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OPINION

Syndrome which usually occurs in months 4-6 of a baby's life. conditions so that everyone can have coverage for everything. No
Hardly a measure of our healthcare system having babies dying at problem; just raise the premium. And as I discussed, minimum es-
home from suffocation. The IMR was the single most cited reason sential benefits are quite robust. No problem; just raise the pre-
that the USA's healthcare system was broken and needed "reform." mium. Yes, when the government tinkers with our "market-based"
And the way the IMR statistics is often presented, one would believe healthcare system, the market is no longer in control of creating a
that our hospitals are terrible at infant care; a claim that is prepos- product that is affordable for millions of Americans.
terous. We lead the world in managing some of the most vulnerable The other good news here in the USA is that as we continue to
very low birth weight babies to a healthy status than any other in- get older, we live longer. And the Baby Boomer generation has
dustrialized country. An extremely low birth weight infant is one boomed. And all of the innovations have kept us living longer. That
with a birth weight of less than 1,000 g (2 lb, 3 oz). Most extremely comes at a price as well. Capital follows innovation and if one looks
low birth weight infants are also the youngest of premature new- at countries that are more socialistic or communistic, there is little
borns, usually born at 27 weeks' gestational age or younger. Globally, innovation because there is little desire by the citizens to innovate
the prevalence of very low birth weight is approximately 15.5 per- when the government will take the fruits of their intellectual prop-
cent compared to the USA which is approximately 7 percent. And erty away from them. Also, since innovation and excess capital go
because of our tremendous high-quality healthcare system, we save hand-in-hand, it seems rather obvious to me that if 20 percent of
80 percent of this population. Not the case in other countries. our economy (Healthcare represents about 20 percent of GDP)
Seldom do we consider the reason WHY healthcare is expensive evaporates out of the private sector in favor of the government sec-
here in the USA. And unfortunately, in today’s world, too many peo- tor, the private capital market and innovation will disappear as well.
ple lack the capacity to reason and simply blame one aspect of a Is that what you want with single-payer healthcare?
healthcare delivery system as to the woes of the entire system. One The Federal Government is notorious for adding layers and layers
reason that healthcare costs continue to increase is directly due to of administrative cost to any agency. Can you name an agency that
government mandates! The government mandates that insurance has had a reduction in administrative costs? Probably not, which is
companies offer “minimum essential benefits.” These benefits are one reason why the USA is about $20 trillion in debt!
neither minimum nor essential. They are however costly. And every Be careful when a politician dangles the word FREE! Not much
time the government mandates that the insurance company offer in life is free, and ultimately someone must pay for all the free stuff.
some benefit, you the consumer pays for the mandate in the form And the payment for the free stuff comes in all shapes and sizes.
of higher premiums or deductibles. Even when healthcare is not Longer waiting lines, fewer substitutes in services, higher de-
government-run, they insert themselves into the picture and the re- ductibles, higher taxes, payment cuts, less innovation, and the politi-
sult is higher costs to everyone. cization of our healthcare system. There are valid reasons why
The ACA is full of engineering mechanisms designed to create a monopolies are illegal in the USA. How is Medicare for all any dif-
more "fair" and equitable healthcare system. However, all of that ferent? The only difference is that it becomes a government mo-
"fairness" has increased the costs of healthcare. Consider the de- nopoly as opposed to a private monopoly and that seems like a
crease in rating bands. It went from a ten-fold band limit to four, terrible idea to me. However, I am one who likes choices and com-
meaning the highest premium costs could not be greater than ten petition! Something tells me that if people understood than
times the lowest premium costs to now no more than four times. Medicare for all is a monopoly, I doubt 70 percent of the public
If you were running an insurance company, would you take the would be in favor of such, particularly if we increased their taxes
highest cost members and lower their cost, so they are only a four- to pay for all of that free healthcare.
time factor of the low-cost members premium? Or would you in-
crease the low-cost members premium to be closer to the Dr. Alan Preston is an experienced Chief Executive Officer with a demon-
highest-cost members premium? Yes, the latter is what happened. strated history of working in the managed care and the healthcare industry. He
Consider the fact of removing the ceiling on lifetime maximums. has a Doctor of Science (Sc.D.) focused in Public Health, Health Services Re-
Sounds great; however, it is very costly to underwrite when there search from Tulane University School of Public Health and Tropical Medicine.
are no limits. No problem; just raise the premium! Increase the de- He has been very involved in risk-sharing contracts, ACOs, Medicare Advan-
pendency to age 26 for families that still have their kids at home at tage including RAP scores, HEDIS, and STAR ratings which helps physicians
that age. No problem; just raise the premium. Remove pre-existing and health plans alike in reducing MLR. Alan@Preston101.com.

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