Age of the Geek

Serious Sam
     The health care system is turning into a bit of a mess. Marketplace insurers are fleeing the state. Wellmark is raising premiums at unsustainable rates.
     And we know who is to blame for all of this.
     Sam.
     That’s probably not their actual name, but names humanize things and it’s important to remember that we’re talking about a person.
     Sam has a severe genetic disorder that, in 2016 ran up $1,000,000 in health care costs every month for Wellmark, according to Wellmark Executive Vice President Laura Jackson in a Des Moines Register article.
     I don’t know what this money was spent on. It could be a treatment to fix whatever ails Sam permanently, or it could just be the cost of what it takes to keep Sam going.
     What we can be sure of is that, because it’s a genetic condition, no amount of “clean living” would have prevented it. Sam didn’t get this condition because of bad choices, it was forced onto him or her at birth.
     Likewise, no amount of frugality would enable Sam to pay for this treatment on their own and without the Affordable Care Act’s provision about pre-existing conditions its unlikely Sam would be allowed to buy insurance at any price, much less an affordable one.
     If you’re one of the 30,000 people whose Blue Cross & Blue Shield premiums went up 40 percent this year, you can attribute 10 of those percentage points to the cost of Sam’s health care.
     But only 10. Sam may be the outlier, but many people are taking advantage of the consumer protections provided by the ACA. Personal bankruptcies have plummeted since cancer patients have stopped having to worry about lifetime limits, but that comes at a cost of higher premiums for everybody else.
     Lots of people are getting a lot of healthcare under the current system and it’s costing a lot of money. But it’s easier to fixate on a single outlier, so we’re going to pick on Sam.
     There are a lot of hard questions to be answered when it comes to figuring out a manageable way to deal with health care in this country, but the one question that must be answered is the one everybody seems to want to avoid.
     That question being, who has to be the one to tell Sam that they cost too much to take care of?
     From the standpoint of the heartless collective, it’s a fair question. There are lots of social benefits to subsidizing each other’s health expenses. Obviously a healthy person is more productive to society than an unhealthy one, but even the security of simply knowing that your health will be taken care of allows people to put their attention and energies into more productive endeavors.
     But there’s a limit to how much economic benefit one person can really produce. Even if Sam’s expensive treatments eventually result in allowing them to live a relatively normal life, it’s highly unlikely that Sam’s contribution to society will ever outweigh the resources society has put in to their health.
     One might say that we should provide Sam with the healthcare they need just because it’s the right thing to do. That if we have the ability to help, we are morally obligated to do it.
     In 1986, we, as a society, decided that anybody that walks into an emergency room should get whatever help they need, regardless of ability to pay. Hospitals passed that expense to insurance companies, who passed it on to their customers through higher premiums. Ironically, this priced out the poor and the sick, leaving the emergency room as their only viable option for health care. Their expenses were passed on to insurance companies, who passed it on to their customers, and so on and so forth.
     In 2011, we tried to end that cycle, forcing everybody to buy insurance and forcing insurance companies to take everybody. Yet, in spite of big government subsidies and penalties from the people not buying insurance, premiums still go up and Sam is still too costly to take care of.
     While some people believe Sam should get treatment no matter the cost, there are just as many that believe the cost matters a lot. Especially when that cost gets passed on to them personally.
     Which brings us back to the question. Who tells Sam that society will no longer be investing in their continued health?
     One would think it would be our elected representatives. After all, that’s kind of what they’re elected to do. However, many of them, especially those of one particular party, treat this responsibility like a hot potato. At the federal level, their go-to play is to pass the buck on to the states. This is seen in a lot of ways. Any time block grants are suggested as a way to save on Medicare spending, what it really means is that the federal government wants to cut funding and leave it to the states to decide who gets the short end of the stick.
     And then there’s last week’s health care bill. Even House Republicans are reluctant to sign their name on legislation that takes away pre-existing condition protections, but they’ll pass a bill that lets states do it.
     Of course once the buck gets passed to the states, they pass it on to somebody else. Sometime’s literally. We have all seen this in Iowa as the governor outsourced responsibility for Medicaid to private companies. It’s not politically expedient for elected officials to reduce Medicaid services, but it is what we expect from for-profit corporations.
     If the state is allowed to allow Wellmark to deny coverage to people with pre-existing conditions, what’s anybody going to do about it? You can’t vote out the CEO of Wellmark. You can’t even vote with your wallet because they are just about the only game in town and even if they weren’t, the competition wouldn’t be any better.
     But while our legislators play a shell game with social responsibility, there’s another question that I can’t help but feel is overlooked.
     Why does it cost $1,000,000 a month to make or keep Sam healthy? Why are insurance companies losing millions of dollars a year while rates continue to go up?
     Where is that money going? It doesn’t just fall in a hole and vanish.
     One million dollars a month. That’s more than $33,000 a day. That’s about $1,400 an hour. What costs that much? Three dozen people working eight hour shifts around the clock at $50 an hour treating Sam with six pills a day made of pure gold wouldn’t cost half that much.
     Everybody needs to make a living, but it’s hard to believe that there isn’t some part of that expense that’s costing more than it needs to.
     Maybe we need to follow the money. Maybe we need to see who is getting rich while all our premiums go up. Maybe instead of passing around blame for who is sinking the boat we’re all on, we should figure out how to plug the leak.
     Maybe then we can afford to give Sam the care they need and have affordable premiums at the same time.
     Travis Fischer is a news writer for Mid-America Publishing and wonders if we’re really going to wait for the entire system to collapse before joining the rest of the civilized world with the single-payer model.