Everyone is entitled to his own opinion, but not his own facts.  Daniel Patrick Moynihan

Government provided or mandated medical care appears ready to bankrupt the civilized world. Here are two examples of the mess we’ve created in an effort to make life better. First contraception. The Patient Protection and Affordable Care Act (the most oxymoronic name since Health Insurance) requires that companies with more than 25 to 50 employees provide health insurance. As everyone  now surely knows HHS (figure this abbreviation out yourself) has required that contraception be included as part of the package. The resulting firestorm has cause the president to move the onus from the employer to the insurance company – a distinction without a difference.

Why do people have health insurance? The better question is why should people have health insurance? The answer to the latter is to protect themselves from unexpected and large medical costs that they otherwise couldn’t afford. It’s not to cover every routine medical expense that they could afford to pay. If an insurance policy is working as it’s supposed to, the average person will pay over the course of his life more or less what he receives in benefits. This is the only way an insurance policy is viable. Insurance doesn’t lower a person’s costs, it spreads them over time. First dollar coverage, even with a deductible, is a recipe for economic disaster because it separates the cost of a service from its delivery. What people need is catastrophic health insurance which protects them from the cost of a major illness which will yield a bill beyond anything they could reasonably be expected to pay.

Why should health insurance cover the coast of contraception? Put aside the very real issues of government mandates, religious freedom, and surrender of liberty. If you listen to NY Times columnist Nicholas Kristoff who in his column Beyond Pelvic Politics manages in an orgy of liberal angst to get so many thing wrong in so few words that we need Winston Churchill back to encapsulate Kristoff’s fugue state to an oratorical fanfare – something akin to never have so many owed so much to so few. Basically Mr Kristoff thinks birth control is beyond the means of poor people. He therefore thinks that employers should provide contraception through their health insurance plans. But people with jobs are not typically among the poorest of the poor. Also Medicaid provides poor people with contraception at no cost, at least to them. And even if you do have to pay for it, you can get a month’s dose of birth control pills at Walmart for $9. Put Sprintec or Tri-Sprintec into Walmart’s drug search engine and see for yourself. Those are the two generic birth control pills that Walmart sells. So what’s his point? A bit of fact checking could have given him the day off.

This vignette shows how we have infantilized our population to the point where many think that $9 a month is too much to pay for something they think very very important. Alternatively, they don’t know or care what medical care costs, they just want it for free. The cause of this problem is described following the second vignette.

A couple of days ago I received a packet from Life Line Screening. They offered five screening tests for a special rate of $149. Click the link and you’ll see the five tests. The remarkable part of this offer is not that you should undergo these screening tests – you shouldn’t – but rather their cost. If you had a good reason to have these tests, and just being alive is not such a reason, they would cost you about ten times what Life Line is selling them for. Incidently, you can screen yourself for atrial fibrillation simply by taking your own pulse. If it’s regular you don’t have atrial fibrillation. While I don’t think these tests are of any real value I have no objection to your wasting your own money getting them. That’s the point here. You have to pay up front for these tests. No insurance, no Medicare, no Medicaid – cash (or credit card) on the barrelhead. Not having to deal with a third party and getting immediate payment allows Life Line to do the tests at a low cost while still making a profit.

The reason medical care costs so much is that government either pays for it or mandates it. Conventional health insurance got started during World War II when wage and price controls were in effect. Health insurance was offered to workers as a way to get around the wage controls that then prevailed. Once begun, it was as addicting as nicotine. Costs went up when a third party started to pay for them. The arrival of Medicare in 1965 was the rocket that sent costs to outer space. For more than 30 years reimbursement was “usual and customary charges” which of course made usual the same as higher.

Note that it’s the government that got this vehicle started and which keeps it going. To think that the government will fix it is to inhabit the same fanatsy world that Mr Kristoff has built his mansion in.

Lasciate ogne speranza, voi ch’intrate should be put atop of every doctor’s medical school diploma.