I have spoken on this topic a few times before and it usually sparks a lot of heated debate, as it should. So many of us are just sitting here wondering what will happen to the healthcare industry and what it means for our jobs. For me, there are just too many unknowns. I know that our system is broken, but I’m not so sure we went about the right way of fixing it. I don’t claim to have all the answers, but I think I have a pretty good idea of what works and what doesn’t. What bothers me is that people like you and me are continually left out of the decision making process. Instead we have people writing bills that have probably never seen a patient, tried to collect an insurance payment, or tried to run a private medical practice.

The talking heads continue to tell us that we need to cram trillions of federal dollars into the healthcare system in order to keep it afloat. But they never tell you why the system got to where it’s at in the first place. Medical care in the US is so expensive that most people simply can’t afford it without insurance. And many people can’t afford insurance. But have you ever sat down and looked at why it’s so damned expensive? Granted I’m no “expert” economist. I’m just a dumb-ass paramedic. But even I can see that the service I provide is expensive because nobody pays their bill.

Ambulance services can’t survive with half of their customers skipping out on the bill. We also can’t refuse service based on one’s ability to pay. I’m not saying I think we should, but it is a huge factor in the cost. Any other business in the world would call the cops if they saw someone return to their store who took something without paying. Not us. We just give them what they want and expect that they won’t pay. So how do we stay in business?

Someone has to pick up the tab for those that eat and run, and that usually falls on the insurance companies. And no, I don’t mean Medicare and Medicaid, I mean private insurance. Medicare and Medicaid walk into the restaurant and pay what they feel is fair market value and ignore the listed price on the menu. But wait, isn’t that illegal? Well, normally yes. But they’re the government and they’re here to help. The business is forced to raise their prices, which means that the people that do pay are not only paying their tab, but all the tabs of the people that didn’t pay. This nifty little technique is called “cost shifting”. It’s basically a narrowing scale that will eventually spike to the point that nobody is able to afford the cost. Think of it this way, every time the price goes up, less people will be able to afford it.

It’s arguable whether or not expanding Medicare and Medicaid benefits would help this issue. On one hand, ideally, more people would be covered by some kind of insurance which is better than nothing. But the big question is, are more people going to utilize medical services because they are now covered by government aid? If so, then it actually makes the problem worse (refer back to the restaurant analogy). Not to mention that doing so increases the national debt, which usually leads to increased taxes, which usually leads to people with less money, which then leads to less money being spent, which leads to layoffs and more people without insurance. It can make your head hurt thinking about it.

Forcing people to purchase health insurance could help solve this problem, or it could have the reverse affect. The theory behind this soon-t0-be mandate is that more people will be able to pay their medical bills, which would in return cut down on the cost of doing business. But let’s look at this from a different angle. If health insurance was affordable, most people would buy it. So do you think that some 27 year old guy working paycheck to paycheck at a dead-end job is going to be able to take a $500.00 a month hit? Probably not, so instead we hit him with a large penalty? That’s like telling me to buy an expensive sports car to avoid being charged $50,000. You would probably have to throw me in jail because you’re not getting either out of me.

So what’s the next option, forcing employers to provide health insurance? You could do that, but then the business owner would have to offset that loss somehow. And I think we both know that it would end up falling on payroll, which is usually the largest business expense. They would either have to cut wages to make up for the loss or lay off people. That doesn’t help much at all. Instead that just adds more people the uninsured pit.

This of course brings us to our next up-coming “solution”. Now we want to force health insurance companies to take all applicants regardless of their past medical history. I get the reasoning behind this, but are we really looking at the overall picture here? Health insurance companies make money by collecting your monthly premiums and hoping that you either never make a claim or do so as little as possible. They don’t want to take people with serious conditions because they know it’s a money loser from the start. It’s the same reason why auto-insurance companies don’t want drivers with bad records. It’s a losing deal. Do you think it would be fair to get in a car accident without insurance, then apply for coverage and expect them to cover your accident? What do you think a move like this is going to do your monthly premiums? Now the 27 year old guy REALLY can’t afford his coverage. I get that there is not as much of an emotional argument that goes with auto coverage, but it doesn’t change the fact that insurance companies have to stay in business in order to pay for your medical problems. Now before you come at me with torches and pitchforks, I still think that there needs to be a way for people with pre-existing conditions to get insurance. I think a good starting point would be to get more people on private insurance plans so that these companies can afford to lessen their standards. I’ll get to a broader explanation of fixing this problem later.

The next option, and in my option, the worst, is raising taxes to expand government coverage. Taking money from one person to pay for another doesn’t help the problem. Instead you take money from the people that are supposed to be supporting the economy. If you take $200.00 a month from me, you have just taken $200.00 that I would have normally spent elsewhere. This means that the movie theater, grocery store, auto shop, etc now get that much less of my money every month. Multiply by this by millions and you get a recession. Now let’s look at the opposite end of the spectrum. Lowering my taxes would not only let me keep my $200.00, but would give me more money to spend. This means that all those business now get more of my money. Multiply that by millions and you get increased demand and cash flow. This means that businesses have to hire more people in order to keep up with the demand for their product. This then translates to more jobs, which means more people with insurance benefits, paying taxes and being able to pay their medical bills. See where I’m going with this?

Now we may not be considered to be as “intelligent” as the decision makers, but even the simplest of minds can see that if a problem is caused by people not having enough money, we solve it by either getting more money to the people or making the service affordable. Now I know this doesn’t solve all our problems, but it’s a good start. We have already seen how putting money into the hands of the consumer can help, so let’s talk about how to get the cost of doing business down. Many hospitals and ambulance services operate on 40-60% of their patients actually paying their bills. So by using cost shifting, they are forced to increase their prices by that much in order to stay in business. Now imagine if everyone paid their bills. I know that’s unrealistic, but bear with me for a second. If everyone paid their bill, then the service operating with a 50% collection rate could essentially lower their prices by 50%. Sure, that’s a very simplified example, but you get the point. You might notice how I referred to the economy several times. This is because I firmly believe that fixing the economy is more than half the battle of fixing healthcare. It’s rather simple. Get more people back to working, then you will get more people being able to pay their bills.

There are of course plenty of other issues that need to be addressed like the ability to route patients to proper forms of treatment other than just the ER and the lawsuits that lead doctors to practicing defensive medicine. But for the purpose of this article, I’ll leave it here and touch on those subjects later. Like I said before, I don’t have all the answers. I could very well be dead wrong. And to be honest, I hope I am.