Dirty Words

We are in a series exploring the idea of a single payer healthcare system.  Click here to find the prior posts.

One day when I was in the fifth grade the school principal came to the door with a troubled look on his face.  After a short discussion in the hall with the teacher, the girls were suddenly ushered out for an unplanned recess while the boys had to stay behind.  Discrimination!

We were instructed to get out a crayon and write the following words on a sheet of paper:






Someone quickly got it and whispers spread across the room.  This odd spelling test was a nifty piece of detective work.  Dirty words were found scrawled across the bathroom wall and the culprit was about to be found out.

Sadly, it seems a little quaint now, but dirty words were a big deal in the small town south back in the day.  Well, I guess ‘my raisin’ didn’t take’ because I am going to use some dirty words today.


Oh, in some conservative circles, that is downright scandalous.   Mamma’s gonna wash my mouth out with P&G soap.

In our last post, we noted that our average per capita spend is now over $10,000 a year, a number that is unsustainable.  It is now well established that number is not equally distributed, with 5% of the population (16 million people) accounting for half the total (call it $1.7 trillion).  Even this psychology major can figure out that rings in at over $100,000 per person for each of those people.  The next most expensive 5% of the population are not quite as extreme, but still cost more than $30,000 per person per year.  What is more, research shows that a large percentage of these folks remain in these high cost bands year after year, compounding the devastating financial impact.

This is just the far tail of the curve.  As the high deductible plans on the ObamaCare exchanges have shown, even a $6,000 family deductible is out of reach for many.

With the possible exception of Gordon Gekko, not even the most steely-eyed capitalist would say that these people are on their own when it comes to paying for their healthcare. Therefore, it is a given that we are going to move money from some people over to other people in order to help pay for their healthcare.  Now we are only debating the mechanism we will use. 

There are essentially only three options: Charity, pooled risk, or government.

We used to use charity, but that ship has sailed and you can make your own assessment of the good or bad in that. Of late, we’ve had some Frankensteinian child of insurance and government-facilitated income redistribution.  And though we disagree on the particulars, most everyone concedes it is not working.

Next week, we’ll look at the argument from the single payer advocates as to why going all in on the government is our best option.


5 × 2 =


Tim Coan, ALN’s CEO, writes an insightful and witty blog three times a week about a variety of topics relevant to independent physician practices.

Yes, I'd like to get Tim's blog.