patrick.net

This article is the fascinating story of how the city of McAllen has the highest medicare costs in the country:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?printable=true

Select excerpt:

So I asked him why McAllen’s health-care costs were so high. What he gave me was a disquisition on the theory and history of American health-care financing going back to Lyndon Johnson and the creation of Medicare, the upshot of which was: (1) Government is the problem in health care. “The people in charge of the purse strings don’t know what they’re doing.” (2) If anything, government insurance programs like Medicare don’t pay enough. “I, as an anesthesiologist, know that they pay me ten per cent of what a private insurer pays.” (3) Government programs are full of waste. “Every person in this room could easily go through the expenditures of Medicare and Medicaid and see all kinds of waste.” (4) But not in McAllen. The clinicians here, at least at Doctors Hospital at Renaissance, “are providing necessary, essential health care,” Gelman said. “We don’t invent patients.”

We all vote republican because of various issues that are important to us (right to life, limited government, protection of individual liberties, etc)

Oh I love republicans...putting "right to life" in the same sentence as "limited government and protection of individual liberties"

See a report by the California Medical Association on HMO administrative spending in California, where Blue Cross spends over 20% of every dollar on overhead (download the 2005 report or visit CMA’s website).
http://www.masscare.org/uploads/2007/05/CMAMedicalExpendituresReport05.pdf
I can’t find the 30% number at the moment. It may not be direct overhead, but rather how much more we pay than country X which has the same level of quality of health care. can anyone help?

Thanks

Bass,
Indeed. The whole lawsuit/malpractice thing is mostly a red herring used to justify high prices. See my link to the newyorker story, and read about Texas. Lawsuits are down to nothing after they limited torts (pain and suffering) to 250k/case.
But I think you can sue city hall, still. It may be a bit harder to win.

Johare,

>>You do understand that the cost of health care is double what it should be because of the blizzard of frivolous lawsuits the health care industry has had to endure for the last 25 or 30 years…right?

Now that is patently nonsense. I dare you to show any reliable source that will show that 50% of medical expenditures go to malpractise insurance and overly defensive testing-happy behavior.

I should have included this line from the New Yorker:

"Lawrence Gelman was a fifty-seven-year-old anesthesiologist with a Bill Clinton shock of white hair and a weekly local radio show tag-lined “Opinions from an Unrelenting Conservative Spirit.”

In other words, he is a Republican living off Medicare revenue who thought the government was not paying him enough., while at the same time complaining about government waste.

Par for the course, I suppose.

10%

rhvonlehe1,

How about this, from today:

My findings about the market from start to finish were of no surprise. The S&P 500 is down 32% over the past 12 months and down 31% over the past 10 years (-3.6%/yr). However, it’s the “long haul” where I’ve been promised and 8% annual return – and sure enough the returns did improve. The S&P 500 is up 100% (+4.7%/yr) over the past 15 years, up 500% (+7.4%/yr) over the past 25 years and up a staggering 5,313% (+6.9%/yr) since inception in 1950.

http://globaleconomicanalysis.blogspot.com/2009/06/long-term-buy-and-hold-is-still-bad.html

We all vote republican because of various issues that are important to us (right to life, limited government, protection of individual liberties, etc)

Oh I love republicans…putting “right to life” in the same sentence as “limited government and protection of individual liberties”

I'm guessing that you consider abortion an individual liberty, which is why you find my statement funny.

I'm not here to try to convince anyone otherwise, I'll just share a personal story. We have one 3 year old boy and we love him. We've had 4 miscarriages since then. Two of these were in the 2nd trimester. We chose to have these 2 babies delivered rather than scraped out (a DNE/DNC medically). We held them in our arms and grieved at their loss. From my perspective they had every essence of a human being, but frail and defenseless. I can only say that I will never understand how a doctor can purposely end the life of a beautiful human being at this stage or any stage of development.

