…versus universal health care. Some thoughts from (MD) Paul Hsieh:
According to a recent CNN poll, 8 out of 10 Americans are generally happy with their current health care. But they are legitimately concerned about rising costs. Furthermore, the constant media drumbeat about our health care “crisis” is making most Americans think that everybody else is having a rough time with health care (even if they themselves are doing relatively well). This fuels the false perception that we need drastic change in the form of government-managed “universal health care.” In fact, the opposite is true. If Americans are satisfied with their health care quality but unhappy with rising costs, then the proper course is free-market reforms that lower costs, preserve quality, and respect individual rights.
Americans have already been burned by the congressional rush to pass the “stimulus” bill, which many legislators now acknowledge that they didn’t even read before voting for. Congress should not make the same mistake by rushing to pass “universal health care” legislation. Instead, Congress should slow down, take a deep breath, and engage in a full, honest discussion about the kinds of genuine reforms we need to actually correct our current problems.
Yeah, like that’s gonna happen.
8 out of 10 Americans are generally happy with their current health care.
And 2 out of 10 (40 million of 300 million) don’t have health care. That group is the problem we are trying to solve.
They have health care (they can use emergency rooms, and clinics, and they can pay out of pocket for services) — they just don’t have health insurance. And many of them neither need or want it (e.g., healthy young people) — they have other priorities for their money.
The US wildly overspends on Health Care, and with some basic reforms, would go a long way towards solving this.
Give everybody medicare and add a 4% checkoff tax on earned income.
Limit the Medicare Part D to Generic Drugs.
Limit Medicare to 30 Days ICU, and 60 days hospitalization, after that you have to go to a nursing home or hospice or pay out of pocket.
Let Private Insurance pay for Patented drugs, extended ICU, Extended Hospitalization.
My Grandparents used to pay for Medi-GAP insurance,
let everyone sign up for that.
Then require any doctor who is taking Medicare to use electronic patient records compliant with VA and Require pharmacies taking medicare to use VA dispensing standards.
That allows electronic auditing, reduces errors and saves a fortune.
Also, you need to allow a doctor who makes an error that results in patient harm to be able to make a written apology within 72 hours of discovery of the error that cannot be entered into any court action for malpractice.
Most people who get hurt don’t want money they want an apology.
I have an HSA, so I saw my real bills. A simple stage 1 skin cancer cost $5,000, and a gallbladder removal (outpatient) cost $6,000. Out-of-pocket is out of reach for most people. Nor are either of those ailments easily preventable. They can happen to anybody.
Saying “they can use emergency rooms” is true, but lousy policy. In no particular order:
1) Emergency rooms are not free. The cost of running the facility is baked into everybody else’s health care.
2) Emergency rooms are the most expensive form of health care, so we (AKA “you and me”) pay more than if they had a regular doctor.
3) Certain conditions, such as diabetes, can be easily and cheaply managed. But emergency rooms aren’t set up to do that, so you get folks showing up with complications in ambulances.
4) Other conditions, for example many cancers, are stealth deseases. By the time you feel sick enough to go to an emergency room, the prognosis is grim and the follow-on treatment costly.
In short, we want everybody to have some health insurance, in order to reduce everybody’s cost.
Chris, in the first place, are those numbers supposed to be scary? $5000 is a fair chunk of change, about what your average consumer spends on his cable TV over four whole years, good gosh. But it’s nowhere near the cost of a college degree, a divorce, a five-year-old used car, or even a really nice plasma TV plus home stereo setup. And people pay for those things all the time, without a murmur.
Let’s also bear in mind that very few people get their gall bladders removed or diagnosed with skin cancer every year, too. These are once in a lifetime expenses. Do you know anyone who can’t afford a $5000 charge for a once in a lifetime medical expense? I sure don’t. And if you haven’t saved up for completely foreseeable medical expenses, I’m as unsympathetic as if you built your house in a flood plain and neglected to take out insurance.
Secondly, are you suggesting these numbers are somehow unfair, outrageously overpriced? What do you think it should cost to get your gall bladder removed, or skin cancer diagnosed and treated? What do you want to pay all those MDs and RNs who are saving your life? The same as the garbage man or the kid at McDonald’s? Or would you like to, you know, encourage the straight-A chemistry major to go into medicine instead of law, because he can earn enough to buy a nice house and a college education for his kids?
Thirdly, since you get your medical bills — like, um, everyone else I know, regardless of how it’s paid — you can see for yourself the major reason those numbers are high. Look at the difference between what the hospital charges and what they get paid by the insurance plan, or by Medicare. That difference is very often as much as 50-100%, meaning the hospital bills $5000 but actually gets $2500.
Now, the hospital can’t stay in business if they don’t actually get the money it takes to pay their employees, buy equipment, et cetera. So what they get is what it costs. But the big insurance plan, or the government, can just state arbitrarily what percentage of the bill they’re going to pay. These folks — the insurers, still less the government — don’t care if the doctor or hospital agrees or not. If they don’t; well, there are plenty of other providers. They don’t give a damn if the provider who will sign up is the one you, the patient, want. Not Their Problem.
So obviously the doctor or the hospital bills far in excess of the actual cost, because they know Medicare or your HMO are going to only pay 50% of what they bill anyway. This is the major reason you get screwed if you’re without insurance. Not because you have to pay out of pocket, but because you are paying bills that are factors of 2 and 3 larger than what insurance would pay, because of the way the system is totally rigged against the individual consumer, and in favor of large players. The costs of the uninsured have pretty much zero to do with it. That’s just a straw man put up by the big players — particularly government — to bamboozle useful idiots, such as yourself.
