word "free" attached that causes us to gravitate to these types of things time and again with no learning curve.

A distinctly American Way.

This, of course, is nothing new to marketers. But this promise has become the linch-pin of Obamacare spin from its inception. If it's free, do we care what it really costs? If it's free, do we care what the quality is? If it's free, do we care what the data about the utility of the test is? If it's free, do we care how the results are delivered?

Of course we do.

When the results come back and we're clutching the phone hoping to hear a familiar voice when none is there - that will be our new reality - but we're not pitching reality. Or costs.

There's a common sense saying: "If it sounds too good to be true, it probably is too good to be true." Even if we find that the $19.99 infomercial slicer/dicer doesn't work at home as it did on television, American's love the psychological reassurance that this time the government will make health care available to all without restriction, expense, or consequence, be they boys or girls, legal or illegal, young or old, right-handed or left-handed, with preexisting condition or not, - no one will be left behind in our new omnipotent era of Patient Protection and Affordability.

We should all know better, but the sad fact is, we're all suckers.

Not that some of the promises made wouldn't be useful, helpful, or even critical to many families. But to position health care reform (and the Patient Protection and Affordable Care Act in particular) as a win-win with no hard choices, no limits to health care for our seniors, no future commoditization of medicine, unlimited access to procedures and doctors, and all with no enormous financial cost, is to stick one's head in the sand.

Package it, spin it, wrap it in plastic - then put it next to a cheeseburger.

No matter what you call it, it's still Hopium.

-Wes

Reference: Images courtesy of 'A Bite to Eat,' Craftster.org

18 comments:

makin said...

The British have been doing it since 1948 and it's still in perpetual crisis mode. I recently discovered "Yes Minister." The episode on the NHS was amazingly brilliant (The Compassionate Society). The Minister struggles to understand why a hospital has been open for 15 months without any patients. And Yes Minister ran in the 1980s! Hope springs eternal.

Anonymous said...

Have you not heard about the health insurance mandates? They have engendered a certain amount of rage which leads me to believe that the American public expects to have to pay and is damn mad about it. I think they have been pretty well convinced by the party of "No" that there is no need to pay for armies, roads, food safety, environmental safety. You call them "suckers"? No, they have chosen to believe the sound bites from the guys whose goal has been to ruin Obama. They are misled and misinformed and have no wish to be otherwise. They believe deficits will be cured by cutting taxes. Some additional reading from other sources will help to enlighten them. And by the way, I'm pretty sure illegals are not part of the bill. If the are, I shall offer you an apology. If they are not, their inclusion is distasteful.

Anonymous said...

"Illegal immigrants will not be allowed to buy health insurance in the exchanges -- even if they pay completely with their own money."

Is there something I missed that contradicts the above quote?

DrWes said...

Anony 02:34AM and 02:41 -

So are we to assume that we will not care for illegals when they present to our ERs? I think not. To remove illegals from the the health care cost discussion is nothing more than avoidance of a very serious (and expensive) issue.

Of course, I'm pretty sure a doctor payment "fix" was left out of the bill, too, to make it's the bill's costs more palatable to Congress and the American people.

But please, don't mention that, okay? It's the spin that matters. After all, doctors and their patient-funders are the little people in this debate, right?

Anonymous said...

"No, they have chosen to believe the sound bites from the guys whose goal has been to ruin Obama."

No, some of us are living in the reality of your fantasy. My husband and I are small business owners, provide health insurance and pay 100% of premiums AND HSA contributions for our employees.

Our employees CHOSE the HSA plan because they felt it better provided for their needs and allowed them more flexibility to discuss and decide about visits, tests and such. With our previous PPO, with co-pays and deductibles no one questioned anything, yet no one in our employ utilized anywhere near the premiums paid each year ($4,800 single, $12,500 family). The most anyone used in a single year was $2,300.

When confronted with that reality at our last renewal, and reviewing the HSA deductions of $3,000 and $6,000 (single, family), with premiums of $1,400 and $3,900, it was a no-brainer - not only did we pay less (significantly less) for premiums, even with HSA contributions by us, the employer, we were still paying less overall and our employees could now roll any dollars not used in one year to the next.

