10.06.09 - Part III in a series analyzing, evaluating, and exploring the humorous, political, and social implications of the state of healthcare.

[Disclaimer: The following commentary is not intended to be a substitute, nor should it be used as a substitute for medical care by a qualified medical practitioner. No offense is intended to practitioners of magic, card tricks, or slight of hand.]

Every time President Obama or a Democrat discusses the healthcare reform behemoth, they talk about insurance coverage. Insurance, insurance, insurance. Doesn't this miss the point? Which begs the question what IS the point? See, what's going on with the healthcare reform legislation is like a magic trick. You, the audience, thinks you are seeing one thing, but really it is simply a cleverly performed illusion. Slight of hand grabs your attention to focus on a certain point, while all manner of chagrining is happening mere inches away, literally under your nose. As with any deftly executed magic act, your attention is distracted by a master magician directing your interest to their words, engaging you with an activity, and mesmerizing you with magical words - away from any sneaky slight of hand.

The Great Obama, aided by his eager assistant the spell binding Pelosi, is doing all of this with healthcare reform, sans the cape, wand, top hat, and sequins. Note the vocabulary - reform. Generally, reform has a positive connotation, unless one is referring to reform school. This recalls Part II of Almost Healthy: Don't Bus My Healthcare. My analogy in that piece just gets better and more accurate with time. Back to the words, which are important. Ask yourself: Do we need or want improvement? Or, do we need or want reform? What's the difference you ask? Lots. The Healthcare Improvement Act of 2009 is NOT the title gracing the various proposed bills circulating. Reform truly is a more systemic top to bottom, all or nothing, all in, touching everything reference point than improvement for example. Reform also suggests a redemptive quality. This harkens back again to the school busing parallel. This is very much like holding the entire class over because one student passed a note. Back in the day, I found this group-punishment very unfair and unjust. Why should I be punished just because someone else did something wrong?

Keep in mind that while most assume that reform means improvement it does not. Reform means just that - the subject at hand will be re-formed. You remember all the change from the campaign right? Re-formed makes no mention of improving standards, quality, or efficiency. Re-formed means that the subject is no better off than a slab of clay being mauled by too many grubby hands. As in Part II - Don't Bus My Healthcare; the focus is on re-forming things rather than improving things. See, when you improve things those items that are working well are left alone. When you improve things, you only tinker with those things needing improvement.

So The Great Obama has you focused on re-form. Improvement is not even in the deck of cards, so to speak. Next... Poof! the access to care is magically changed to insurance coverage. While you were studying a card The Great Obama asked you to look at, he switched things up without you noticing. As they talk about it they should refer to Universal Health Insurance Coverage. That doesn't sound like it has much to do with access or quality of health care. Insurance versus care. These are two very different things. [There are plenty of medical industry professionals who can discuss what single payer is and why they believe it's bad.]

What about insurance? Let's understand the basic principle behind an insurance company. Say they have one hundred (100) customers. Each customer pays a premium. The insurance company collects this money and invests it to make more money. Out of the 100 customers 10 make a claim. The probability theorem, Law of Large Numbers, often applied to games of chance can be applied here too. The insurance company pays the claims of the 10. Insurance companies are able to pay the claims out because less people make a claim than the total number of customers. The insurance company makes money by gambling that fewer customers will make a claim than pay premiums. Now anyone who has insurance of any kind knows that policies don't cover everything. So, even if EVERYONE had insurance, having insurance is not the same thing as having coverage. Importantly, having coverage is not the same thing as having treatment.

After Hillary Care, HMOs [Health Maintenance Organization] seemed to get a shot in the arm and came in the vogue. Similarly, health insurance, moved away from coverage for catastrophic care to cover everyday routine items. While some will argue this is due to the value of preventive care, it seems more likely it was in response to the competition from the HMOs. Part of how insurance works is by spreading and minimizing risk. Another way of saying that is an insurance company is a viable business if it can limit payout chances while offering a valuable service to its customers. If you have insurance, a particular brand of insurance, it's like you're a member of a club. Club members have specific benefits. The benefits of one club are different from the benefits of another club. You have the choice to pick the club that meets your needs and budget the best. If EVERYONE has insurance, there is no risk buffer and effectively no clubs. In a way it is almost as if no one has insurance then. Further to this point, if everyone is insured and coverage is mandated to cover everything, health insurance no longer remains a viable business, as they can't reliably sustain profitability. Insurance companies not being profitable will not cover things because they will be out of business. Of course, the prospect of a bailout might presume to save the day but wouldn't that effectively put the government in the insurance business?

So whether effectively or actually no insurance exists, clearly that's not an improvement, nor is it a re-form that most Americans would welcome, want, or endorse.

What does insurance have to do with Healthcare improvement? In any case one of the pieces of legislation floating around, H.R. 3200 is called America's Affordable Health Choices Act of 2009. Health Choices Act? It costs nearly nothing to take a walk. Drinking lots of water is affordable. Proper amounts of sleep are practically free. It's cost effective NOT to smoke. We need legislation for this? What about access to care and insurance? Access and insurance aren't even in the title, yet we are told these are the issues being pushed.

See The Great Obama. He tells you there is nothing up his sleeve. While you're looking up his right sleeve, he's doing a slight of hand with the left.

Abracadabra surtax allakhazam public option - poof! What happened to the greatest medical system in the world? See it disappear before your eyes.


[ Part I - A Tale of Three Patients | Part II - Don't Bus My Healthcare!]

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