Your argument that ER care is unusually expensive because people don’t go in until it’s too damn late is a common talking point, but it’s exactly backwards. Generally, people who don’t get routine care or screening for chronic illnesses (such as high blood pressure, or cancer, or diabetes) run up lower total health-care bills, not higher. The reason is that they tend to simply die, which saves money.
That is, if A is poor and “can’t afford” chronic health care for his high blood pressure and diabetes, what happens is that he spends zero money on blood pressure medicine and angiograms and stents and whatnot, and then presents to the ER in 10 years with a massive coronary, which kills him. So his total lifetime cost is the ambulance trip, an hour on the table while they code him, and then a few hours in the morgue.
On the other hand if B is wealthy and takes good care of a body with much the same genetic predispositions, he spends a fortune on Lipitor and blood pressure medicines, on stents and angiograms and MRIs, and on expensive treatment for some mild heart attacks over the years, plus rehab, until finally succumbing to the fatal MI after 20 years. His lifetime expenses are enormous.
The difference, of course, is that B has enjoyed 10 more years of life than A, and almost certainly had better quality of life during many of those. So that’s why the expense is worth it to B.
This is actually pretty obvious, if you think about it. The situation of no “preventative” or chronic care is exactly what most people lived with, say, 50 years ago, when there was no such thing as Lipitor or angiograms or MRIs and whatnot, when the only treatment you got for heart disease started after the first heart attack. And, amazingly enough, healthcare was much cheaper then. It’s even cheaper in Third World Countries, where there’s no air ambulance to rush you in the middle of your stroke to the hospital, so that by the time your neighbors bring you in to the ER in their old Ford Fairlane (that they have to jump to start) you’re stone cold dead.
The argument that good non-ER “preventative” care can reduce overall expenses is a nice fantasy, but it’s just that. People have actually run the numbers on this, and proven that such care does not reduce total lifetime expenses, it just extends life and makes it better.
The problem is people are stuck thinking about medical care as if it’s like taking care of a new car, as if “changing the oil” frequently means you can avoid big repair expenses. But the analogy is flawed. To the extent people can “change the oii” it’s about lifestyle stuff, like not getting fat, not smoking, wearing your seat belt. These are the only things that put you abnormally at risk for health problems. But there’s no “changing the oil” that can prevent your mortal destiny written into your genes. If your genes say you’re going to die of heart disease, that’s what’s going to happen. No “changing the oil” will change that fact. The only thing regular care can do for you is put off the time when it happens, and that raises your total expenses, because you’ve still got to pay for the final illness (which typically sucks up 75-90% of your lifetime expenses), plus all the regular care you got before then.
You — and we as a nation — need to just face the facts, Chris. Medical care takes an increasingly large chunk of our earnings for two very simple facts: (1) we’re willing to pay almost arbitrarily large amounts of money not to die, and (2) we’re fated by our genes to die, so that we’re in the business of rolling back the tide at enormous expense.
There are two, and only two, ways to “fix” this. First, simply stop fighting. Get government health-care and ration it, so that people who given the choice themselves would spend giant amounts of money staying alive a few more months, aren’t allowed to, because it’s no longer “their” money and “we” don’t think it’s worth it. Basically roll the clock back to the 19th century, except for cheap hygiene stuff.
Second, discover some miracle that gives us eternal life for very little expense. Some amazing genetic manipulation, uploading minds to computers, cloning, whatever. I say “eternal life” here because nothing short of that will satisfy people. If you can cure cancer, all forms, at any stage, with a $50 shot, you will extend average lifespan by roughly 5-10 years (from 80 to 85 or 90). But do you think the saved money will then not be spent on health care? Ha. 90-year-olds don’t want to die any more than 70-year-olds, and people will spend just as much to not die of a stroke as they will to not die of cancer. So we will spend just as much money, just on different causes of death. The only way to prevent massive spending on avoiding death is to find a cheap way to prevent death altogether.
Carl – There’s rather a lot of stuff in your post, so let me address the high points as I see them.
1) No, $5,000 is not “too high,” nor do I want to reduce what doctors, et. al. get paid. It’s also the sum of the checks cut to the providers, not some magical “billing only” number. It’s actually dirt-cheap – a trip to the ER for the gallbladder could have doubled that in a heartbeat.
2) Actually, I had these two conditions back-to-back over two years.
3) Yes, folks do spend more then $5,000 for a car. But the average Joe gets to finance his car over 60 months. Try to get a loan for a hospital bill and see how that works.
4) The bulk of your argument is that it would be cheaper if we just let people die. D’uh. You wonder why people call libertarians “wingnuts” – that’s the answer. The whole point of civilization is to live better then we would without it.
The only people I know who call libertarians “wingnuts” are wingnuts.
Carl Pham Says :
” Do you know anyone who can’t afford a $5000 charge for a once in a lifetime medical expense? I sure don’t”
I sure do. The guy who cuts my grass. The lady who cleans my house. All those people who work at the Wal-Mart.
Anyone who is making below median income.
> And 2 out of 10 (40 million of 300 million) don’t have health care. That group is the problem we are trying to solve.
As someone else pointed out, they’re not without health care. They’re without health insurance, which is a very different thing.
A large fraction are folks between jobs. Handling their diabetes is very different from handling the diabetes of someone who is permanently out of the insurance system.
Another large fraction are folks who do perfectly well without insurance.
Note that any system that subsidizes someone must also take money from someone else. I suspect that a large fraction of the folks who are “out of the system” have figured out that they’re in the latter group.
For them, staying out of the system is a benefit, which is why the universal health care folks constantly talk about mandates and requirements.
Being that sort of person, I’ll ask – what does Gerrib want to do about folks who refuse to pay for their “universal healthcare”? Jail? Fines?