With the purchasing power back in their hands, they're happier. Utilization remains around the same, but they've all become much more conscious about various tests and procedures, actually ASK if they're needed and why.

It is AMAZING how things change, for the better IMO, when people are given responsibility for their health care purchases and don't have the illusion it's FREE! It's not free!

Yet now, with us happier and our employees happier, we live with the specter that our health insurance - with NO lifetime limits, no in-network versus out of network limits, from a top provider in the country - may be deemed "unacceptable" and we'll be forced back into a "comprehensive" plan that provides "free" stuff that we have to PAY MORE for!

Disgusting is what it is!

Dandapani said...

TANSTAFL. Never has been, never will be.

Aggravated DocSurg said...

Dr. Wes, as always, you are right on target. Just as with the McDonald's version, the adults will be stuck with the bill for this bit of Hopium --- full of hot air, empty promises, poor planning, and enough federal involvement in everyday healthcare decisions to make Friedrich Engels blush with excitement.

Anonymous said...

Anonymous @ Sun Sep 26, 02:41:00 AM said, "Illegal immigrants will not be allowed to buy health insurance in the exchanges -- even if they pay completely with their own money."

Is there something I missed that contradicts the above quote?"


You want that shiny toy in the Happy Meal, don't you? It looks really, really cool, doesn't it?

Do you think that our compassionate government will do something as RACIST as asking for proof of immigration status? Think for a minute. Keep your mind from being clouded by thoughts of that lovely toy. Think of Arizona. Think of how the feds and our betters in the entertainment industry and the media reacted to Arizona proposing that police ask for proof of citizenship upon someone being stopped for a traffic violation, or some other reason unrelated to immigration status.

Think of how accurately Arizona's law was portrayed by the aforementioned group.

And they're going to ask people for proof of immigration status before purchasing health insurance? Do you think they'll make these poor (potential Democrat voters) people even pay for the insurance much less check that they're citizens or legal residents? Do you think that when they show up in the ER that they'll be forced to pay for those services?

You just keep thinking about how wonderful that toy will be.

Sheesh.

Ritchie The Riveter said...

Anon, it is you who are spreading the misinformation ...

... for conservatives are not seeking the total elimination of government services.

We want our government institutions, instead, to concentrate on the one-size-fits-all areas -- defense, physical infrastructure, law enforcement that protects against fraud as well as murder -- areas where they are capable of acting effectively and efficiently to resolve problems.

Individual-specific areas are another matter entirely ... in areas like health care, personal finance, and business decisions, this rights-respecting, equal-protection-under-the-law government lacks the precision to accurately deal with the often-highly-divergent needs of individuals.

Compared to a relative few Best and Brightest in DC controlling such details of 300 million lives over 300 million lifetimes, building Saturn V's and going to the moon a half-dozen times ... an endeavor that took tens of thousands of engineers over a decade to accomplish at a cost of tens of billions of 1960's dollars ... was a mere exercise in LEGO(TM) building.

Furthermore, in the case of health care, we will be removing the fault tolerance from the system. Right now, if my insurance company does not meet my needs, I can change companies (I just did that, as a matter of fact) ... or change employers (actually considered that a few years back, when my family was beginning to encroach on an out-of-network lifetime limit) ... or pay cash and/or seek charitable assistance.

At best, government run health care will be just another money-sucking entitlement ... but at worst government-run healthcare will inexorably devolve the system into a single-payer model, that removes ALL the work-arounds listed above, leaving you with no recourse outside the glacial-and-unpredictable political process when the bureaucrats get it wrong!

That makes the PATRIOT Act look downright libertarian, when it comes to the effects on my life and liberty ... especially if they seek to make the process more "efficient/effective" by working around privacy protections and/or compelling detailed behavior changes by the force of law.

