Look Forward to a Healthier America (by Olav Grinde)

There are many ways of getting a society to “do the right thing”. Many years ago, as I was driving into San Francisco across the Bay Bridge, traffic was at a crawl – except for two lanes labeled Car Pool. Those cars whizzed by and their drivers didn’t even have to stop to pay the road toll. Life can be so unfair to a lonely guy in a BMW or Porsche.

Above the highway was a billboard advertising, in large letters, the Car Pool Switchboard; its sole function was to hook up people regularly commuting from one place to another at roughly the same time. Saving a few dimes by sharing gas expenses, or even being forgiven a couple of bucks in road toll, may not have seemed like much of an incentive – but getting to work (and home) 20–30 minutes faster each day, most certainly was!

City of Angels

As Mayor Eric Carcetti of Los Angeles recently pointed out to Time Magazine, if you could increase the average number of people in a car, from 1.1 to 1.6 people, then his city would instantly be rid of its traffic congestion. The “City of Angels” would once again become a functional city – as the Founding Angels intended.

I am sure that every one of those drivers has an excellent reason for driving alone. Collectively, however, it is sheer lunacy and it is a recipe for metropolitan paralysis. In fact, that congestion reaches far out into every Los Angeles suburb.

Sure, you can try to legislate individual dos and don’ts – such as the number of people in private cars – for the common good. Good luck with that! Such infringement of personal freedom might well have worked in yesterday’s East Germany, Romania or China – but not in today’s land of the Free, the Brave and Gridlocked.

Applying sensible pressures

If you apply the right pressures, then a number of people will start to behave more rationally. It’s all about giving people the right incentives. It’s amazing how much recycling happens because people get their deposits back on beer bottles and Coke cans!

That’s why Obamacare has an individual mandate. The ingenious legislative architects suspected that taxpayers wouldn’t really appreciate the thought of having an additional 1 % of their annual income confiscated. Nevertheless, one of the biggest surprise findings of the recent Rand Corporation study, was that as many as 8.2 million Americans have found it timely to opt into Employer Sponsored Insurance plans (ESI) offered through their workplace. Nobody suspected that the Individual mandate would be that effective. (Don’t expect Fox News, Forbes or the National Review to be shouting this good news from rooftop antennas any time soon or, God forbid, crediting Obamacare.)

And remember: in this day and age, corporations are people, too. If you squeeze the corporate bottom line, I guarantee you that those pressures will be passed onwards to the entire society. But for heaven’s sake don’t call this social engineering! Let’s call it social shiatsu.

The previously sick be damned

Critics have long feared that insurance premiums will skyrocket as millions of sick people are added to the risk pools. Previously, the insurance companies had the option to deny insurance, or at least relevant coverage, to all sorts of sub-groups with pre-existing conditions: diabetics, asthmatics, former cancer patients, etc etc. That made good sense for the corporate “bottom line”. Heck, there was even a well-entrenched policy of rescission, which meant dropping coverage retroactively.

This, of course, is a far more accurate meaning of the term Death Panel. Compassion and people be damned – until now… Obamacare has changed the dynamic for the better.

Legislated compassion

Suddenly there is a new reality. In order to protect their bottom lines, insurance companies have a strengthened interest in making sure far fewer Americans get sick. As Charles Gaba pointed out, this means, among other things, making sure diabetics see their physicians, watch their diets and take their medications.

Come to think of it, smoking hurts the corporate bottom line, too. And child obesity really threatens the future annual profits of American insurers! As a result, we can expect lots of unhealthy American habits to change.

Maybe you won’t stop smoking because you might die of emphysema or lung cancer in an expensive hospital bed. But Aetna, Blue Cross and Kaiser may soon be doing their utmost to convince you to give up your lethal habit, if for no other reason than for the health of their bottom line.

It’s a beautiful irony that compassion is becoming an ulterior motive. So be it!

A bum deal

For many years I have wondered why Americans insist on paying 30–70 % more per capita for health care than Europeans do. I am torn between concluding that this is just their way of supporting “the free market”, and crediting America’s famed generosity. Strangely enough, those Europeans are on average also healthier, so Americans have clearly been getting a bum deal. I bet you anything that those 30–70 % extra costs pad the bottom line – lots of bottom lines. To bend the cost curve, and make the nation healthier, some of that padding needs to go. (But don’t tell any CEOs that.)

The resurgence of preventive care

I am convinced that America is seeing the dawn of a resurging focus on preventive health care, which of course is the cheapest health care of all. In fact, it’s free under Obamacare. What a novel idea! Good, preventive health care will keep more Americans healthier – and protect the sacred profit of insurers. Combining those interests into an incredibly powerful cost-reducing and health-inducing force, may well be Obamacare’s best legacy.

In one respect, however, antagonistic conservative pundits are absolutely right. Obamacare will continue to be a failure – because it still won’t solve the traffic problems in Los Angeles.