Even the consultants are worried.

If you’re not worried or confused, you’re missing the problem.  I’m having a Roemer Minute.  I am one of those people who feel it’s his responsibility to teach the world how to drive, on road-raged lunatic at a time.  I’m an INTJ who’s so far off the scale I would have made Howard Hughes seem like a people person.

I write in the belief that it helps me explain complex issues to me—if that helps you we both win.  I am beginning to believe that the problem no longer lies with me.  Each time someone explains reform I feel like the half-life on my IQ Do you feel that way each time you hear another explanation of the same issues?  After a certain number of times being confused about the same thing, you being to say, “I am not that dumb.  It’s not me who doesn’t get it, it’s the explainers.”

We have arrived at where we were before we left, but at least we still have the weekend to look forward to.  Here’s my best shot at explaining this to myself—this is deliberately oversimplified.  If I can’t explain it in a simple manner I think it means they are trying to fool all of us.

Maybe healthcare reform is meant to be like the Jedi mime trick: You have two buckets – one holds exactly 5 gallons and the other 3 gallons.  How can you measure out 4 gallons of water into the 5 gallon bucket?

Let’s try this illustration.  Take out two measuring cups, the healthcare cup which holds 2 cups, and a healthcare cost cup, a 4 cup cup—sounds like ‘wood chuck chuck’ but we covered that earlier.

The 2 cup line on the healthcare container represents full healthcare coverage for all.  The line at 1 ½ cups represents those who currently have healthcare.  Now, fill the 4 cup cup to three cups.  Let’s state that represents what it currently costs to provide healthcare for 1 ½ cups worth of people.  So, just to keep my mind from exploding, cost to coverage is a simple ratio of 2:1—it is not meant to represent reality, just call it Roemer Math.

Now, we have been told reform has two goals;

• Provide coverage for all—add water to the 2 cup healthcare cup
• Bring costs down—take water from the 4 cup healthcare costs cup

As we add water to the 2 cupper, we must add twice as much water to the 4 cupper.  Why, because more healthcare costs something.  Am I missing something?  Now we are going to bring costs down.  Take water out of the healthcare costs 4 cupper.  What does that require?  Exactly, we must also take water out of the healthcare two-cupper.  No matter which way you start, adding water, or taking it away, the result is the same.  There is no way to add to one and subtract from the other, unless of course we decide to add cost and decrease the number of people covered—some would argue that that is our current model.

There is a way to make this model work.  It requires a few more nuances.  It’s these ‘nuances’ that are being incorporated, but remain unspoken are called fine print.  How can it be made to work?  Ignore for a moment those who do not have healthcare, they will be covered momentarily.  Let’s do one thing at a time.  Let’s bring down the cost of healthcare for those who are covered.

We take water out of our cost cup to the level somebody at a high pay-grade determines, but leave the line at 1 ½ cups in the healthcare cup.  How can we make that happen?  Make the amount of water (healthcare) appear to be the same even though it won’t be.  Maybe there’s a way to insert air in the water to make it look the same, but we all know there is now less water (healthcare) in the cup to distribute to those people.

Now we need to fill the healthcare cup all the way to the 2 cup line, and we need to do this without adding any water to the healthcare costs cup, the 4-cupper.  Okay sports fans, what next?  The only option is more air.  Since the volume in the 4-cupper is now a constant, we must make the 2-cupper appear full using only the amount of water it has.  How to do that?  More air.  More nothing.

We know this is nonsense.  The only way to make this happen is to take something away from those who have healthcare.  What is there to take away?  Services, access, coverage, quality, quantity.  If enough of those are removed, costs can come down.  If you remove them yet again, you can add new people.

The argument they are trying to sell is you don’t have to take any of those away.  You can do it without rationing, without raising taxes.  You become more efficient, remove waste.  How do you do that?  Government healthcare.  You do the math.