Is He Dumb, Or Does He Think We Are?

     I admit it: my views on health insurance/health care have changed.  Coming up with a system that ensures all citizens get adequate health care is apparently so incredibly difficult that every industrialized democracy (and larger autocracies) except the U.S. has figured it out, in several different ways.

     Rand Paul, talking about the expiring Obamacare subsidies on Meet The Press this morning, first complained, "It's the artificial demand  that has driven prices up," by which he apparently means the weakly-enforced requirement (not to mention general individual desire) that everyone buys insurance.  How is that an artificial demand?  Was the point to have more health care for more people, or to encourage the weak and poor to die off?  Because the second is what we had before ACA, and what we have a little less of now.

     But that logical glitch was nothing compared to what followed: asked what he would do, the Senator from Kentucky explained that his plan would "...let Americans buy their healthcare at CVS, at [list of large retailers], at Amazon, and when you have a million or more individuals, that's bigger than any corporation," quite sensibly implying that per-person costs would fall; a sufficiently large pool of people is statistically predictable, allowing the insurer to manage risk, and the more of them you've got in the pool, the better that's going to work.  It's a great idea -- and works even better as it is scaled up.  It'd be a real hum-dinger if the insured consisted of, oh, the entire population.

     Don't hold your breath.  Not for an insure-everyone plan, or even for bopping over to Walmart to pick up their nationally-sold health-insurance package during the post-Thanksgiving sale.  If you take a look at Open Secrets, the majority of the top five political contributors are insurance companies, hospital corporations, and pharmaceutical companies; healthcare and HMO's are in the top twelve.  They know who to schmooze in Washington, and exactly how.  Every part of healthcare has an ownership/administrative layer taking a cut, and they'd all like a bigger slice of the pie.  It forms a kind of financial ratchet, and an increase at any point results in every part of the network turning the dial up.  It's a mess because it is a mess; the ACA legislation tried to make it less messy without asking any part of it to accept a smaller slice and, unsurprisingly, all that did was bake the messiness in. 

     Maybe Rand Paul is right; maybe it'll take a "Category Killer" to do to the insurance/medical complex what they did to the office-supply store, the corner grocer, the independent drugstore and the five and dime.  But while those little enterprises got squashed like bugs, Here Be Dragons, and it may have to all fall apart before it can be remedied.

     I'm not holding my breath for that, either.

     Pie in the sky is lovely to look at, but it's not nutritious.