Once upon a time, I endured an 11-year career in healthcare, working for and with the biggest names in the industry. When I first entered the healthcare scene, health insurance for my entire family cost a little over $70 per month, and health insurers were dropping like flies to Chapter 11 amidst the ‘rising cost of healthcare.’ Today, that same coverage costs over $500 per month and now American families are struggling to keep the lights on. What happened? Insurers became better poker players, and the rest of us are trying to learn the
tells, as they say in the world of poker.
Our healthcare system isn’t in a crisis, at least not for the reasons our government would have us believe. It’s merely in a state of flux, not unlike a high stakes poker game, where the pots are never evenly (or fairly) distributed. Poker is one part chance and two parts strategy, where the better player effectively shifts the odds to their favor. At the healthcare poker (debate) table the players include consumers (We The People), payers (insurers and governments), practitioners (doctors, nurses, specialists, hospitals) and suppliers (pharmaceutical and medical supply manufacturers). The game is a competition for the pot, and everyone plays against one another. No one sides together, or in the Old West you get shot for cheating. ‘But wait,’ someone says, ‘my doctor is on my team.’ You may have a great physician attending your needs, but unless he or she charges no fee for service, they are in business for profit. They are playing for the pot, just like you, so you cannot be on the same team. Any attempt to alter this natural law of economics and you will cause an untimely end to the game.
Now that we understand the players and objective of the game, here’s how the independent strategies shape up:
Consumers
Consumers play the game for the winnings and nothing more. If the game were called ‘losing’ they certainly wouldn’t bother coming to the table to risk their chips. Rather they contribute to the pot in hopes that the hand they’ve been dealt will take precedence over the hands of their competitors. They like playing with practitioners, because they enrich the game. Consumers appreciate how practitioners usually find ways for consumers to keep some of their chips, even with a losing hand. Consumers dislike the payers, because they have too many rules and seldom do consumers win any hands the payers deal. Still, payers are in favor of table limits, and without them, most consumers couldn’t afford to play. Concerning suppliers, consumers are very suspicious. Suppliers always seem to be sitting behind a massive mountain of chips, and more often than not, they win the pot. Nonetheless, it is the investment of suppliers’ chips into the pot that keeps consumers coming back to the table for their chance to win.
Payers
Payers like it when consumers have a healthy stack of chips, because they tend to wager more in the pot. They also like a large group of consumers to attend the game, just not those who are sick or can’t afford the minimum bet. Payers are happiest when they deal, because only then can they impose restrictions, terms and conditions that disproportionately slant the odds in their favor. They don’t like to lose the pot to anyone, but they especially don’t like it when consumers win. Consumers are wasteful, foolish spenders. Winnings should be reserved for those who know best how to spend! Thus, when a payer senses a strong consumer hand, they’ll often resort to the
bluff. Bluffs are an important strategic tool for payers, though they try not to overuse them for fear that consumers will stop coming to the table with their chips. As an added incentive for consumers, payers lobby for table limits, which allow more consumers with fewer chips to play.
Practitioners
Practitioners are among the pros at the table. They are meticulous in implementing their strategy, but sometimes get lost in the shuffle. Many practitioners would probably play for free, but it’s better to have a pot, because more people come to play. Everyone at the table enjoys the practitioners’ game play, because they rarely bluff and almost never fold. Payers would prefer that practitioners bluff more often, but consumers are happy they don’t. Practitioners realize they need to work on their tells. Suppliers, in particular, have caught on that practitioners will follow their lead on any given hand. Consumers have found the same to be true. This has led the practitioners to play into the suppliers’ hands far too often. Practitioners have also recognized that rarely do they win when payers deal. Consequently, practitioners are beginning to select specialized games when it’s their turn to deal. Their winnings have begun to increase again, and so they stay in the game.