I know this is a hot-button and off-topic, but I find it helps others to understand my perspective when I share this.

rhvonlehe1,
Well it seems that you care so very little about babies dying in the second trimester that you risk it by continuing to try to get pregnant over and over again.

Along with this...how would you like someone telling your wife that since she is obviously an "at risk" person for late stage miscarriages, she's no longer allowed to try to get pregnant?

Tude - thanks for the understanding comments. No, we've both gone through the battery of tests and the Perinatologist gives us 80% chance of success. The average pregnancy has a 15% chance of miscarriage.

"Along with this…how would you like someone telling your wife that since she is obviously an “at risk” person for late stage miscarriages, she’s no longer allowed to try to get pregnant?"

They don't - which is why I like my current health insurance. I don't want a bureaucrat making those kinds of decisions for me.

Right, and here’s where liberals and conservatives differ: Liberals believe that it should be YOUR choice whether or not to do it, whereas conservatives believe it should be the GOVERNMENT’S choice. We believe that if you consider abortion as “ending the life of a beautiful human being”, that you should be free to choose not to do it, and nobody should have the right to tell you otherwise.

Right. But where we also differ is when a person gains his "inalienable" rights afforded by the constitution. Liberals will claim those rights do not exist for the unborn. Conservatives will say they do. So we're at an impasse.

What I consider hypocritical is this: any case where a pregnant woman loses their child due to a violent attack, the attacker is charged with murder or manslaughter. So is it a human being or not? There's an obvious double standard.

An attack in which the woman loses a pregnant child is not a danger on the woman itself? Do you know that any loss of child from the pregnant woman could cause the woman to die as well? It is not a matter of recognizing the right of the unborn child, but the right of the woman.

I think it is ok for bureaucrat to make that kind of decision for you in terms whether your wife should receive late stage pregnancy or not, if you are NOT entirely paying yourself. Medical treatment for people who are not paying entirely cash should be based on principal of efficiency and practicality, so delivery two still borns to aid your grief is a cost to the society and others who are paying into this system. So do it fast and do it simple.

Also, for your wife, if she is clearly at risk for miscarriage at a late stage pregnancy, the insurance is obviously wrong to have us, the normal people to pay for your wife's adventure. That is pure selfishness, because that may cost me my wife's premium who have no clear history of complications. So people with an established history of complications should be allowed to pursue the risky route on their own cost ONLY.

Now as a true conservative, if you are paying entirely yourself, then nobody has any right to tell you do whatever. I am a Libertarian that believes that if people want to pursue a risky route intentionally, they should be completely responsible financially for their decisions. The current insurance policy is too loose, they should tighten up on guys who like to abuse it.

My point is, no one should have the right to tell you wife what to do with her body. If she doesn’t mind having 4 miscarriages, and continues to get pregnant over and over again, that’s her right. If I want to terminate my pregnancy I don’t think you have the right to tell me I cannot!

"They don’t - which is why I like my current health insurance. I don’t want a bureaucrat making those kinds of decisions for me."

Last I checked, private health insurance companies are run by bureaucrats.

All insurance involves rationing of some sort. It's simply not possible for everybody get all they want when if comes to health care. The question is do you want the rationing being done by a corporation who's sole motivation is profit, or who's motivation is to help the greatest number of people with the resources available.

It is his wife's right to keep getting pregnant and keep getting miscarriages or risk her life, whatever, let her be. The fact that she is knowingly doing this while under insurance is a form of abuse, because she knows insurance will pick up the bill, which will increase premium for everyone else.

So rhvonlehe1 is a phony conservative who is no different from the Democrat leeches who just want to abuse the hell of the system. His liking of his insurance is because he can abuse it to death.

Insure means guarding against potential risk. If the risk is already there, it is not insurance, it is straight cost. I guess Mr. "Conservative" Blue Collar doesn't care about this as long as he gets what he wants. Basically his "conservative principal" is, I like everything that works to my favor, and fuck the fairness principals.

