Why our Healthcare is so Expensive

[Lord Mord]

Any society is going to give pretty good care to the people who can afford it. What kind of test is that for the quality of its ideals?

I think goodness is never the norm -- goodness is what is reached-for, while the norm is simply our conditioning. It's sort of like taking care of your kids. I hear it said sometimes that people are sick of people applauding a father who may not get on well with the mother, but nevertheless sticks around and takes a serious, considered hand in his child's raising -- that they're sick of hearing this applause because that's what you're supposed to do.

You're supposed to provide good care to the people who can afford it. Good for fucking you. What, you want a medal?

Think of it from an employment perspective. Yes, you like the drones who come in and just put in their eight hours with a half-hour break for lunch, who, yes, seem to be pretty much mostly productive in that time, and who never make a fuss or raise their voice or otherwise attract attention. They're fine. But do you have any admiration for them? They're drones. I mean, great, yeah, they're doing what they get paid to do, but will you be sorry if one quits or drops dead? I mean, it's a loss, it's no great thing, but you'll get along fine without them, in most cases, and you can replace them without too very much difficulty.

The ones you'd miss are the stand-outs. Who go above and beyond, because their mission is bigger than their job, it's bigger than the bare minimum responsibilities to get by. A problem emerges in billing, and even though Thora is in customer service, she knows exactly what the system problem is, and takes time off from a few lunches to offer an alternate billing strategy and training in a new procedure, while maintaining excellence at her own job. Nobody asked her, and it wasn't her problem. But she knew a solution, and even though it cut into her precious break-time, she made herself available and took the necessary action. That is what a good employee looks like.

Why shouldn't nations be judged on the same scale? Nations are intended to serve humanity -- humanity is the employer, our overall welfare the mission. If we just punch a clock and keep our heads down, sure, we're playing fair and being decent, but really, what good are we? So, we're not bad, so fucking what? Why shouldn't we expected to reach for something better before we give ourselves a pat on the back?

[Nymeria Sand]

Brick - the US is a capitalist society. We tend to think "profit", not the "common good". And thank god for that.

Chataya, why is putting profit over the "common good" a good thing?

[IheartTesla]

Good news everyone! Even money grubbing pharmaceutical companies want more people to be insured so that more of them can purchase their sugar coated drugs. So over the next month or so we will see ads funded by them to push through for some health care reform.

I cant stand the fact that there are two different prices for drugs for insured and uninsured people....so if the 'for profit' mantra is driving certain pharma companies to take this stand I am all for it. Hooray for capitalism!

[KazigluBey]

The ones you'd miss are the stand-outs. Who go above and beyond, because their mission is bigger than their job, it's bigger than the bare minimum responsibilities to get by. A problem emerges in billing, and even though Thora is in customer service, she knows exactly what the system problem is, and takes time off from a few lunches to offer an alternate billing strategy and training in a new procedure, while maintaining excellence at her own job. Nobody asked her, and it wasn't her problem. But she knew a solution, and even though it cut into her precious break-time, she made herself available and took the necessary action. That is what a good employee looks like.

Actually that employee would cost it's employer thousands of dollars in fines, at least in california. As soon as one "exceptional" employee starts skipping lunches for work, then all the other employees are expected to as well, and then you no longer have lunches. I remember my first job the freaking videos they showed us told us to skip our state mandated breaks and lunches so that we could help customers. Not surprisingly they were eventually drowned in lawsuits and got rid of those stupid videos, along with the managers who enforced them.

[TrueMetis]

It's really better for all, over time :) IMO.

Brick clearly has his or her own opinions, which vary. I just wanted to point out that some societies value different things, and that neither is wrong, nor better than the other. Saying that one is better than the other depends upon one's perspective.

Thousands of people dying because they can't afford healthcare is a good thing?

[Nymeria Sand]

It's really better for all, over time :) IMO.

Brick clearly has his or her own opinions, which vary. I just wanted to point out that some societies value different things, and that neither is wrong, nor better than the other. Saying that one is better than the other depends upon one's perspective.

