A Votre Santé!

In case you didn't know, that's French for, "To your health!"  (Gotta do something with those 12 hours of French I took in high school and college.)

I'm speaking of health care, and taking a bit of a risk in doing so, as the GOP's proposed replacement for Obamacare (the AHCA) may not survive the week.  But I'll take a shot anyway, because my final point will remain valid regardless what ultimately becomes of government attempts to get involved in health care.  So read on, but you might want to pour yourself a drink, use the bathroom if you need to, and get comfy, as this may be a bit of a long read.

I haven't paid too much attention to news coverage of the plan, because a) the biases are clear, depending on whether your chosen news source leans left or right, and b) there's more noise around this thing than sitting amidst a bunch of teenage girls at a One Direction concert.  Besides, when it comes to things like the AHCA or the "Skinny" Budget, I prefer a different source of information:

The document itself.

So I sat down to read the AHCA.  But I gave up after a few pages, for a couple of reasons.  First, I realize that whatever it looks like now is probably not what it'll look like if/when it passes the House and Senate, and I also understand that it's merely phase one of a planned three-phase effort (more on that later).  And second, it didn't take me long to figure out that I know little of the logistical and operational workings of health care.

I just want to know, in the end, how it will affect me.  And I suspect that's true of all Americans.

Okay, it's probably only true of half of Americans.  The other half just want to jump on Facebook and scream things like "TRUMP IS TAKING AWAY OUR HEALTH CARE!" and "HE'S GOING TO END COVERAGE FOR PRE-EXISTING CONDITIONS!" and "HE'S GOING TO END COVERAGE FOR MY 26-YEAR-OLD WHO LIVES IN THE BASEMENT!" and "TRUMP HATES PUPPIES!"

In a Quixotic attempt to assuage those "progressive" fears, let me say the following: first, Trump has never indicated a desire to take away health care.  He just wants to take away a crappy health care plan that got shoved down people's throats and wound up giving everybody less choice for a whole lot more money, and required doctors to increasingly practice defensive medicine, and replace it with something that actually benefits all constituencies involved, in a fair manner.

Second, he wants to retain coverage for both pre-existing conditions (with which I partially agree) and kids up to age 26 on their parents' plans (with which I disagree).

However, I recognize that those assurances will not slake the thirst for partisan fear-mongering of those predisposed to hate anything Trump does.  Especially if the thing undoes something Obama did (no matter how poorly).  So to those folks, I'd simply say ... keep screaming.  Nobody's listening to you anymore anyway.

To those on the far right who are opposed to AHCA because it doesn't go far enough, please understand that it is, again, just the first phase of a three-phase plan.  The GOP Congressional leadership has learned from decades of partisan gamesmanship in our nation's cessp- er, capital.  They know that they don't have a large enough majority to get all of the pieces passed at once.  Thus they're going to have to use a three-phase approach, plus some pretty arcane legislative machinations, to get it done.

So phase one is to get Obamacare repealed, and replace those parts of it that can easily pass a first vote, while retaining some parts of it that may not satisfy the far right, but that's temporary.  Admittedly, that also means leaving off the table - for now - things like the ability to buy insurance across state lines.  But that's in the plans for one of the subsequent phases.  Patience is a virtue.

Let's take a detour to try and calm the fear-mongers on the other side now, futile as that may be.

Yes, the (ever-accurate) CBO has indicated that a whole lot more people would be uninsured under this plan by 2018, and even more some years after that.  Several points are in order:

1.  Even the CBO acknowledges that most of those additional uninsured through 2018 would be uninsured by choice.  In other words, they don't want to pay for insurance, since they think they don't need it.  Maybe they're young, with no dependents.  Maybe they're really healthy.  Maybe they're not thinking clearly.  No matter the whys; they don't want insurance, and, given the opportunity to not be penalized for exercising their choice, they will elect not to have it.

