Get the Market Out of Healthcare

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A new Los Angeles Times poll, conducted with the Kaiser Family Foundation, shows how desperately awful health insurance is becoming in this country. The poll revealed that more than four in 10 people with employer-sponsored insurance—you know, the kind politicians claim we all love—have a high deductible plan, and one in five Americans say “healthcare costs have eaten up all or most of their savings.”

The poll defined “high deductible” as more than $1,500 for an individual or $3,000 for a family. Only 15 percent of those workers had no deductible at all. 21 percent had a deductible above $3,000 for an individual, which is more than most households have in liquid assets—meaning if they needed to use any kind of expensive healthcare, they’d have to pony up more than they have on hand. It’s no wonder that Americans are borrowing $88 billion a year to pay for healthcare.

Why did deductibles ever become a thing? Because of the utterly ridiculous and revolting idea of giving patients “skin in the game”:

Backers of the high-deductible strategy nevertheless argued that patients, given “skin in the game,” would become active consumers who would force drugmakers, hospitals and other medical providers to rein in prices.

“The thing that caught people’s imagination was this idea of unleashing American patients as consumers,” said Dr. Arnie Milstein, medical director of the California-based Pacific Business Group on Health, an organization of large companies, including Boeing, Safeway, Walmart and Wells Fargo.


And the president of the American Medical Association—an organization that fights attempts to bring in single-payer, and has done so since the Truman administration—said the idea behind deductibles was to give patients “responsibility”:

“The original idea of deductibles and co-pays theoretically might have made sense — if patients have more responsibility for how they spend medical dollars, they would be more careful,” McAneny said. “But it is just shifting costs to the patients, and people are foregoing care they need.”

But the guy who came up with the high deductible regime, who should be jeered and booed every time he tries to go outside, appears to still think it was a good idea that got ruined by naughty employers:

As high-deductible plans caught fire, however, many employers saw they could save even more by not contributing to their employees’ accounts.

“The idea was hijacked,” said Tony Miller, a Minnesota healthcare entrepreneur who developed some of the first high-deductible plans for large employers like medical device giant Medtronic, but who has since grown disenchanted with how companies shifted costs onto patients.


Is there anyone in America who makes less than, say, $150,000 a year who thinks that patients need “skin in the game” to prevent them from using too much healthcare, or using it ‘irresponsibly?’ Is there anyone you have ever met, outside of Washington think tanks, who thinks of patients as consumers and not, you know, sick people?

How little could you possibly understand the most basic facts about healthcare? That everyone needs it at some point, that sick people do not have much opportunity to shop around for prices? That businesses will always do what is most profitable for them, including contributing less to workers’ premiums by signing them up for high deductibles? And, perhaps most importantly, that hospitals are not a fucking Mattress Firm where you can hold out or walk away for a better deal?


It’s helpful to see the utterly insane core of the market-based approach to healthcare laid out like this. If your moral justification for throwing patients to the dogs of capital is that you’re totally sure market forces will lead to low prices and high quality, it’s probably time to either admit that you were wrong or that you have absolutely no moral belief in the rights of people not to die as a result of treatable illnesses.