An All-Inclusive Resort Only Costs $400 a Night...

If I were the sort of person who wallowed in statistics, or even bartered in facts for that matter, this article would be filled with tedious decimal points and percentage values; it would contain citations and references to tables, graphs, and historical data; and it would be as painful to read as it would be to write.  Luckily, veracity and exactitude do not concern me (nor most of America, apparently) when it comes to crafting a good story.  Personal experience is the most reliable source of useful information.  And writing about myself is far more interesting to me than is compiling and summarizing the opinions of a bunch of educated, well-informed strangers.  However, just because my supporting arguments will be entirely anecdotal (and, there will be some numbers and probably a chart) is no reason to throw out proper form and structure.  Therefore, allow me to begin with a hypothesis:

Healthcare in America is stupid.

OK, perhaps that statement is too broad.  The actual 'care' portion of healthcare in America is awesome.  The doctors and surgeons, the facilities and resources, and approximately 10% of the nurses are exceptional.  Methods are modern, clean, and effective.  I received excellent world-class care for my health.  Seriously, I cannot praise my team at RMC Medical Center enough, although I may have some serious displacement issues with the very attractive surgeons who so tenderly reassembled my broken leg and gave me lots of delicious pain killers.

However, in America "healthcare" is a double-barreled word which also describes the idiotic and confounding accounting and payment practices that support an otherwise wonderful team of talented and dedicated caregivers (minus 90% of nurses, of course).  The word - which should belong exclusively to the realm of solace and comfort -  is inextricably linked to anxiety-inducing terms such as monthly premiums, co-payments, and out-of-pocket maximums.  I think it is a bit of a shame (why am I pulling punches? I think it is a bloody disgrace) that any consideration of well-being jumps immediately to an evaluation of the affordability of treatment or prophylaxis.

But, IS healthcare in America REALLY  that expensive? This lovely little summary from my insurance company illustrates the amount of slop and overhead that is built into the current healthcare accounting strategy:

At first glance, the answer to my semi-rhetorical question is Absofuckinglutely, healthcare in America is preposterously expensive and add to that an additional $18,000 worth of emergency services bringing the total billable expenses to $378,000 or ~$3,000 per HOUR for my 5-night stay.   That's about the size of an average 30-year mortgage.

However, on closer inspection of the bill, you'll notice an accounting miracle called "discounts" whereby 80% of the bill magically disappears, leaving behind $65,000 in actual charges which represents a slightly more reasonable hourly charge of $520.  My actual out-of-pocket expenses for the whole party total $4,000, or a mere $32/per hour - which is about what I make, come to think of it.

Luckily, I am among the fortunate well-employed who have bonafide health insurance.  I pay $3600 per year in premium co-payments.  My company pays an additional $6,000.  With my current coverage, I must budget $7600 - $11, 600 per year for healthcare to cover out-of-pocket expenses, including the premium.  Is it a lot of money?  Yes, but it won't send me to the poorhouse.

But, what if you don't have health insurance?  How can anyone but the wealthiest citizens afford a hospital bill the size of a 30 year mortgage, especially when they can't even afford a 30-year mortgage? 

There is a dirty little secret about healthcare that most Americans don't know.  If you do NOT have insurance, there is another magical accounting strategy that employs 'write offs' in place of  'discounts'.  This method avoids heart-stopping over-inflated bills such as above, and in the end the patient still ends up paying the same amount of cash out of pocket - only on a per-incident basis instead of some arbitrary calendar dates.  In many ways, not having insurance is more streamlined, less confusing, but just as stupid.  For specific personal details of what happens when you have a broken leg without insurance, I refer you to the sad and desperate events13 years ago, which inadvertently lead to my 30 year mortgage.

By this point, I am sure that some of my foreign-national readers, and perhaps many of my domestic, are asking, but what about Obamacare?  Didn't that fix things?

Absofuckinglutely not.

I want to be clear to divorce my admiration for the Man from my disappointment at his attempt to reform our stupid healthcare system.  Americans on both sides of the Obamacare debate were completely misinformed as to its function.  Central to the arguments both for and against Obamacare was the assumption that it was in fact, free and universal healthcare.  It is neither.  It is merely a mandate to purchase health insurance coverage at levels similar to what I have described above - and at similar costs, with one important distinction.  If your employer does not provide benefits or you do not qualify for assistance, then you are forced to cover the entire annual premium of $9600+ per year (plus budget $4,000 per person to actually use the insurance).  The average American household income is $50,000 per year.  

Obamacare is not healthcare.  It is mandatory catastrophe insurance that is causing many Americans real financial harm in the form of a brand new $9600 per year bill that arose from the simple sweep of a pen. More insidiously, Obamacare strives to dissipate the advantages of not having health insurance by imposing a penalty tax that is equivalent to the premiums on those that 'choose' not to purchase it.  So, you can pay $9600 per year for insurance you can't afford to use or pay $9600 in penalties, and still not have insurance.  I fail to see how this is an improvement for anyone other than the government and the insurance companies.

Just plain stupid.   

Oh, but how to fix it?  I mean really fix it...

The insurance companies must be removed from primary healthcare decisions.  There is still a place for insurance - it can be the vehicle through which the wealthy may purchase superior services, but never at the expense of basic services for the poor.  Premiums are replaced with taxes - but not 20% of one's income!!  Patients should contract with primary care providers directly - "Negotiated rates" get replaced with true-and-fair costs.  Doctors need to be more humble and less revered.  They are humans who try to help, not infallible healers nor demigods.  Providers must have protection from litigation and must never be influenced by profit margins or costs when prescribing the best course of treatment. Ideally, healthcare is not tied to employment, so that one never feels trapped or unable to take a risk.  With a system such as I propose, there is room for lots of care, and lots of health - for a cost that is fair and affordable.

I know this system works well, because I have experienced it first hand in Australia during those sad and desperate events 5 years ago - where $65,000 worth of healthcare cost us absofuckinglutely nothing.