Very good points, Kevin.

My only issue is comparing Switzerland, Canada, and Japan to the US relative to health care. These 3 nations do not have large populations of overweight individuals nor large numbers of foreign nationals who have entered the country illegally and who would access gov’t-provided health care with the blessing from politicians and organizations interested in votes, contributions, and funding from sympathetic sources.

In Canada and other commonwealth nations, only those who are in the country legally, and visitors such as on a visa, can access gov’t health care. This is how they are able to provide healthcare for the citizenry without it being a fiscal burden.

~Misstrial

Do illegal immigrants represent half of our population? Do you honestly believe that they account for HALF of our medical bills? No? Then why does it cost us twice as much per capita as Canada? Why nearly three times switzerland? Do you just look for any excuse to blame all of the problems that the US has on illegal immigrants? Do you believe that no illegal immigrants work for a living, pay taxes, or have their own health insurance?

We need real solutions to real problems, not scapegoating.

The longer term healing effects of homeopathy and chiropractic, naturopathy etc. are ignored these days, but will emerge as the stuff that helps people the most.

Not disputing your other comments, or "alternative" medicine in general, but do you even know what homeopathy is? It's pure bullshit, and anyone who believes in it is as naive as people who believe in the tooth fairy. It was invented by a crackpot german physician in the late 1700s.

Either he thinks we’re incredibly stupid or he really doesn’t understand the consequences of a public health plan - how it will drive private health insurers out of business.

And your point is what, exactly? Insurers offer no inherent value -- they are middlemen who's business is based on gambling. They are betting that your premiums will be worth more than any claims you might make.

Honestly, I'd rather just pay hospitals directly (which would drive down prices as a whole) than have insurance companies. Insurance makes sense when you're using it to "insure" against a catastrophe. Routine health care is not a catastrophe. Why am I paying for "insurance" for routine check ups? How does that make any sense whatsoever? That would be like paying for utility insurance.

Kevin,

your insurance plan must not be group PPO.

If you have the so-called best group PPO plan, you wouldn’t be paying $3000 at all. You also don’t need to deal with reimbursement, the insurance company deals with it all. Even when I go out of network, the doctor’s office handles that for me, billing insurance first then me.

At today’s inflated rate of around $35000 (best hospital and best doctors) for child birth, your insurance contract rate is about 30-40% of that, and the max you need to pay out of pocket will only be $1000 or so (10% co-pay for group PPO).

I recently switched from Aetna to Blue shield PPO -- and they both have the same deal. I had to pay 10% of the ~$28k insurance negotiated rate. With my daughter (born almost 2 years ago), we paid roughly the same. Neither of them seem to have a single in-network anesthesiologist.

or example, in this country, any elderly can subscribe to in-home oxygen delivery just by complaining, that cost about $1.2K a month. In other countries, you will have to be on advanced stage cancer or COPD to get that treatment, and there is an upper spending limit. There are tons of abuses in Medicare, because there is NO out-of-pocket for our seniors.

BULLSHIT. My father has been waiting 3 months for an oxygen tank (he currently rents one) on medicare, and his doctors are giving him less than 5 years to live. He was diagnosed with COPD over 2 years ago and can't go anywhere without oxygen.

Also -- just because medicare has flaws does not mean that every plan would. Look at any other wealthy country on this planet (and even most of the not-so-wealthy ones). Observe that they all have better, cheaper health care than we do. Pick a system at random and we would probably be better off under it.

Think: how does the USA compete with India and China where healthcare isnt even a glimmer?

If you want to work, you best think about what entitlements did to GM and how they could strangle the USA to the point of second world living.

OH MY GOD! If we aren't careful we might wind up with standards of living as low as that of Germany or Luxembourg! HORROR!

You do understand that the cost of health care is double what it should be because of the blizzard of frivolous lawsuits the health care industry has had to endure for the last 25 or 30 years…right?

