McCain has trotted out a warmed over Bush plan for health care. As I understand it, he wants to sprinkle some free market fairy dust on the current mess and hope for the best. I can think of at least two reasons why a market model doesn’t work very well for health care.
First, there is just no transparency. Try to do some comparison shopping as to what a given procedure will cost you. By and large, the various hospitals hold on to their pricing lists tighter than the Coke formula. I suppose this one is fixable if you really want to make hospitals post apples-to-apples pricing lists. The more serious drawback to a market approach to health care financing is that it’s a transaction you can’t really walk away from. And, to make mattes worse, sometimes there is an emergency such that you can’t even go shopping for the best price.
When is the last time McCain had to buy health insurance on the free market? I mean, he could since he left his first wife to marry into a beer fortune. But that option isn’t open to everybody. But, near as I can figure, as the son of an admiral and the grandson of an admiral, and a military man turned Congressman, he’s been covered by the military and then the Congress since forever. No wonder he doesn’t get it.
Hillary’s healthcare plan will best suit americans. We cannot keep subsidizing state and fed. paid hospitals to take care of those without insurance. We must have plans available for all but must require all to have a plan or we will continue paying for those that don’t have insurance.
http://www.dontvoteobama.net public records of why the Obama’s can’t beat McCain. We must take america back and Hillary is the only choice that will win.
I don’t trust you.
drjune,
If you keep up with politics you should know that the young supporters of Obama are not democrats.Theyre just Obama supporters. They will not vote for an ‘old lady,soap opera queen’like Hillary ( not my characterization, but it does get to the base of her persona ).These younger voters are a substantial number of voters,who would vote Democrat this time only because Obama is Democrat.
I personally hope that Obama will appoint H Clinton to work on the development of a national health care plan,or even put her in charge of it. That would be a master stroke by Obama.I do like her plan better than Obama’s. (Hers is forced 100% participation and that’s the only way any plan will work),but I am an Obama supporter overall.
You’re right not to trust Dr. June and its clones. But you know me. You know I’m not a clone.
In my mind, Healthcare ties into economic concerns just as much as the war does. And I know, from her experience, where Hillary stands on health care. Which is why I’m voting for her. To offer a $5000 tax credit for health insurance doesn’t mean squat if you can’t get health insurance.
Nice post drjune. You had me going there with your discussion of healthcare. Then I clicked on your oh-so-relevant linky and learned the relevant fact that “Barack Hussein Obama” is “of Muslim blood”.
Fuck you very much for the info.
So now I’m getting that Obama is Muslim (see above); he’s an Angry Black Christian (see Rev. Wright); and the latest, he’s a Jew — the latest one is because I’ve been told that he’s the Antichrist who, of course – according to Rev. Jerry Falwell – is Jewish.
It’s as if Obama is Abraham himself, uniting Christian, Jew, and Muslim. If I start hearing that Obama used to have a son that he killed because God told him to, I’m probably going to start praying.
Doug–
You forget that those from other-than-Obama camps like to derisively call Obama “The Messiah”.
Who knew Jesus was a former atheist, Muslim, black separatist Christian, Jew (ok, we knew that one), Marxist married to an America-hating elitist Ivy Leaguer and prone to socializing with a terrorist? And in that light, what should I make of the Hamas endorsement? I mean, I’ve heard we might not recognize the Savior were he to return and live among us, but this is ridiculous!
To get back to the topic at hand…
It is a misnomer that health care is anything different than any other kind of good found on the free market.
Despite what T will tell you, a great deal of medicine is NOT black and white. You go to the doctor with a problem, and it is not always clear what the diagnosis should be.
So the doctor does what all doctors do in the face of uncertainty. He throws technology at you.
Get an MRI. Get an EKG. etc.
Does that really make the diagnosis any more right? If so, at what cost?
And if YOU were paying for the MRI, would YOU go through with it?
For some reason, with healthcare, the cost/ benefit calculation goes out the window. The reason for that, I think, is that the insurance company is paying for it, not we ourselves directly.
As for what prices are, or that in some cases, you are in no position to negotiate, those are NOT what is driving health care costs.
I finished “Crisis of Abundance” recently, and it goes into all this stuff.
Buzzcut makes a great point here:
Most people complain about health care costs. Few take ownership of their actions that cause high costs.
So…what is the answer to the point that is made? Regardless if the healthcare costs are government paid or paid by Blue Cross, people will insist on spending tons on money to make sure they live. In either case, I pay for it.
Even if I choose to pay cash and have no collective paying for me, I still pay for the collections costs most healthcare places have to cover. How many people in any doctor’s office are there for health, and how many are there to push papers to get paid? You’re paying for all of them.
I was talking about this with one of my church memebers; how across the board pricing is for different procedures. He mentioned his wife was in the hospital for four days for flu-like symptoms and the bill was $4,000. I told him I had him beat. My wife had MOHS surgery for skin cancer. (That’s where a pathologist in on-premisis and tells you they have all the cancer cells before you leave.) We were there 15 minutes from start to finish. Total bill: $4,400.
In both cases we were lucky to have good health insurance and have to pay very little out of pocket. Also the bills were reduced by the health insurance companies.
Something has to be done to get health care under control and I think the dems are the only ones with a plan.
How much does that MRI cost?
Seems like a simple question, but it’s tough to get a straight answer. Medicaid is different than Medicare is different than Blue Cross is different than another insurer is different than cash up front is different than the sticker price. There are probably a bunch of other variables I’m not thinking of. So, it’s tough to take ownership without all the facts.
We were both talking about sticker price.