With all due respect, I think that's a weak argument and you're avoiding the question. Why do you think it's better for all over time?

[Shryke]

Thousands of people dying because they can't afford healthcare is a good thing?

Well, it is cheaper to pay street cleaners then doctors.

[Dumas]

How about the argument that bringing down healthcare costs could boost profitability in other industries? With employers bearing such a large proportion of health insurance premiums, bringing those down could be a good thing for them.

[Annelise]

Call them and find out. They are usually quite friendly, and perhaps there has been a mistake. A thyroid test is usually a normal test for a physical exam. Unless your contract states that you get one only every other year, or something...and then they should be able to tell you that.

Hubby called them and they said in no uncertain terms that it was not a covered benefit. :/ So I guess I will go to my doctor and ask him to write a letter explaining why it was medically necessary and appeal. We actually won a previous appeal based on medical necessity after the therapist wrote a letter but then Blue Cross switched their objection to the location. That is, they went on to deny the claim anyway because the treatment was given in an office setting instead of a hospital, even though the qualifications of the therapists are the same as those that operate out of the hospital.

We saw online while looking at the thyroid stuff that they also list something the pediatrician did during the boy's annual physical as not a covered benefit, so I'm sure we'll be getting that bill ($100) soon too. May as well go ahead and call in advance I suppose, and get on with asking the pediatrician to write a letter.

If I ever snapped and went on a killing spree, it would be over a culmination of things like this I think. Which is why it's in our marital contract that hubby deals with insurance. The only time I call is when we get the $30 office visit copay bill. Even though you have to pay in the office at the time of treatment, they still send you a bill but it's a fast, mindless call so I don't mind apart that I have to be bothered in the first place.

[Annelise]

- the US is a capitalist society. We tend to think "profit", not the "common good".

Pretty often, yes, so it kinda surprised me that majority wants something done about getting coverage to those without it. Whether that sentiment survives the whole HCR storm I have no idea, but I was rather surprised to see it that high in the first place.

[Security Squish]

Where I live, UPMC (University of Pittsburgh Medical Center) owns the bulk of the hospitals in the region and is also our biggest employer. The pricing difference between them and West Penn Allegheny, the next biggest provider, is enough to make you wonder, "What the hell are they doing?" Here's an article that says UPMC was paid thousands more for bypass surgery than its competitors. And West Penn Allegheny recently filed a lawsuit against UPMC and Highmark (the largest insurance provider). It'll be interesting to see how that goes.

http://www.post-gazette.com/pg/07165/794076-28.stm

UPMC claims to be non-profit, but it usually posts $600 million in assets. They tried to make a deal with the city, which was going to strip them of non-profit status--in which they'd pay $100 million lump sum with no tax obligation in the future. No one bought that. The definition of non-profit (I'm pretty sure) is that whatever money you take in above and beyond your administrative costs has to be plowed back into the community. Or something like that.

Even the Catholic hospitals in the area have been eaten up by UPMC.

I'm with you here, there are hospitals that are true non-profits, and ones that aren't. I know I took that into account when I was looking for an employeer. Lots of shady dealings out there. Still lots of good work done too. This just illustrates the fact that we don't have a defined healthcare system, rather many small and medium ones that both compete against and help each other depending on the situation at hand. I would recomend only doing buisness with a hospital that has a platform you agree with, but unforunately that isn't always possible. Most people don;t look at hospitals at all, they really don't bother.

[Lord Mord]

KazigluBey,

Actually that employee would cost it's employer thousands of dollars in fines, at least in california. As soon as one "exceptional" employee starts skipping lunches for work, then all the other employees are expected to as well, and then you no longer have lunches. I remember my first job the freaking videos they showed us told us to skip our state mandated breaks and lunches so that we could help customers. Not surprisingly they were eventually drowned in lawsuits and got rid of those stupid videos, along with the managers who enforced them.

An interesting anecdote. I suppose I will have to craft my analogies with slightly greater care.

[Annelise]

No, really the numbers I've seen are closer to 50/50. It's not the "majority". And even among those 50% that "want something done", there's a good chunk of those who only want something done if they don't have to pay for it.