I think its time for some Legal Reform OUTRAGE !!

Despite lawsuit settlements and malpractice insurance COMBINED representing less than 1% of all medical spending? Really? More bullshit, scare mongering crap.

HMOs want tort reform badly because it means that they can get away with sub-par care without fear of repercussion.

Insurers don't want tort reform because they've managed to scare doctors shitless about getting sued and can rip them off to no end with malpractice premiums.

Right. But where we also differ is when a person gains his “inalienable” rights afforded by the constitution. Liberals will claim those rights do not exist for the unborn. Conservatives will say they do. So we’re at an impasse.

[most of us] don't disagree on when "rights" are granted, we disagree on when "life" starts (meaningful life that is).

I don't consider a 2 month old fetus to be a human being any more than I consider the eggs my wife sheds every month to be human. My children became human beings around the time that their bodies were well developed enough to live on their own.

C) You may not trust republicans, or drug companies, but what about the doctors themselves? The American Medical Association recently came out against Obama’s plan: http://www.nytimes.com/2009/06/11/us/politics/11health.html.

The AMA is not "doctors", and you're a fool if you believe that it is. Less than 20% of physicians are even members. The AMA is a lobbying group.

That said, do you believe Real Estate agents about house prices? They're the experts after all, aren't they?

Is there ANYONE who believes that America has the best health care system in the world? Anyone? Does anyone think that our health care system is TWICE AS GOOD as the next closest competitor's?

I can't believe the number of people who are still pretending like somebody is proposing "government run" health care on this thread. Is this willful ignorance, or blatant dishonesty?

There is no doubt that America is in serious need of health care reform. But why on earth would you want that reform to model something that sucks like the system in Canada? Why shoot for mediocrity?

Kevin:
Your father shouldn't have to rent an 02 tank (concentrator/portables) on his own. He needs to have sats below 89% on room air, and medicare will pay for it. If he meets that qualification, he gets it (even with a Medicare HMO). Call another DME company and they'll help with it; Medicare pays most of the cost but there is a co-pay I believe.

Danville woman asserts that alternative medicine cures all evils and that all we need is catastrophic coverage- Bullshit! If one only practices alternative medicine, they'll surely need that catastrophic coverage. Not saying that alternatives don't work, but denying the leaps & bounds we've made in our medical care in the past century is just plain nuts. Please tell Kevin's dad that he doesn't need oxygen, but he needs some oil rubbed on him or needles stuck in him as they wheel him into the ER with respiratory failure.

I wrote some articles on hospice/end of life care on the nursing home forum. Talk about millions of dollars spent on medicare services! Some hospice care is warranted, but hospice providers have figured out how to twist the system to their advantage. They'll sign on anyone whether they need it or not, whether they benefit or not - but the hospice will benefit. I worked for a national hospice and, after showing a family around, the manager asked me if I "made the sale." As if a patient were a piece of meat. Ugh!

Our system is horribly broken. Why not try to fix it, without the help of the insurance companies? The idea of keeping private but also offering public means that insurance companies will dump every patient that costs them money - the govt will help them.

Kevin,

you need to find a doctor who knows how to work with Medicare for your dad. My FIL is completely capable of living without oxygen, has no COPD, he drives around on his own, but he got the rental completely paid for by Medicare for 5 years already. He just complained about not being able to sleep well at night and got Medicare to foot the bill.

Another friend of his has been on Medicare-paid oxygen for 12 years, looked completely healthy to me except for wheel chair bound. I guess it takes doctors that know how to manipulate the loopholes.

For my FIL's case, there is zero co-pay, everything paid for by Medicare. The oxygen company delivers the tank every 2 weeks. He often brags about how much he cost the Medicare.

Kevin,
you need to find a doctor who knows how to work with Medicare for your dad. My FIL is completely capable of living without oxygen, has no COPD, he drives around on his own, but he got the rental completely paid for by Medicare for 5 years already. He just complained about not being able to sleep well at night and got Medicare to foot the bill.
Another friend of his has been on Medicare-paid oxygen for 12 years, looked completely healthy to me except for wheel chair bound. I guess it takes doctors that know how to manipulate the loopholes.

