BillboCare! A modern solution to the healthcare issue.

-- opus in progressu -- Once again I am not sure what many folks are thinking when it comes to what is commonly referred to as Obamacare, more specifically the Patient Protection and Affordable Care Act.  I personally don't like the Obamacare label.  Legislation should be looked at on its own merits, not just on who champions it. Going forward I will refer to this legislation as ACA and although well intended, it is a terrible tax and not sustainable long term. Unfortunately, we have to abandon it and reboot our healthcare product and delivery system.  The only concept that will work long term is to let Americans decide for themselves what health care they purchase "in potentia emptor".  I might have a way to do that.  I am calling it BillboCare (every initiative needs a clever moniker or flag).

But first, as always, Dr. Bill thinks we need to step back and examine where we are, how we might have got here and where it is we want to go.  Without documenting the history of employer based healthcare post WWII, or what we now refer to as the "cafeteria plans/deductions allowed under IRS Section 125, our immediate concern is the increasing costs that Americans are paying for healthcare.

QUIZ QUESTION: Who thinks "healthcare is affordable"?  Anybody?  If you say it is, I have a followup question "when was the last time you or a family member were actually sick or needed healthcare?" Even folks who might be a bona fide beneficiary under the ACA will tell you there is nothing affordable about it, and the annual deductibles should you need healthcare are killing them. Dr. Gruber told us it was a tax and they were counting on the "stupidity of the American Voter" when they forced it upon us.  I hear stories of folks having to "wait till next year" to go see the doctor since they cannot afford the deductibles.

Unfortunately, ACA solved nothing at the expense of taxing a couple hundred million of us, raising the average cost of care, forcing many to lose their preferred physicians and putting an increased administrative burden on businesses and medical providers.  Luckily we passed it on Christmas eve, so we could read what was in it (it was voted on before it was published.. that in and of itself should be a crime.)  And even if the intent of the party line legislation (thanks Arlen Specter you traitor) was noble (and not just to benefit the insurance lobby who wrote it), its execution was definitely flawed on about every level.  If you take it's intended goal of insuring 49 million and grade that against the best numbers any reasonable person would conclude it is a giant failure.  The Obamacare Facts website says there are 17.6 million signed up which includes medicaid signups. The best math I can prove is that ACA might have caused 5 million in new sign ups (not displaced folks whose policies were cancelled or the medicaid folks).  5 million folks were assessed an IRS tax penalty (I wonder if that increases or decreases blood pressure. mmm even Dr. Bill can see that).

So what do we do now?  Republicans have never been too clever in these problem solving areas, their solution is usually to do nothing and ignore the real elephant in front of them (see what I did there?). Meanwhile, our Democratic friends think money is printed from thin air and it is their/our duty to feed, school, house and healthcare everyone, even asses who do not follow our laws (somebody got it?).  Since they are both, wrong let me propose a terribly wonderful more better solution.

• I propose that we allow Every American who wants/needs healthcare to obtain services at their local VA medical center and they can pay whatever they are able (everyone pays something).

That's right, government provided healthcare (notice I did not call it free, since nothing is free). Now, this new class of patients will sit behind the service personnel in terms of waits or preference but we can handle them all.  And I do not envision this "government provided healthcare to be "concierge level service" like you might find at Cedar Sinai or Johns Hopkins.  This is basic government supplied coverage and we will charge the folks as much as they can pay (5% likely).  I encourage all folks to participate in the more dynamic private healthcare system which is costing some folks around as much as 40% of their after-tax income.

Now based on a modest amount of research, it appears the VA system provided "healthcare" to 5.9 million customers in 2016 at a cost of $65 billion or roughly $10,972 per person.  While the entire VA budget is $182 billion, the VA system itself has many other missions in addition to healthcare including benefits ($110 billion), national cemetery maintenance, various research programs, loan and mortgage assistance and several other programs.  The VA balance sheet shows it has $6 billion in assets so it is very stable and can easily scale up to absorb twice the customers with twice the (or something less than twice) the absorbed cost.

Now many will deflect and talk about a few horror stories concerning VA service instead of giving this proposal serious thought.  But remember how many the VA has really served since 1930.  We need to provide a solution here rather than "kick the can" further down the road.  I am afraid the future is more about "snowflakes needing a safe space" than someone "tightening their belt and saying get out my way, I got this" while they climb the mountain or slay the dragon.  If we cannot go back, my solution works on many levels going forward.  It will be way less costly to manage this benefit this way than the current ACA.  More importantly, it allows those who can to provide and make choices for themselves.  There is no instance where consumer choice did not make products better and more affordable.  Sure the VA has problems as does every business especially those managed by the government (no offense government folks and honestly, we should be embarrassed that we have not fixed things at the VA.) My proposal assumes we fund this correctly and hire proper management.  And sure this is quasi-socialized medicine but maybe not quite as bad as forced-communist medicine.  In our modern progressive think-set it is assumed and perhaps necessary that we provide for the millennial snowflakes who were not taught to provide for themselves.

Let's be sure to consider the "cost of healthcare" for anyone who does not go to the VA which is most consumers at the margin.  By providing an alternative government service, the demand for similar private services will be decreased in a negative manner.  In theory, should millions of customer leave a market for something, absent some large immediate change in supply, the price of that something should go down as vendors compete for the consumers who are left.  That means the cost of healthcare in the private system should go down or at least not increase.

Let's be clear the real reason the cost of healthcare is twofold.  The first and foremost reason is most humans seem to take very poor care of themselves and enjoy many habits with negative health affects.  The second reason is that the "employer based insurance model" makes the consumer/employee ignorant to the true costs of the service.  Unfortunately most folks do not truly value the cost of surgery or a casket until they do.  By then, the price cannot be negotiated.  I am calling my plan BillboCare.  Please support it or come up with something better.

Sources: 2015 VA Financial Report, Blue Cross Blue Shield, Health Works Collective, Stanford Medicine, LA Times, Medicare Interactive, Kaiser Foundation, Financial Samuri