The reason that "something is being done" is because the cost curve for government-run health care programs is currently unsustainable. The government needs to "reform health care" and bend the cost curve so that Medicare doesn't go bankrupt by 2017 or start consuming every available tax dollar (along with Social Security) by 2040.

This is from Kaiser's July poll on the subject:

Specific proposals to cover the uninsured, while still supported by majorities, also show a weakening in support. For example, overall support for an employer mandate fell from 69 percent to 64 percent since last month and those who "strongly" favored the idea fell from 42 percent to 29 percent.

[...]

Roughly half (51%) of the public is willing to pay more for expanding health coverage--up ten percentage points from last month.

From effective arguments for HCR:

#Would provide financial help to get health insurance for those who need it (63%)

The others they identify are:

# Can keep own doctor or health plan (74% more likely to support reform if they heard)

# Would ensure financial health of Medicare (67%)

# Would cover pre-existing conditions (66%)

# Won’t increase budget deficit (63%)

# Would save country money over time (63%)

# Higher quality of care for Medicare patients (59%)

http://www.kff.org/kaiserpolls/pomr072309nr.cfm

[Geddon]

Thousands of people dying because they can't afford healthcare is a good thing?

Exactly. Look, it's all those pesky poor and uninsured people that are ruining the stats for the american health care system. As they all die off from lack of basic medical care the proportion of insured to uninsured rises and the US shoots up the international healthcare rankings.

The US is just in that messy period waiting for all the uninsured to die, once they're gone everything will be hunky dory. That's what is so annoying about medicaid and other "help the poor" type programs, they are just prolonging this difficult and necessary transitional period.

You'll see, in the long run everybody still alive will be better off.

[Aemon Stark]

I'm sorry to have missed this thread, but the stories about claims denied or appealed or billed and then reappealed are about as clear a demonstration of the abysmal waste in the US system as anything. Have you considered just how much dead weight costs are imposed by all those claims adjusters, actuaries, and insurance industry bureaucrats?

We don't have any of that nonsense, and *that* is where we save so much money. Public health care - in Canada and elsewhere - is most emphatically not bureaucratic in any similar way, and why anyone would want to continue putting up with that is beyond my comprehension.

[The Progressive]

The Cost Of Health Insurance Administration In California: Estimates For Insurers, Physicians, And Hospitals:

Private insurers spend 9.9 percent of revenue on administration and 8 percent on BIR. Physician offices spend 27 percent and 14 percent, and hospitals, 21 percent and 7–11 percent, respectively.

http://content.healthaffairs.org/cgi/content/full/24/6/1629

[AndyP]

Interesting article, Jaime. Thanks. I'm not persuaded that more consumer choice and free-market principle will be quite as helpful as the author thinks, but he's certainly given me something to think about.

But why not, giving people choices, works for the rest of the economy. You know if we did pay for most of our medical care out of pocket, we would have rationing. We would start rationing the incomes of doctor, clinics, hospitals, and other health care providers because most people would be unwilling or unable to pay the rates they are demanding.

Jaime L

Thanks for the article it is always more interesting when someone like this author thinks outside of the box and finds a better way.

Aemon Stark

One of the things you have to understand about the current debate in the states. None of the plans in Congress would change the way the American system works as fundamentally as this article's solution. Even if the public option where to be enacted, all that does initially is add another player. No one promises that the government insurer will behave any differently than private companies.

[TerraPrime]

We would start rationing the incomes of doctor, clinics, hospitals, and other health care providers because most people would be unwilling or unable to pay the rates they are demanding.

I think "rationing care" is just a nicer way of saying poor people not getting health care, or put another way, your health care quality will be pegged to your income level. By my own ethics and morals, this is not a desirable outcome to me. People deserve basic health care to remain healthy, imo, especially in countries where this is affordable and where the infrastructure is available.