And people wonder why we are screwed...

It is his wife’s right to keep getting pregnant and keep getting miscarriages or risk her life, whatever, let her be. The fact that she is knowingly doing this while under insurance is a form of abuse, because she knows insurance will pick up the bill, which will increase premium for everyone else.
So rhvonlehe1 is a phony conservative who is no different from the Democrat leeches who just want to abuse the hell of the system. His liking of his insurance is because he can abuse it to death.
Insure means guarding against potential risk. If the risk is already there, it is not insurance, it is straight cost. I guess Mr. “Conservative” Blue Collar doesn’t care about this as long as he gets what he wants. Basically his “conservative principal” is, I like everything that works to my favor, and fuck the fairness principals.

There will never be absolute fairness. In theory, the closest thing to that would be no insurance at all. Pay as you go. Are you suggesting that?

But you raise an interesting point. In fact, I know many employers "subsidize" if you will those who have families by paying a larger amount towards their premium. Am I going to feel bad about having 2 or 3 kids? Not likely. Is that an F.U. attitude? Perhaps to you.

I like having private insurance because I have greater degrees of freedom as a consumer. Yes, there are bean-counters who try to ration things. But this is kept in check because there is competition among insurers. If our plan gets too expensive or the coverage gets too limited, our employer can choose another one that is more cost-effective.

I disagree that we abuse insurance. Lance Armstrong had a 40% chance of survival when his cancer spread to his abdomen and brain. We probably should have denied him treatment with those odds. He definitely abused insurance, using your logic. The fact is, if you're trying to get people to stop having children or stop people from getting expensive procedures or trying to treat cancer claiming that they're soaking the system, you're in a minority.

I think we share some common ground, though. I think that former CEO from United Health (can't remember his name) who pulled in $150M over several years should be demonized. He was running a non-profit for Pete's sake. So no I'm not Polyanna thinking private insurance is perfect. I just think competition keeps prices under control better than a government-only option. And I will continue to cite the fact that we have current government obligations that are massively underfunded: social security and medicare. We should figure out how were going to pay for our current obligations before adding new ones.

Bottom line - the government cannot afford to take over health care. It has already made promises that it is not able to keep. Besides, the plan this administration had put forward still leaves millions uninsured - at huge cost. This is according to the congressional budget office:

"Enacting the proposal would result in a net increase in federal budget deficits of about $1.0 trillion over the 2010–2019 period. Once the proposal was fully implemented, about 39 million individuals would obtain coverage through the new insurance exchanges. At the same time, the number of people who had coverage through an employer would decline by about 15 million (or roughly 10 percent), and coverage from other sources would fall by about 8 million, so the net decrease in the number of people uninsured would be about 16 million. – CBO Analysis"

We do abuse insurance. In fact, I see endless amounts of commercials aimed towards senior citizens that actively promote them on TV to use their Medicare to pay for treatments and products like wheelchairs. Any senior citizen watching this will naturally say to themselves, "I better go get my free wheel chair". My father is a physician. We know plenty of doctors who design business plans entirely on the ability to deliver treatments where Medicaid pays high premiums. This is the failure of Single Payer Systems. You create a giant piggy bank of money and everyone figures out how they can defraud millions from it. As far as private insurance goes, I know plenty of people who regularly defraud it by leeching off other people's prescription plans and getting their prescriptions written in their name. The concept of 3rd party transactions is the problem altogether. It's the same reason securitization of mortgages ultimately failed. The key to quality health care is the firm establishment of the doctor patient relationship. This can only be done through freedom of choice. Healthcare is going to cost money out of everyone's pocket regardless of what system we have. If you want universal coverage, then you MUST implement a system in which the individual is fiscally responsible for how his/her money is spent. This cannot be done through price fixing. It cannot be done through full nationalization. And it cannot be done through a single payer system. Singapore has accomplished this by forcing their citizens to divert funds to a health savings account that the individual is in full control of. They have freedom of choice and if they do decide to opt for the government option, they still have to pay significant copays. The truly poor are the only ones who get free healthcare but they get it from the government only, which is still forced to compete with a private system that has delivered competitive low prices through market forces. Rather than establishing some stupid totalitarian rule over the healthcare system as nearly every other nation in this world has done, Singapore simply violates their citizen's individual freedoms by forcing them to save money. In terms of violations of civil liberties, I'm not too offended by a country that forces their citizens to save money.