Suppliers
Suppliers are well known for being the shrewdest players at the table. They hold their cards close to the vest and love to play without limits. Their winnings are legendary, and often they have all the other players at the table unwittingly playing into their hands. They were the original players of the game, so they know it best. Despite their advantage, everyone looks for a supplier at the table. Without them there would be no game. Their best allies are payers and practitioners, for they grow the pot and increase the winnings. Their greatest threat is that consumers will fold and walk away from the table. Whenever the payers deal and impose table limits, suppliers tend to sit back, bet small and reserve their best game for the next hand. They’ve heard rumors that one particular group among the payers is vying to be the sole dealer! If that happens, they may just fold up the game table and take it somewhere it may otherwise be appreciated.
The translation . . .
The
game is the free market healthcare system, as it exists today. The round poker
table, where there is no head or foot, represents the free market’s balance of power. Each player comes to the table with equal odds, although any player may improve their odds with a superior game strategy—that’s the American way. The
chips in the game represent each player’s particular line of capital, but note that all capital (or wealth) originates from consumer spending (insurance premiums, purchases) and taxation. The dealt
hand signifies the use of a healthcare product or service. Players wager chips into the
pot (collection of capital investments), based upon their perceived odds of their hand taking precedence over those of the other players. Never forget that players only risk their chips for the sake of
winnings. Regardless of what any player may say, they are in the game to win. If the game were called ‘sharing,’ once again, no one would play. Charity is a venture not suited for competitive engagements, and We The People are second to none in the giving department.
Bluffs can be common in the game of poker, and can manifest themselves in the healthcare world as coverage rejections and benefit restrictions. Some restrictions make sense, particularly when the American taxpayer foots the bill, but most are designed to increase payer profits and assert control. When any insurer says, ‘We’re concerned about wasteful spending and better health outcomes,’ you should cry ‘Bluff!’ They are really saying, ‘We’re concerned that we’re not making enough money!’ When the government, in turn, says, ‘We’re concerned about wasteful spending—’ just hit the mute button. Who are they to talk about spending! Look at what they have done to We The People’s budget! Yes, let us fix healthcare by spending another TRILLION DOLLARS! I suppose you have to have a PHD in economics to make sense of that.
At last, we come to the dreaded
fold, which is essentially giving up on the hand, or perhaps the entire game. In the free market, the occurrence of too many folds results in new options and offerings from entrepreneurs seeking the American Dream, absent overregulation by government. This is the beauty of the capitalist system and why the healthcare market would naturally remedy itself if left alone. On the contrary, artificial interference from government hinders the free market response, often setting the table for a new game called
Monopoly. Suppliers and payers immensely appreciate and enjoy that game, because they have less threat of competition. Nonetheless, no one at the table wants the government to step into the poker game as the only
dealer. That’s a monopoly game of a different sort. If you are wondering why more players, including practitioners, are not decrying this threat, just ask yourself what do these players have to fear? The answer is much, for they depend so much on the government’s chips, funded by taxation of all the other players, but especially the consumers. Clearly, these are not the ‘trust-busting’ days of Teddy Roosevelt and William Howard Taft, intended to pave the way for new competition. Government today wants to compete with the free market, while making all the rules. How is that fair, unless you’re a proprietor of the government?
Don’t listen to what politicians will tell you. Instead, take note of what they don’t say, what they say won’t happen, or what
they the government promise not to do. These are precisely the things that will go wrong and be made worse by
they the government’s meddling.
God made mankind to aspire and to achieve, not to do the work of a drone for one’s apportionment of nectar. Just try to stop your children from dreaming and reaching for the stars. It won’t take. They will fight it with the very essence of their being. And that is precisely what We The People must do.
I promise you that in the day
they the government succeed in taking over the game, there will be a celebration in Washington unrivaled since the end of WWII. In spite of that, one by one the players will eventually fold and leave the table. Before the next generation in this country reaches its sunset years, the government will be the only player left and will possess all the chips. In that day, ‘quality and affordable’ won’t be used in the same sentence as healthcare any more.
Thomas N. Tabback
July 9, 2009
Author of Things Forgotten
Co-author of Joe The Plumber – Fighting for the American Dream
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