On the Third Hand: Bad guys

So, why exactly is it that the only true government-run health care systems are for old people, poor people, soldiers and military veterans?

I think it’s really because most of the patients in those systems are too poor, sick or frail to speak up for themselves, or because the patients are used to following orders and mentally unprepared to take on a system.

Most of the time, Congress puts private companies in charge of benefits decisions not because our leaders are such ardent capitalists, but because they don’t want to be the ones responsible for saying no.

Even if they’re budget hawk conservatives, members of Congress want to be in a position to wag their fingers at the insurance companies if the companies refuse to pay for (experimental, likely futile, extremely expensive) surgery for a photogenic child with parents who had a combined total of 100,000 Twitter followers and Facebook friends before they even got married.

On the one hand, certainly, there are greedy, insensitive jerks in the insurance industry, and it could be that the government has actually been paying too much to mediocre Medicare Advantage plans.

Jonathan Blum, the head of Medicare, testified about a year ago that the gap between per-capita support for enrollees in the traditional, government-run Medicare program and enrollees in private Medicare plans had shrunk to 4 percent in 2013, from 14 percent a few years earlier. But, of course, even if that 4 percent is now 2 percent, that 2 percent is a lot of money. Medicare managers should do something about that 2 percent.

But, on the other hand, I was just reading an editorial about the topic by the Bloomberg editors and wondering how much fun editors will have in their own personal lives when Bloomberg takes a budget cleaver to their health benefits and gives those healthy, young and hypereducated folks the kind of lovely “skin in the game” that Democrats and Republicans alike now want to give the frail older people in Medicare.

To some extent, Medicare Advantage may cost more because of inefficiency.

But it also costs more because it gives enrollees the kind of low-hassle care we’d all want for our loved ones, not technically competent refugee hospital-level care that will keep people who are willing to camp out in a doctor’s office alive long enough to spend their last days worrying about medical bills they’ll never actually be able to pay.

A few years ago, I naively signed up for a high-deductible plan that gave me some skin in the game. I’m young. I have a bachelor’s degree in economics, and many clips based on interviews with the developers of the modern U.S. health account programs. I’d interviewed all sorts of Davos-caliber experts on health care cost transparency.