? said:
Kevin,

you need to find a doctor who knows how to work with Medicare for your dad. My FIL is completely capable of living without oxygen, has no COPD, he drives around on his own, but he got the rental completely paid for by Medicare for 5 years already. He just complained about not being able to sleep well at night and got Medicare to foot the bill. Another friend of his has been on Medicare-paid oxygen for 12 years, looked completely healthy to me except for wheel chair bound. I guess it takes doctors that know how to manipulate the loopholes."
---------------------------------
My reply:
Medicare requires that a patient's Oxygen Saturation Rate (sats) are 89% or less on room air - meaning that the patient, while not on Oxygen, de-sats to a rate that is dangerous to his/her health. There is no requirement that the patient have Chronic Obstructive Pulmonary Disease (COPD) - many diagnoses can cause sats to be low enough to qualify.

It is VERY common for people to de-sat during the night, waking them up and causing their sleep to be disturbed to the point that their health is compromised. There are also diseases & disorders that manifest themselves in a condition called sleep apnea, where the patient stops breathing during the night. There are types of equipment that address this - cpap, bipap, etc. Sleep studies are now required to ensure that the equipment is sufficient to meet the patient's needs. So, merely not being able to sleep doesn't mean that someone will get Oxygen.

It doesn't matter what the doctor says, Medicare & insurance won't pay for these items unless there is independent verification of the criteria that qualifies a patient for these services. At least two providers would be lying if a patient doesn't qualify based on sats. People in wheelchairs often require oxygen because their bodies are unable to draw in enough oxygen to keep them functioning - and the disease that placed the person in the wheelchair may be lung-related. Not enough info.

There are many times that provider's payment is denied, and the equipment company doesn't get reimbursed nor are they allowed to charge the patient. They're out the money, so they're not going to risk getting payment pulled if a patient doesn't qualify. For the most part - because there are some companies out there that totally suck and shouldn't be allowed to operate.

Medicare used to pay rental for these items at a huge cost, never actually buying the equipment. But recent changes mandate that the many pieces of equipment are owned by the patient after the rental charges exceed the purchase cost. The equipment company is required to support the equipment, even if the patient owns it. Seriously - equipment companies are providing O2 portables at no cost to the patient or to Medicare, for free.

While there is some scamming going on, it's harder for equipment companies, doctors & such, to do so. FYI

theoakman - well said.

rhvonlehe1,

most professional athletes do not have commerical insurance, not your standard PPO, HMO packages. Their medical expenses come from sponsorship.

>>And your point is what, exactly? Insurers offer no inherent value — they are middlemen who’s business is based on gambling. They are betting that your premiums will be worth more than any claims you might make.

Honestly, I’d rather just pay hospitals directly (which would drive down prices as a whole) than have insurance companies. Insurance makes sense when you’re using it to “insure” against a catastrophe. Routine health care is not a catastrophe. Why am I paying for “insurance” for routine check ups? How does that make any sense whatsoever? That would be like paying for utility insurance.

Very well put, Kevn. I won't repeat the good things I've seen here. But I'd like to add that if we'd gone with a public health care system all along (back in the 1940s when that almost happened), most of us would find it absurd even to consider privatizing it.