He was on medicaid and I have BC/BS. Although even BC/BS could be different if you have HMO, PPO, etc.
Doug, You also have to remember that you could call around and find the cheapest price, but then your insurance may not cover that provider.
Assuming they’d quote you a price when you called.
Do I hear an “Amen?”
We use a freestanding radiology group in Owensboro for a lot of our patients, when not an emergency. They quote a price and give breaks for cash paying patients. When my wife became pregnant and we didn’t have OB coverage on the policy (bought our own policy, the wait period before it would kick in was more in premiums than the pregnancy care would have been), we were able to get an ultrasound for several hundred dollars less than was quoted by my hospital.
The ultrasound was for bleeding. The local OB advertises “An ultrasound picture of your baby on your first visit!” I believe that would fall firmly in Buzzcut’s waste category, and I concur wholeheartedly.
Some of the technology saves money, though. Appendicitis is so potentially devastating and so important to not miss on exam, that it was said during my training that for every seven surgeries performed for that diagnosis, only one should actually have it. The other six would be false positive exams. If your physical exam wasn’t that sensitive, you were probably missing some actual cases. CT scan changed all of that. Now you do the same physical, send the same seven cases to the scanner, and the one that really has it goes under the knife. Cost of six needless surgeries vs. seven scans is how many tens of thousands of dollars? Not going under the knife when you don’t really have to? Priceless.
Newest mammography technologies–digital, breast MRI, etc– are initially more expensive but become less so, and I believe ultimately pay for themselves in less invasive surguries, less biopsies of benign masses, lives saved, etc.
There are, however, situations where society will have to decide how much a little bit of extra info is worth.
Many patients opt to not get studies that I recommend. I tell them what I’m reasonably able to know about their case from my exam, communicate clearly why I deem a test necessary, and the risks of not doing the test, and then I carefully document that it was refused. I then formulate my next-best plan, again making it clear in my documentation why that course is being taken. I could still be sued (“Doctor, couldn’t you have been more persuasive?”), but I still want to help if I can. Statistically, most of the time the next-best way will work. When it doesn’t, it might result in death. Then you hope the daughter in Phoenix who wasn’t there understands why more wasn’t done.
I’m really going to piss off T now.
Why don’t medical providers publish their rates?
Because they don’t WANT to deal directly with consumers. They WANT to deal with insurance companies.
Why did health insurance develop the way that it did? Employer provided, comprehensive insurance with very small deductibles dominate the market, and have since the mid-1950s.
Insurance evolved this way because DOCTORS wanted it to. Doctors back in the ’50s wanted to be sure that they would get paid for procedures. Employer provided comprehensice insurance does exactly that.
I’m surprised that McCain’s plan isn’t getting more positive coverage from “progressives”. By making employer provided insurance a taxable benefit, it exposes to what extent this “benefit” is nothing more than welfare for the upper middle class and rich.
Employer provided comprehensive insurance is a tax dodge! Eliminating that loophole can generate tons and tons of revenue that would allow the poor to recieve better coverage.
McCain should also propose to make Medicare a taxable benefit. We need to stop subsidizing medical care for those who can easily afford to pay for it themselves.
For what it’s worth – and I’m not sure it does anything to your point one way or another – I’m fairly certain that employer-centered health insurance is a by-product of the World War II war effort where employers couldn’t increase wages but were free to offer benefits like health insurance.
Actaully, I have heard of many GP doctors going cash-only. They only need one “helper” in the office to book appointments and take calls. Because they’re not chasing 100 insurance companies for cash, they don’t have an internal collections department.
As a result, they can charge 1/2 to 1/3 of what they were charging before since they have less overhead, and they can also spend a hour with one person on a checkup rather than doing a “fast food” approach, seeing as many people as they can in a given hour.
However, this only works in a cash upfront enviroment. How do we make the above part of either corporate or tax-funded healthcare? Does the above example work for other doctors, or just generalists?
I worked at a clinic in New Castle that was cash only. Basically, one complaint was like $38, and more than one was $49 or something like that. It was open 1-6 pm daily. I was the weekend guy. There was no shortage of patients.
I don’t really know the history of why insurance is how it is today. If doctors’ wanting to be paid was a factors, I can understand that. On the occasion that I put a lot of work into a case and find out that I didn’t get paid but actually also lost money on supplies, staff and overhead, collections, maybe another twenty bucks if the check bounced, I feel a bit less than swell.
Our office fees are given out freely over the phone if asked. I suppose we could put a menu up, but it would be a long one once you add in the various in-house testing of cholesterol, coumadin management, xrays, urinalysis, etc. We make it a point to offer all of these cheaper than any other local provider (in most cases significantly so–in fact we lose money on the xrays but are willing to do that for our own convenience not having to chase down results or wait for copies to be sent). We also offer 15% discount for cash payment at time of service.
From an insurance standpoint, many insurers base their reimbursement on some percentage of what Medicare pays. The others have their own schedules and it often doesn’t matter what price we set as they are going to pay what they feel like.
Doug, the WWII thing explains why the benefit is not taxable, not why comprehensive insurance took over the market in the 1950s.
Once again, “Crisis of Abundance”. Read it. It’s less than ten bucks at Amazon. It’s like 150 pages or something negligible. Semi-literate Buzzcut read it in a weekend. It should take a smart guy like T or Brandy 15 minutes.
You claim to not have an outstanding memory, but you remember insults from months ago. Bravo.
I’ll look into it.
I’ll look into it.
I’ve got my copy available. Book swap?
Sure. Let me look on the shelf and see what might be good.