2.  On that point, consider what Obamacare really did in "providing coverage to all."  It forced people to buy something whether they wanted it or not, and taxed them if they exercised free choice by not buying it.  Then, the Obama administration crowed about how many more people were insured after Obamacare than before.  That's a bit like a car salesman holding people at gunpoint, threatening to shoot them dead if they don't buy a car, then bragging about how many cars he sold.

3.  And on a related note, recognize that the CBO's estimates cite "additional" uninsured.  That acknowledges that Obamacare left some people uninsured.  That's right, boys and girls, your revered President Obama left millions of Americans uninsured.  Where's the fake outrage over that?

4.  As for those additional numbers of uninsured that would crop up in years subsequent to 2018, it's true that many of those would be uninsured for reasons other than choice.  However, note that phases two and three are not in place yet, and are intended to remedy that.

I know, I know, you're not convinced.  So ... keep screaming.  Nobody's listening to you anymore anyway.

Back to phases two and three, for the far right skeptics.  True, we don't yet know what those phases will look like, in part because we don't know what the final phase one will look like once the House and Senate finish tweaking it.

But we have hints: things that have been left out of phase one, but are tougher nuts to crack, like the ability to buy insurance across state lines.  Once Obamacare is out of the way, Democrat lawmakers will be faced with the choice of getting on board with those phases, or leaving those additional people uninsured, which will then be on them.  Again, the GOP lawmakers understand gamesmanship, and they're playing a long game here, one whose final whistle will come after the mid-terms.

You also need to realize that the GOP doesn't want to pull a Pelosi and draft some bloated, verbose Frankenstein's monster of a bill, then urge their colleagues to "pass this so we can see what's in it."

Now, I'm going to skewer some sacred cows, and see how many people I can make angry.

First, I am all for taking care of the elderly.  I count among their number some beloved family members and friends.  Heck, I'm pushing 60 myself.  So I'm all for things like Medicare, which we pay into with our own hard-earned money and have the right to access after we stop working.  (Congress just needs to keep their cotton-pickin' hands off those funds, instead of "borrowing" them and never paying them back.)

However, one of the things that opponents of the AHCA are screaming about is that, while Obamacare caps health care costs for the elderly at three times the cost for younger folks, the AHCA would lift that cap to five times.

Well, even three times might be too high for some, and again, where was the fake outrage over that (especially since Obamacare sent premiums soaring for all, so that means they've soared three times as high for the elderly)?  Get premiums back under control, and the five-times cap under AHCA will still translate to less dollars than the three-times cap under Obamacare.  It's simple math: if premiums double, three times two is six, which is more than five times one.

Also, I don't take issue with the notion that us older folks should pay more for health insurance.  The insurance game is about risks and probabilities, and the probability is higher that I'm going to be at risk of getting sick or having health problems than my 26-year-old daughter.

To wit, last year - my 58th - I had a shoulder x-ray, two chest x-rays, a sonogram (no, I'm not pregnant), an abdominal CT scan, and a brain MRI.  Plus enough blood draws to qualify me for pincushion status, and I capped the year off with triple-hernia surgery.  Sadly, my guess is that, as I get even older, the hits are gonna keep on coming.

It's like a driver who gets in more accidents than the average Joe: he's going to pay higher auto insurance premiums, right?  Or should those of us who don't get in accidents pay more to subsidize him, so that his premiums are no higher than ours?  (Note to Bernie Sanders voters: don't answer that question.)

Second, regarding coverage for pre-existing conditions, I'm okay with that if one is changing insurance coverage.  However, if one has previously been uninsured, then contracts a disease, and decides to obtain coverage after the diagnosis now that they realize they're going to incur high medical expenses and thus need insurance - sorry, but that's on you.

Sounds heartless, I know.  But again, let's use an auto insurance analogy.  It's like an uninsured motorist who gets in an accident, then tries to buy an auto policy to cover the cost of the damage.  No insurer would cover that motorist - you're required to maintain constant coverage to get a new auto policy.  So why should health insurance cover the heretofore uninsured who, once ill, want insurance to cover that particular illness?

