On the Third Hand: What's Essential

To me, it looks as if the idea that society can let poor, uninsured people with serious health problems die on the sidewalk is gaining momentum.

The idea that we can take benefits away from those folks but that some hazy someone will do something about sick people on the sidewalk seems to be much more popular.

To me, it seems, though, as if the philosophy that really dominates health care finance in the United States is that just about anyone who is really cute, young, brave, or otherwise attractive can use media coverage to get coverage for whatever treatment he or she thinks might possibly increase his or lifespan by about two hours or more, no matter what the cost be.

On the one hand: I’m a softie. I want everyone to have every access to every imaginable treatment. I read those stories and want someone to do something.

On the other hand: Offering all reasonably media-friendly people with serious health problems warm and fuzzy assurances that every life is precious, and that we’ll spend whatever we have to spend to give everyone the best possible medical care, probably hastens the arrival of the day when the system breaks down and we have no choice but to dump people on the sidewalk. Running an insurance company is all about the painful task of recognizing that the maximum amount of supply that can really be available will always, always, always constrain the amount of demand that can be fulfilled, no matter how fervently we might wish otherwise. Rebelling against the physical constraints by saying “yes” to pleas that can’t realistically be fulfilled is foolish.

On the third hand: The battle over the “Essential Health Benefits” (EHB) package that will (apparently; Congress and any court challenges still in the pipeline permitting) be created by the Patient Protection and Affordable Care Act of 2010 (PPACA) may be the place where the claws of demand will go at it with the claws of bloody in vicious, bloody combat until the political landscape is covered with dazed, whimpering interest groups.

The system created by PPACA would use the EHB as a yardstick consumers and others could use to measure the actuarial value provided by health plans. 

The California Department of Insurance recently gave us a peek at what the gladiatorial combat might look like holding an EHB hearing.