Wednesday, March 28, 2012

Why the PPACA hearing is the very definition of insanity

I haven't said much about the SCOTUS hearing of the PPACA, but it is time to break my silence. I have been listening to some of the details of the arguments, and I cannot help but be nauseated. It feels to me like the Justices are behaving like my teen: they take literalness to its absurd limit. Health insurance and cell phones, really? This betrays a complete disregard for probability. What are the chances that you will within your lifetime in the US need to dial 911 in the absence of a landline or another human with a cell phone within shouting distance? And what are the odds that you will at some point in your life require a medical consultation? I rest my case.

The more I think about it, the more convinced I am that the bill should have introduced single payer a priori -- funding our access to medicine through a tax. Yes, a tax. Perhaps the government is not the most efficient agent of this, and the overhaul could have been accomplished through some public-private hybrid model. In the end, as I have said here, our priorities are misaligned, as are our perceptions of what is important in this debate. We spend 97% of all the healthcare money on medicine, and we spend well over 97% of our national discussion about health on access to healthcare and medical interventions, which can only make a 10% difference in our health. The real money, so-to-speak, is in public health, which contributes 60% to our true health and gets only 3% of the expenditures and practically no conversational energy.

So, once again I find myself turning to the wisdom of Albert Einstein, who defined insanity as "doing the same thing over and over again, and expecting different results." The SCOTUS circus is the poster child for this insanity. Whatever the outcome, and I am not at all optimistic about the individual mandate, my sense is that nothing will change until we start paying attention to the root causes of our collective illness.

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