Third, I believe that, at 26, you ought to be able to get a job that has insurance coverage.  (There would be more of those jobs if Obamacare's high costs hadn't forced so many small businesses to drop coverage for their employees.)

I've had health coverage through my employers since I graduated from college.  Oh, I can hear the feel-the-Berners now:  "But dude, that was like, 100 years ago!"

Okay.  My daughter, who is 26, has had health care coverage through her employer since she graduated from college at 22.  So has her 27-year-old husband.  So have three of my colleagues, who are aged 26 to 28.  It can be done.

Granted, there are those against whom the odds are stacked.  However, there are also numerous examples of those against whom the odds were stacked, who defied those odds and rose above the situation.  And for those in other situations where the odds are more firmly stacked against them, the reasons represent other root problems that need to be addressed, like urban blight and single-parent households and poor inner-city education opportunities and ... you get the idea.

In other words, you don't fix those root problems by just giving the affected people everything they might need for free.  In fact, that only serves to perpetuate those problems.  And even free health care can't overcome the myriad other adverse effects of those root causal factors.  Let's address them concurrently.

So, under my plan, no coverage for 26-year-olds under their parents' plans.  Sorry, helicopter parents.  You may just have to learn to stop enabling, and cut that cord.

And what would my plan be?

I don't have the foggiest.  I'd prefer to leave that to the experts, so let's invite the health care providers to weigh in.  I don't do health care; my doctor doesn't do economic analysis.  However, I do have a few thoughts (and sorry for all the numbered lists of things in this post; it's how my brain works).

First, we need meaningful tort reform so that doctors aren't forced to practice defensive medicine for fear of being sued to the moon and back.  Maybe we should cap awards.  Differentiate between truly negligent malpractice and the inevitable issues that arise from practicing the inexact science that is medicine.  If there were no such thing as classaction.com blaring ads on TV every day, maybe doctors could get back to the business of being doctors.  ("If you or a loved one has died of mesothelioma, call Dewey, Cheatham and Howe," as if I could make that call post-mortem.)

Here's a real-life example.  My doc has decades of experience.  He's good, he's pragmatic, I trust him, I like him, and we're more like friends than doctor and patient.  He talks to me, and listens to me.

Last year, he was going to write me a prescription, but he needed to do some blood work first, to make sure that other levels were in order.  Well, the lab results showed that one of my levels was too high, and that could have indicated other issues.  So he ordered the brain scan (turns out I have one - who knew?), but ordered a second round of labs first.

That test showed that the levels were back in line, but he had me go ahead with the brain scan anyway, "just to be sure."  (In other words, just to be sure I couldn't sue him, which I wouldn't have done anyway.)  The scan turned out fine.  So we did one more blood test, and the levels were again fine.  Only then did he write me the script.

This extreme defensive medicine is necessitated by unfettered litigiousness.  But good luck getting tort reform through a Congress whose 535 members count among their number  nearly 200 lawyers.  That employment group has the largest representation of any among lawmakers, and their lobby is powerful.  Still, the percentage of lawyers in Congress has declined steadily since 1965, so there's hope.  (Disclaimer: I am not disparaging lawyers in summa.  Summa my favorite people are lawyers.)

Second, we need to overhaul the FDA and make it easier to get drugs approved in this country.  And we should re-think how long before drug companies can compete.  Drug companies cite their R&D expenditures as justification for that lengthy span.  But drug companies spend way more on advertising than on R&D, and they spend more on R&D for "lifestyle" drugs like Viagra than they do on drugs that will cure serious diseases - supply and demand.

I've found that the only thing that will cure my annual sinus infections is a good ol' Z-Pack.  Spare me the Madame Curie-esque soliloquies about the perils of antibiotic overuse - sinus infections are no fun at all, and the Z-Pack knocks 'em out in a few days.  Yet I always seem to get them when I'm traveling, and the urgent care docs would rather lecture me about antibiotic abuse than prescribe what I need.  So I wind up taking their homespun remedies for a week or more, then going to my doc when I return home to get a Z-Pack.