Also, none of these cost-reduction effects that the proposed free market can allegedly deliver are out of reach using government regulations, as far as I can see. The major difference is that we don't know if the free market solution will provide these promised changes in cost structure, because as others have repeatedly pointed out, the free market model hides a lot of assumptions, such as free competition and informed customers, that we know don't apply to the issue of health care purchases. In comparison, if we simply enact regulations to exert price control at critical points, like in procedural costs or doctor's fees or cost of prescription drugs, we know we will achieve the pricing structure that can be sustained to provide basic health care for all (advanced care will still depend a bit on each family's own resources, i.e., not everyone will get to enjoy the most state-of-the-art top expert treatment (but then, we don't now, either)).

No one promises that the government insurer will behave any differently than private companies.

Promises are hard to come by.

Nevertheless, the presumption, and a reasonable one at that, is that the government as an insuring agent will behave different from the private for-profit insurance companies, because, well, they're not using this to turn profit. I think the success (success here defined as providing coverage to those who would not otherwise have health care) for Medicaid and Medicare both argue that the government insurance operates differently from private for-profit outfits.

[AndyP]

I think "rationing care" is just a nicer way of saying poor people not getting health care, or put another way, your health care quality will be pegged to your income level. By my own ethics and morals, this is not a desirable outcome to me. People deserve basic health care to remain healthy, imo, especially in countries where this is affordable and where the infrastructure is available.

Also, none of these cost-reduction effects that the proposed free market can allegedly deliver are out of reach using government regulations, as far as I can see.

The major difference is that we don't know if the free market solution will provide these promised changes in cost structure, because as others have repeatedly pointed out, the free market model hides a lot of assumptions, such as free competition and informed customers, that we know don't apply to the issue of health care purchases.

We know that they don't apply under the current health care model. I doubt that the assumption your making here would hold up under a system such as the author of the article outlines. I find your statement here about informed customers to be silly btw.

In comparison, if we simply enact regulations to exert price control at critical points, like in procedural costs or doctor's fees or cost of prescription drugs, we know we will achieve the pricing structure that can be sustained to provide basic health care for all (advanced care will still depend a bit on each family's own resources, i.e., not everyone will get to enjoy the most state-of-the-art top expert treatment (but then, we don't now, either)).

In the 1970s they thought wage and price controls were a good idea until they didn't work.

Promises are hard to come by.

Nevertheless, the presumption, and a reasonable one at that, is that the government as an insuring agent will behave different from the private for-profit insurance companies, because, well, they're not using this to turn profit. I think the success (success here defined as providing coverage to those who would not otherwise have health care) for Medicaid and Medicare both argue that the government insurance operates differently from private for-profit outfits.

In some states Blue Cross/Blue Shield operates as a not for profit and doesn't operate any differently then for profit companies. IIRC BC/BS of Michigan was a not for profit when I lived there and most people I knew said it was the worst insurance you could have.

[TerraPrime]

We know that they don't apply under the current health care model. I doubt that the assumption your making here would hold up under a system such as the author of the article outlines. I find your statement here about informed customers to be silly btw.

Well, lots of people talk pretty on paper. None of what the author of the OP said strike me as anything new or ingenuous that dozens of others who champion free market philosophy had not said before, about things ranging from steel import/export to agriculture subsidies.

In the 1970s they thought wage and price controls were a good idea until they didn't work.

Yes, and fire-fighting as private pay-to-use services was replaced by public-funded service for all citizens once people realized that some things are better handled by shared cost of risk.

Not to mention, there are plenty of examples of different forms of price control on healthcare in countries that implement universal health care. I don't see their economy suffering from an irrecoverable slump with uncontrollable inflation.

In some states Blue Cross/Blue Shield operates as a not for profit and doesn't operate any differently then for profit companies. IIRC BC/BS of Michigan was a not for profit when I lived there and most people I knew said it was the worst insurance you could have.

Yes, and I grew up in a system where universal care exists alongside private insurance. My family relied on public health care when we could not afford private care, and when our finances were better, we purchased some extra insurance for my aging parents. That system was not without flaws, but it saved my life, my father's life, my grandma's life, all without our family having to go bankrupt to provide the medical care.

So I see your anecdote from "most people [you] knew" and raise it by "my experience is different." Your call.