IT AIN'T THEIR JOB ... IT IS OURS, AS INDIVIDUALS WORKING SEPARATELY AND/OR TOGETHER OUTSIDE GOVERNMENT ... to solve these individual-specific problems, for our government is structurally incapable of solving such problems.

Ritchie The Riveter said...

Anon, it is you who are spreading the misinformation ...

... for conservatives are not seeking the total elimination of government services.

We want our government institutions, instead, to concentrate on the one-size-fits-all areas -- defense, physical infrastructure, law enforcement that protects against fraud as well as murder -- areas where they are capable of acting effectively and efficiently to resolve problems.

Individual-specific areas are another matter entirely ... in areas like health care, personal finance, and business decisions, this rights-respecting, equal-protection-under-the-law government lacks the precision to accurately deal with the often-highly-divergent needs of individuals.

Compared to a relative few Best and Brightest in DC controlling such details of 300 million lives over 300 million lifetimes, building Saturn V's and going to the moon a half-dozen times ... an endeavor that took tens of thousands of engineers over a decade to accomplish at a cost of tens of billions of 1960's dollars ... was a mere exercise in LEGO(TM) building.

Furthermore, in the case of health care, we will be removing the fault tolerance from the system. Right now, if my insurance company does not meet my needs, I can change companies (I just did that, as a matter of fact) ... or change employers (actually considered that a few years back, when my family was beginning to encroach on an out-of-network lifetime limit) ... or pay cash and/or seek charitable assistance.

At best, government run health care will be just another money-sucking entitlement ... but at worst government-run healthcare will inexorably devolve the system into a single-payer model, that removes ALL the work-arounds listed above, leaving you with no recourse outside the glacial-and-unpredictable political process when the bureaucrats get it wrong!

That makes the PATRIOT Act look downright libertarian, when it comes to the effects on my life and liberty ... especially if they seek to make the process more "efficient/effective" by working around privacy protections and/or compelling detailed behavior changes by the force of law.

IT AIN'T THEIR JOB ... IT IS OURS, AS INDIVIDUALS WORKING SEPARATELY AND/OR TOGETHER OUTSIDE GOVERNMENT ... to solve these individual-specific problems, for our government is structurally incapable of solving such problems.

M. Simon said...

To Anonymous Coward,

The Tea Parties are into cutting spending as well as lowering taxes.

I propose as a first step in that direction a repeal of the Health Care Bill. I think the TEA Parties would agree.

Bonfire of the Idiocies said...

I never bought a happy meal and I am not buying this healthcare crap. I don't care how many times vacuous fops that marry other men's fortunes like John Kerry say I'm ignorant; HE'S the one that's ignorant. If he weren't sponging off of Heinz catsup, he'd been living in a cardboard box within a month.

Anonymous said...

The real problem is we are all taking polar arguments. Both parties are manipulating data to try to please their voters and either path is going to lead us as a country to ruin. The republicans need to agree to raise taxes and the democrats need to stop spending money. I think taxes need to go up for everyone, slightly more for the wealthy. The health care plan has passed and as long as Obama is president, it will not be repealed.

The issue not discussed still is how we are going to pay for it. My practice has 90 providers and none of us can afford to take Medicaid (we take a net loss by seeing these patients after paying for overhead -- not our salary before there are are cries of greed. It is not that we don't want to care for them, we cannot afford to. The rates are less than Medicare and are being cut another 15% this year. When reform kicks in, the number of Medicaid patients are going to increase >30% but their will be no providers to care for them because the government has shifted the costs to the states and the states cannot afford it and continue to cut professional payments every year. The current answer is to charge it to the federal deficit and let the next generation deal with.

Our house of cards is about to crumble if we cannot reduce expenses, start paying down the deficit. Hopefully, the republicans will win the house so we can start seeing compromise. A balanced party legislature is our only hope unless we start seeing more moderates in political office.

Wes, thank you for continuing your blog. I know it takes time but the insights and discussions are priceless.

Keith said...

Give the poor health care plan a chance! I have to agree that problems may develop with the current scheme, but the alternative of doing nothing was unacceptable. If goverment health care is so bad, why do we have all these seniors saying keep your hands off my Medicare?

