Healthcare and the KISS Principle


One of the maxims I strive to live by is the KISS Principle: Keep It Simple, Stupid! It is based on this that I can accepted as fact that society doesn’t scale well, nor do its institutions and bureaucracies. Case in point, the federal online healthcare marketplace stood up at http://www.healthcare.gov. I point to the following excerpt from the non-partisan Starts and Stripes as case in point:

The HealthCare.gov website is a disaster — symbolic to Obamacare opponents, disheartening to supporters, and incredibly frustrating to people who just need to buy insurance. Some computer experts are saying the only way to save the system is to scrap the current bloated code and start over.

Looking back, it seems crazy that neither the Obama administration nor the public was prepared for the startup difficulties. There’s no shortage of database experts willing to opine on the complexities of the problem. Plenty of companies have nightmarish stories to tell about much simpler software projects. And reporting by The New York Times finds that the people involved with the system knew months ago that it was in serious trouble. “We foresee a train wreck,” one said back in February. (Virginia Postrel, 28 Oct 2013, Obamacare was fooled by high-tech glamour)

While I am on my luddite soapbox, I want to be clear that I do not oppose the excellent advances in medical technology in the past century. Had they not occurred, I would have lost my trigger finger due to a table saw accident (NB: Never attempt to cut out a pinewood derby car with a 14″ circular table saw… and never reach across the blade… with the guard off… to turn off the power) when I was eighteen. A very skilled doctor was able to reconnect nerves and tendons and keep me from what I fear might have ended my military career in its first year.

What I do oppose is the unnecessary administrivia associated with modern healthcare a la the insurance cabal. The best definition I have found for this evil institution was written by the sage Ambrose Bierce in his Devil’s Dictionary in 1906:

INSURANCE, n. An ingenious modern game of chance in which the player is permitted to enjoy the comfortable conviction that he is beating the man who keeps the table.

INSURANCE AGENT: My dear sir, that is a fine house – pray let me insure it.

HOUSE OWNER: With pleasure. Please make the annual premium so low that by the time when, according to the tables of your actuary, it will probably be destroyed by fire I will have paid you considerably less than the face of the policy.

INSURANCE AGENT: O dear, no – we could not afford to do that. We must fix the premium so that you will have paid more.

HOUSE OWNER: How, then, can I afford that?

INSURANCE AGENT: Why, your house may burn down at any time. There was Smith’s house, for example, which –

HOUSE OWNER: Spare me – there were Brown’s house, on the contrary, and Jones’s house, and Robinson’s house, which –

INSURANCE AGENT: Spare me!

HOUSE OWNER: Let us understand each other. You want me to pay you money on the supposition that something will occur previously to the time set by yourself for its occurrence. In other words, you expect me to bet that my house will not last so long as you say that it will probably last.

INSURANCE AGENT: But if your house burns without insurance it will be a total loss.

HOUSE OWNER: Beg your pardon – by your own actuary’s tables I shall probably have saved, when it burns, all the premiums I would otherwise have paid to you – amounting to more than the face of the policy they would have bought. But suppose it to burn, uninsured, before the time upon which your figures are based. If I could not afford that, how could you if it were insured?

INSURANCE AGENT: O, we should make ourselves whole from our luckier ventures with other clients. Virtually, they pay your loss.

HOUSE OWNER: And virtually, then, don’t I help to pay their losses? Are not their houses as likely as mine to burn before they have paid you as much as you must pay them? The case stands this way: you expect to take more money from your clients than you pay to them, do you not?

INSURANCE AGENT: Certainly; if we did not –

HOUSE OWNER: I would not trust you with my money. Very well then. If it is certain, with reference to the whole body of your clients, that they lose money on you it is probable, with reference to any one of them, that he will. It is these individual probabilities that make the aggregate certainty.

INSURANCE AGENT: I will not deny it – but look at the figures in this pamph –

HOUSE OWNER: Heaven forbid!

INSURANCE AGENT: You spoke of saving the premiums which you would otherwise pay to me. Will you not be more likely to squander them? We offer you an incentive to thrift.

HOUSE OWNER: The willingness of A to take care of B’s money is not peculiar to insurance, but as a charitable institution you command esteem. Deign to accept its expression from a Deserving Object.

As evidenced by the definition above, insurance violates the KISS principle. However, due to the Affordable Care Act (i.e. Obamacare), one cannot not participate in the scheme without paying a particular fine. There is much debate about the virtues of just paying the fine vice paying for insurance (and in fitting with the dialog in the definition), however, there is one major wrinkle in non-compliance in our modern world: technology. By our playing God in the realm of virulent and bacterial realms, we have intentionally or unintentionally uncorked many nasty little genies over the past century. And the pyramid scheme of insurance (augmented by frivolous lawsuits) has put us in a fine kettle of fish whereby insurance is required to offset the outrageous costs of healthcare.

Unlike many of my fine conservative friends, I do not see Obamacare nor this exchange nonsense as the problem. It is a symptom of the greater problem of the institution of insurance. It has made the means of paying for healthcare unnecessarily burdensome to the point of being unsupportable. It is a welfare state mentality whereby the collective is supposed to support the weight of the system. The problem therein lies in the fact that unless there are healthy people (with little service utilization) supporting the unhealthy (with greater utilization), the system shall collapse. It is inevitable, and expected, thus the mandate that everyone be insured.

That then begs the question, what to do after the system collapses?

Here is where I go off the reservation, or more realistically, back to it. In communities across America there are practitioners of traditional medicine, Native American, Far Eastern, African. Some of their methods have stood the test of centuries, possibly even millennia. We disregard these medicine men or shamans, or whatever term fits, as frauds, snake oil salesmen. Why, how can their primitive tribal practices even compare to our modern medicine? Tell me this: how many diseases has “Big Pharma” cured in the past fifty years with all our advances? Why does it take 95% of a commercial to speed read a pill’s side effects?

The reason we eschew traditional/ folk/tribal treatments is because we have been slowly indoctrinated into the fallacy that Western medicine has all the answers. That the FDA knows best. That 200 years of science trumps 5000 years of practice.

Maybe I am naive, but history tells me that complex, “civilized” systems collapse, and basic, tribal approaches have a way of surviving. They may not be the most advanced, but they may just be enough.

So here is where I propose another healthcare exchange. An alternative healthcare exchange where practitioners pushed off into the shadows are able to offer their treatments and services, outside the confines of the insurance quagmire. It’s called Word-of-Mouth. Reputation. Trust. And a website might not be that bad, either.

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