Health Care versus Sick Care

Here we are in the throes of an intense and, for many, uncomfortable movement to reduce federal government spending. At the grand level, it is really hard to argue with the need.

Depending on where you look, the US federal government’s annual income is ~$5 trillion but the outgo is ~ $6.8 trillion. Which is how we got to about $35 trillion in debt, increasing every minute.

If it were my checkbook, I surely couldn’t keep spending more than I had. Most of us would agree that something has to give, somewhere. But what? We either need more income, less expense, or some combination of the two.

While it is tempting to think there must be many places to trim a lot of expense, categorically there actually aren’t. The SS, Medicare, and Medicaid programs are, by far, the largest expenditures, followed by Defense/VA.

Social Security ($1.2 trillion) almost pays for itself through payroll taxes. About half of Medicare expense (~$850 B) is covered by payroll taxes and premiums; the balance comes from the general fund. Medicaid. Children’s Health Insurance (CHIP), and ACA expenses (~$950B) are paid for out of the general fund.

Everything else is a drop in the bucket. Education is a relatively tiny expense, ~$80M. USAID is ~$892 million. A million dollars sounds like a lot until you realize it takes a thousand millions to make just one billion. And it takes a thousand billions to make just one trillion. We are talking some serious money here.

In other words, you aren’t going to make a timely and meaningful impact on anything by focusing your attention on a drop in the bucket. You have to play in much bigger numbers. And healthcare expense is the biggest thing there is.

This is not what we want to hear, at least those of us who aren’t independently wealthy.

We want to hear that we can get insurance, that our health drugs will cost less, that our Medicare, Medicaid or ACA premiums will be less, that our co-pay is small (preferably none). We want to hear that a doctor’s treatment plan including prescriptions is covered right away, that testing and hospitalizations are available and bills paid in a timely fashion.

That’s what we want but what we actually get may be up for grabs.

Why? Because the federal government’s largest expense, the best candidate for meaningful cost reduction, is Medicare, Medicaid, Children’s Health, and ACA. And somewhere in the process of “reducing expense” some or all of those things we “want” are going to be negatively affected.

What is going to happen? We all wait with bated breath. In the meantime, I offer this, oft repeated, thought. We don’t actually have health care insurance, we have “sick care” insurance.

When our health is good, we need less sick care. If your health is not good, ask yourself these questions. What is causing it and what can you do to fix it? Not the doctor’s visits and drugs you can take to-treat but living your life in a way that minimizes the problems.

Living our lives in the way that keeps us out of the doctor’s office instead of paying for us to be in the doctor’s office.

For sure, any one individual might, in rare circumstances, have some awful genetic deficiency. An auto accident, misstep on your roof, or a fire could require, potentially, serious medical attention. Plus, eventually, we all get old enough that things just break down. But that isn’t the stuff that’s keeping us in the doctor’s office and driving up “healthcare” cost.

It is the chronic health conditions that are the result of what we eat, obesity, stress, not sleeping, lack of exercise. It’s diabetes, cardiovascular disease, kidney failure, etc. etc. The stuff we can’t CURE but simply keep spending to treat forever.

Healthy people are rarely sick. Unhealthy people lean heavily on sick care and the medical community. The message? It is our responsibility to maintain our health through diet and lifestyle, minimizing the need for sick care.

How do you feel? How much weight has crept on over the years? How much sleep do you get, pain do you have? Are you a couch potato? What other symptoms do you have? What reasons do you have for going to the doctor? How many diagnosed conditions do you have? How many medications do you take?

Prepare yourself for the potential that sick care as we now know it might become far less affordable. For the vast majority of people, losing 20 or 30 lbs and keeping it off might be all it would take. There is a reason why the ever-popular weight loss drugs are now on the approved list for those chronic diseases.

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