As for the employers with all their employees in the HSA insurance plan, you fail to state what your employee make up is. If it is all relatively young and healthy people, then it's great, but if they are older, watch out. People will eventually get sick, and watch what happens if one of your employees becomes seriously ill and has to fork over 3000-6000 per year while possibly beintg disabled or out of a job. Do you provide health insurance for your employees when they are disabled?

Health insurance requires the largest pool of insureds to make it work. That is why large companies can get the best deals while small employers get consistently screwed. If you own a small buisiness, you should be thankful for this health care bill since it will likely lower your premiums. Then maybe you won't have to stick your employees with lousy health insurance.

Anonymous said...

As for the employers with all their employees in the HSA insurance plan, you fail to state what your employee make up is. If it is all relatively young and healthy people, then it's great, but if they are older, watch out. People will eventually get sick, and watch what happens if one of your employees becomes seriously ill and has to fork over 3000-6000 per year while possibly beintg disabled or out of a job. Do you provide health insurance for your employees when they are disabled?

We provide a full range of insurance, paid for 100% by us - health insurance HSA (deductible funded 100% by us and premiums), short-term and long-term disability, and term life insurance.

So YES, we do provide a safety net for our employees by providing STD and LTD insurance.

The mix of our employees (12 total):

Female, single, 25
Female, single, 26*
Female, single, 2 kids, 32
Male, married, 2 kids, 32*
Female, married, 3 kids, 35
Female, married, 2 kids, 42
Female, married, no kids, 49
Male, married, 1 kid, 50
Female, married, 3 kids, 51
Female, married, no kids, 54
Female, married, no kids, 59*
Female, single, no kids, 64*

As you can see, we have a wide mix of ages and genders. Those listed as married, with or without kids, are on the family insurance plan. Our 64 year old is our most costly, but that's fine, she's been with us 15 years...and she'll move to medicare, with our plan as secondary, in seven more months, which will reduce her premium for us signnificantly in the near future.

This year our renewal arrived with just a 1% increase over last year and this is with a number of our employees (*) with chronic health issues that require multiple doctor visits and medications throughout the year....and one employee recently having premature twins who needed A LOT of care after birth.

The government looks at small business owners are if we don't care about our employees. We could easily take the $100K or so a year we pay to ensure our employees have NO OUT OF POCKET and keep it ourselves. But we couldn't do our business without them - they're like family - and the expense is one we pay because we value them, not because we "have to"...in fact, I know no other small business in our area that provides the breath and depth of coverage we do, at no expense to our employees. Yet now we're facing having to modify our coverage because the government thinks it knows better!

Anonymous said...

Dr. Wes,

I applaud your concern about the "avoidence of a very serious (and expensive) issue". Let's see....and this problem has been festering for how long? Obama has the courage to tackle it, and NOW you're screaming? And how concerned were you when Bush and pals passed the medicare prescription bill? What a piece of drek that was! And I do remember that there was just a teeny bit of "spin" involved with the cost of that plan. Where were you then? Now let's see what your team has to offer with regard to Social Security reform. Let's see how much courage they have then.

Anonymous said...

Dr. Wes,

Are there any stats on the number of aliens that are visiting the ERs as compared to all the citizens that are merely poor, unemployed, or those who don't carry insurance because they are young and don't believe they will ever suffer a serious accident or illness? Am I out of line in thinking those Americans may be part of a "serious (and very expensive) issue"? When you deny the young white guy health care who is going to live forever and therefore needs no insurance, then we can talk about denying the ER to the brown guy who picks our lettuce, cleans our chickens, watches our children, and bathes our aged parents. Yeah, that will be a country of which we can all be proud.

ffffffffffffff said...

The government looks at small business owners are if we don't care about our employees. We could easily take the $100K or so a year we pay to ensure our employees have NO OUT OF POCKET and keep it ourselves. But we couldn't do our business without them - they're like family - and the expense is one we pay because we value them, not because we "have to"...in fact, I know no other small business in our area that provides the breath and depth of c