One urgent care doc, upon being told that my doc always prescribes a Z-Pack for my sinus woes, replied, "That's bad medicine."  Okay, I thought, I'll be sure and tell my doctor, who's had an established practice for longer than you've been alive and has clinics in the inner city and in Africa, that a mall doc thinks he practices "bad medicine."

So what's the point of this story?  When my wife and I were in Cabo in January, we stopped into a Farmacia and picked up a couple of Z-Packs to have on hand just in case.  No prescription required.  And once when we were in London, my wife strolled into a Boots (the U.K. version of CVS) and bought a prescription medication she'd run out of on the trip, again with no script.  Why can't we do that in the U.S.?

Now (with apologies to the Eagles), to sharpen my steely knife for the last sacred beast:

Health care is not a right.  There, I said it.

I find it ironic that people like Michael Moore, the deranged closet capitalist who has single-handedly doubled America's Big Mac consumption, believes that it is.  Maybe he should exercise his right to exercise.  And eat salads.

President Obama was a smoker when he argued that health care is a right while stumping for passage of Obamacare.

I don't begrudge the President his right to smoke (he reportedly quit in 2011, but was also reportedly seen with a pack of smokes at a G7 summit in 2015).  Nor do I begrudge Michael Moore his right to pop a cheeseburger in each cheek like some bloody great squirrel storing up nuts for the winter.  I really don't care - that's up to them.  I just find it ironic that people who make unhealthy choices (as do I) advocate that health care is a right (as do I not).

Life is a right.  One could argue that health care is vital to life.  Well, for one, my Granddad never went to the doctor until he was in his 70s.  Then he was diagnosed with leukemia, and a few years later, he died - of chemotherapy.  But he lived a long and happy life prior to that, without going to the doctor.  (He also had employer-provided health care in retirement, plus Medicare.)

Also, if health care is a part of the right to life, what about food?  Housing?  A job?  Transportation?  Sure, the Berners will argue that all those things are rights.

Hint: there are reasons Bernie lost, and they're not limited to Debbie Wasserman-Schultz having thrown the game in Hillary's favor.

The former Soviet Union argued that those things were rights, too.  How'd that work out?  Look, if you want to live in a state-provided studio apartment in a tenement block that has more bugs than an entymology lab (and I mean the electronic kind), slave for 15 hours a day in a sooty factory for no wages, ride in sketchy buses and cable cars, and stand in borscht lines, you go right ahead.  I'll take my free-market chances.  (I can only imagine what "free" health care was like back in the USSR, with apologies to the Beatles.)

Liberty is a right.  So forcing people to give up their free choice to not have health care coverage is taking away a right, not granting one.

The pursuit of happiness is a right.  The prospect of losing my insurance coverage or seeing my premiums double under Obamacare doesn't make me happy.  It makes me cranky, and I'm cranky enough as it is.

So what would I propose for when the uninsured get sick?  Simple.  They can try to obtain treatment.  And I'm sure there's a doctor who will feel that to not treat that person is a violation of the Hippocratic Oath.

I don't necessarily disagree.  But don't treat that person and then stick the rest of us with the bill.  They were exercising their free choice to not be insured, and they bear the consequences of their choices.  If you choose to treat them, that's out of your pocket.  As I've said before, your right to punch me in the face ends at my nose.  In other words, your rights end when exercising them infringes on the rights of others.  That includes paying your bills.

I realize that there are nuances that need to be addressed for the hopelessly indigent, but again, let's tackle the root causes, and help them to not be indigent any more, rather than making them even more dependent.  It's tragic when some poor person loses everything they have in an apartment fire, but you don't hear the left crying out for renters' insurance for all, do you?

Oops - sorry I brought that up.