Healthcare – Musical Chairs

Posted on  July 28, 2017


Many adults have memories of playing musical chairs. The essence of the game is that there is always one less chair than the number of participants. The music plays, the children circle the chairs, and when the music stops everyone tries to sit down. Obviously, there will always be one child left standing. That child is eliminated from the game, and one more chair is removed. On to the next round where the same happens again and another child is eliminated.

There are many adult lessons that can be learned from this children’s game. One of them may be that when your demands exceed your resources, the inevitable conclusion is the elimination of a demand. Obviously, choosing which demand to eliminate is often a serious point of contention.

Obamacare presented many changes – some major and some relatively minor. While it is beyond the scope of this post to set forth the issues at a granular level, discussion of a few key issues may underscore the reason why change is so difficult to achieve. Obamacare had many predicates that were interdependent: mandated insurance to raise revenue from the people needing the least care, coverage of pre-existing conditions which would be of limited aggregate cost once there was a mandated insurance program (which obviously contemplated that everyone would have insurance), and the elimination of lifetime caps. The issues of being able to choose one’s doctor and various other promises/provisions are beyond the scope of this post.

Clearly, things did not work out as expected; the public has not embraced the mandated insurance which has negatively impacted the amount of premiums flowing to insurers and apparently is a root cause for skyrocketing premiums and limited or no individual insurance in many counties. It is reported that 6 million people have decided to pay the fines exercising their right not to have insurance. The purpose of this post is not to advance any political position or agenda, but rather to point out that various aspects of insurance reform are interrelated.

Ultimately, every feature has a cost. There has to be someone willing to fund that cost or the feature cannot be offered. Mandating coverage for pre-existing conditions has a cost. Who will pay for it? The elimination of lifetime caps has a cost. Who will pay for it? Mandated insurance has a cost insofar as the people who need the insurance least are either being forced to purchase insurance (which costs votes), or they are forced to pay fines, which similarly does not make voters happy. Elected officials on both sides of the aisle have little to offer with respect to insurance premiums or $5000 deductibles

 Various proposals have been made trying to maintain the features of Obamacare either in whole or in part, without providing the interrelated and interdependent payer of these features, namely, the healthiest and youngest sector of our populace.

The way in which this matter has been approached is reminiscent of a couple who was debating whether to vacation in New York or San Diego and could not resolve their differences so they decided to compromise and vacation in Kansas City.

It may be time to revert back to our youth and remember musical chairs. The basic lesson is that when you have more demands than resources someone is left out in the cold. The bigger question is choosing the child, the feature, the payer, the elderly or the infirm that will invariably be left out in the cold.

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