That would be like privatizing law enforcement or fire & safety. Imagine if you needed to fill out paperwork, worry about networks, or make a co-payment just to call a cop or firefighter. And what if you had no coverage?

Health care is a primary need. It's essential to life, and should not be a profit-driven industry. There should at least be a basic public hospital system in place. If we can bail out greedy bankers or fund questionable military actions, we can fund health care.

Anyway, no matter how bad some of you may say other countries' public systems are, I don't think very many of those countries' citizens would want to switch to a system like ours. Our system, as others have mentioned, places a burden on employers and stifles independence. How many would-be entrepreneurs give up or delay their ideas because they don't want to risk losing their health coverage? How many people stay in bad jobs or marriages because of that?

How many would-be entrepreneurs give up or delay their ideas because they don’t want to risk losing their health coverage?

You can count myself, my husband, and numerous friends in that group.

I have actually put my husband on my insurance to help save the small business he works for.

At one time, we did have the #1 health care system in the entire world. It started to deteriorate when the US Government decided it should become an active player. If anyone thinks that physicians wouldn't offer full services year round at any time for half of what people pay in that year for health insurance, they are nuts. Any service that is not insured by insurance companies or the government, such as laser eye surgery, has not only become better but it's also become cheaper over the past 10 years. Not only that, if you open the newspaper, you see physicians actively advertising their prices to attract customers. The proponents of a single payer system conveniently ignore these facts. They ignore that the doctor will charge you more to stich up your forehead when you hit it than they will for performing breast implant surgery. Medicaid, Medicare, and Giant HMOs are the problem.

Btw...the ultimate solution to this problem is to stop restricting entry into the health professions fields. We have thousands of kids who go to college wanting to be doctors and they get turned away, some for good reason, others for not so good reason. Many like to argue that we need to weed out the people and can only let our nations brightest enter Medical School. To those people, I would suggest that you actually go visit a medical school and talk to them. You'll find that most of them are average people and realistically, there's nothing that distinguishes them from the majority of people in this country. If you flooded the country with new physicians, you would see prices collapse. Oh yeah, but before you even try that, you have to get the government to stop subsidizing student loans and driving up the price of school.

Oakman, I agree with your points about cheap money driving up prices. Things that are not covered by insurance don't generally see such price inflation (e.g., laser and elective surgeries). The problem with health care is with the insurance model, not with whether the government plays a role.

When insurance or cheap money (as in the case of student loans) is invoked to solve a problem, it only solves that problem in the short term (i.e., improving immediate affordability). Prices rise rapidly when people don't pay directly for things.

In any case, we still need a basic system to cover major medical issues. One that is available to all, not just those with good jobs, money, or special coverage.

Regarding ROI, do we pay more than we should for law enforcement or fire & safety services because the government is involved? I doubt whether having private contractors take over those responsibilities would improve things. I don't want the FD or the cops looking to cut corners.

Health care is not an option. We all need it. The insurance model we use to cover health care makes paying for it especially expensive for individuals and for those without insurance, a population whose ranks are growing.

OO says

For my FIL’s case, there is zero co-pay, everything paid for by Medicare. The oxygen company delivers the tank every 2 weeks. He often brags about how much he cost the Medicare.

Medicare covered everything for my parents' last year, except drugs I think.

BTW, this is a test to see if quoting now provides a quotee name and link back to the quote...

Yes, quotes now have a link above them that shows who is being quoted and from where.

You want to deal with hospitals directly? Easy.

Imagine yourself getting hit by a car, and the ambulance arrives. Before the ambulance people picked you up, they asked you for $1000, or they will not carry you. You want to negotiate? Perhaps not. Then they send you to the closest hospital, which again jacked up the price on you and demand cash payment up front before you get treated at all, even if you are dying. Want to negotiate? I think not.

What I said above is not science fiction. It happens in today's China, where patients pay directly to hospitals.

OO says

You want to deal with hospitals directly? Easy.

