Occasionally something nudges me into doing some research. Sometimes I don't end up where I was headed. This is one of those times. I'm not even sure now what I was looking for originally, but in the process of searching, a light bulb did light up, if not the bulb I was trying to switch on.

We're all aware by now that health care costs are outrageously high. If we all had to directly pay health care providers by personal check, rather than having those costs almost disappear as deductions from our paychecks, we would ALL be screaming at the tops of our lungs. As we'll see, though, we wouldn't know who to scream at, and that is a big part of the problem.

We could analyze hospital costs, drug costs, physician costs, nursing costs, and still not understand why all those costs are high. In my lifetime, I've watched a lot of costs plummet... power tools, tires, computers, telephones, air travel, batteries, and household appliances, just to name a few, and in each case, the quality has increased dramatically over the same time. During that same time, health care quality has also increased (with a lot of exceptions), but the costs have skyrocketed. What in the hell is it about health care that makes it such an exception?

I'm going to present some powerful clues... food for thought.
I said that we don't know whom to scream at concerning health care costs, and that's the germ of a clue. There is one group of people who, for many decades, have been claiming to be knowledgeable about and concerned with health care costs, and promising they will do something about it.  Politicians.

The problem is precisely that they have been trying... and trying... and trying. Like all other "solutions" produced by government, their results have been exactly the opposite of what they intended.

As I indicated in the title, health care was once just you and your doctor, with a hospital occasionally included. Health Care has become politicized.

In the 2004 Minnesota legislature, 40 pieces of legislation  concerning health care were considered. FORTY! If you've ever read a legislative bill, you know that's a massive amount of legal language, complex enough to drive one to distraction, filled with qualifiers and exceptions... and loopholes that will require clarification, modification, and more legislation in the future. Every bill pleases some people and displeases others who will introduce contrary legislation or try to revoke the original... and it goes on and on and on.

Of those 40 bills, 13 passed and 27 didn't. Most of the 27 will be back again. The 13 bills that passed will have to be understood by all those who provide health care. They'll have to understand how it affects them, in what ways they must change their operations, and what new reporting requirements they'll be saddled with in order to be in compliance.

The seemingly simple idea of using legislation to improve something (anything) adds immense complexity to a field that is complex to begin with. Medical science is complex, unpredictable, and constantly changing. Add in political tinkering that is often misinformed, or politically biased, and very slow to change, and you've taken a complex scenario and made it damned near impossible to grasp.

One natural result has been the rise of very big corporations in health care. Only an organization with enough size to justify legal and legislative specialists can understand and respond to the complexity created by government tinkering, and that's just the beginning. An organization with that level of expert specialization can affect legislation... introduce it, lobby for and against bills, and create publicity to sway public opinion in favor of their positions... which are positions, naturally, that will further tip the playing field in their favor.

The mere fact that an issue becomes political means that bigger organizations are going to succeed at the expense of smaller ones. Money wins when politics is involved.

I noted some of the organizations formed to deal with the politicization of health care. With effort, I'm sure I could double or triple the size of the list. These organizations each push legislators toward what they want... they inform their members, publicize, investigate, and lobby, but they don't directly produce health care. They are OVERHEAD... overhead whose costs are part of the total health care complex... costs that come back to bite each of us eventually.

Care Providers of Minnesota
Minnesota Pharmacy Association
Minnesota Academy of Family Physicians
Minnesota Hospital Association
Minnesota Medical Association
Minnesota Health and Housing Alliance
EMS Regulatory Board
County Medical Societies
Minnesota Natural Health Coalition
Vaccine Awareness Minnesota
Minnesota Allergy Society
Minnesota Chapter of the American Academy of Pediatrics
Minnesota Safe Kids Coalition
Children's Hospital
Minnesota Ambulance Association
American Automobile Association
Children's Defense Fund
MinnesotaCare
Minnesota Academy of Family Physicians, the
Minnesota Dental Association
Minnesota Dietetic Association
Minnesota Milk Producers
American Accreditation Health Care Commission
Biological Education for Autism Treatments
Minnesota Academy of Family Physicians
American Academy of Pediatrics-MN Chapter
Minnesota Nurses Association
Medical Assistance program
General Assistance Medical Care program
Smoke-Free Coalition
League of Minnesota Cities
Department of Labor and Industry's Workers' Compensation Advisory Council
and the prize winner for longest name:
National Committee for Quality Assurance for the Joint Commission on Accreditation of Healthcare Organizations

As usual, Minnesota is a bit weird. Minnesota is the only state in the nation that requires HMOs to be not-for-profit. I can't tell you what effect that has, but if it were good, surely some other states would agree.

Minnesota also has a weird moratorium on hospital construction (here's your chance to read a bill). It's too complex to go into here, but in 1984, our legislature concluded that there was wasted hospital capacity... too many beds available. Most of us less well-informed folk might think that would actually be POSITIVE... but not our legislature.

Allina wanted to build a hospital in Sartell. They had to seek an exception to the moratorium. The impending presence of new competition in Sartell got the folks at St. Cloud Hospital all excited. In an explanation of why Allina should not be allowed to open a hospital in Sartell, just 6 miles from them. St. Cloud Hospital says:

The St. Cloud Medical community has grown into a regional referral center for Central Minnesota. We have created competition for the Twin Cities hospitals.

So... competing against Twin Cities hospitals is good? Well, uh, I mean... they go on to say:

Competition does not work in health care - it actually drives up costs.

Huh? I guess they mean that competition is good if you're the new kid trying to make a buck, but bad if you're already established and trying to protect your business. To be fair, I'm sure I could find similar contradictions from Allina, but they're a lot bigger, have better writers, and wouldn't be so easily detected.

As soon as politicians get involved in trying to "fix" something, complexity sets in like a never-ending plague, and it always has the effect of killing off the little guys and enabling the big ones. It always has the effect of reducing competition and raising costs. More importantly, it drags resources away from the core business and into attacking and defending through legislation. Health care isn't just health care any longer. It's an industry politically regulated and tinkered with to such an extent that the actual health treatment and care is little more than a by-product.