Imagine yourself getting hit by a car, and the ambulance arrives. Before the ambulance people picked you up, they asked you for $1000, or they will not carry you. You want to negotiate? Perhaps not. Then they send you to the closest hospital, which again jacked up the price on you and demand cash payment up front before you get treated at all, even if you are dying. Want to negotiate? I think not.

What I said above is not science fiction. It happens in today’s China, where patients pay directly to hospitals.

Kind of like armed robbery, isn't it? "Pay us whatever we demand or you die."

China seems to have a true free market for health care, and it isn't pretty. I'll take a bit more socialism with my medical care, thanks.

For those who want to see medical services advertising the price? Do you think you know what procedures are involved in treating your illness? Do you know the subtlety of going one route vs. another, the short-term and long-term implications? Without yourself being equipped to teeth in medical knowledge, you simply cannot compared price.

I would love the country to be divided in half. Half for those who want free competition in medical service, and please be my guest, back up your claims with action and don't look back. The other half stays with the price fixing and heavy government regulation. We will see which half live much longer.

I'm not a supporter of Privatized Services for Law Enforcement or Fire Safety. Health Care is entirely different. Furthermore, there is a great harm to broadly generalize the field of health care as essential. Surgery on your broken leg? Absolutely essential. Pain medication for your sore back? Not so much. Cream for the sunburn you obtained sitting out by the pool? Absolutely not! Somehow, all these things got lumped into one big ball that a lot of people like to refer to as a fundamental right. I can see the logic arguing for a fundamental right to the emergency room for treatment. I cannot, in good conscience, apply that to the life long smoker who now has Lung Cancer. The girl who sat in the tanning salon too long. The 300 pound guy who eats 6 meals a day. The distance runner who messed up his knee (that's me btw).

We don't have the option of not buying food either. We seem to do just fine and dandy without making it a fundamental right. Realistically, the service of providing basic health care should be dirt cheap. The real cost of providing health care is minute to the prices you see in the industry today. Politcians, physicians, lawyers, and HMOs are looting the public.

theoakman says

Somehow, all these things got lumped into one big ball that a lot of people like to refer to as a fundamental right. I can see the logic arguing for a fundamental right to the emergency room for treatment. I cannot, in good conscience, apply that to the life long smoker who now has Lung Cancer.

True, we should make a distinction between essential and nonessential, personal responsibility and irresponsibility in medical care. It's kind of like the housing thing, where some housing is essential, but staying in your overpriced McMansion is not essential. It was irresponsible to buy it, and the public should not have to pay.

Drawing that line is politically difficult though.

I will look at medical service the other way, how far down it is on the cost and adoption curve.

Cancer drug? Essential, but unaffordable. Nobody can really afford cancer drug if he needs to pay entirely out of pocket. Pain-reliever? Non-essential in some circumstances, but the cost is low enough that we can send everyone a free pack.

For something that is very expensive and unaffordable concerning life and death, and a constant group of people will get it, insurance (government administered or not) is necessary, or only multi-millionaires can afford it. For something that is cheap, regardless of incidence, then the payer should be responsible themselves. For something that is moderately expensive and everyone will have it one way or another, like pregnancy, government should subsidize only partially, but not pay for all.

theoakman,

Good post. I would like to see medical insurance similar to car insurance. One typically buys auto policies to protect from the costs of accidents or unexpected major repairs, but not for routine maintenance. In the same way, I would like to see health insurance cover accidents and unexpected illness, but not routine checkups, shots, childbirth, or other reasonablely expected events. And just like a car warranty requires routine maintenance like oil changes be accomplished, a health policy should require checkups to catch illnesses in the early stages. Smokers, overeaters, drug abuser, should pay higher premiums.

Insurance should be for expenses that can financially wipe people out. Prices for routine services would be less if people spent thier own money. Basic medical care is a cost of living that people should budget for. It is no different than the needs of transportation and food.