Very much worth reading — “The $2.7 Trillion Medical Bill” by Elisabeth Rosenthal at the New York Times. It examines why health care costs so much more here than anywhere else. Basically, it’s the fault of a free market — because there are no constraints on what providers and vendors can charge, they’re all squeezing as much out of the system as they can. Other countries treat health care more like a public utility, with cost and rate regulations. But do read the article.
Also, see Paul Krugman, “We Are Not Having A Serious Discussion, Obamacare Edition”
When I was a kid in Queens, NY City, our family Doctor, Dr. Weiss, lived about 4 blocks away. His nice row-house, was also his office, and he did house calls. My parents weren’t rich, so he let them pay him for services rendered, over time.
In college, in 1978, at an audition, I met a wonderful new female friend, an actress, whose father was a Doctor. Their family home was about 6 miles away from my families, and it was also his office.
They were a little better off than my folks were, but not much. Her father was an older man, and his wife was Russian (hence, some of the attraction between their daughter and myself). He also let people pay over time.
Even back in the 90’s, my mother’s Dentist, a nice older man, and a good Dentist, let our family members pay for procedures, over time.
Know anyone who still does that?
Didn’t think so…
Know anyone whose home is also his/her office?
Yeah, but it’s rare – and getting rarer.
Or, it the Doctor’s/Dentists office in some brand-spanking new expensive medical facility, or strip mall – and their home? Well, who the hell knows where, but certainly not amongst us riff-raff.
Probably some McMansion, in a gated community.
I recently went to our local supermarket, where the Pharmacy staff is just great, to pick-up some new medication my Doctor prescribed – one for me, one for my Mom. My prescription was for a popular, relatively new, pain medication. When I went to pick it up, I was told it was $230 for a 30 day supply – and that was WITH Medicaid, which I qualified for because after my father passed away, my Mom and I were finally poor enough, so that I qualified for it. I told them to keep it. $230 is more than our monthly food budget.
My Mom’s cholesterol medication, with Medicare, cost $1.70.
Then I asked how much I would have to pay for it, and the Pharmacist told me, $60. How does anyone account for that $58.30 difference?
Why is there a $58.30 difference?
A very recent survey showed hospitals, in the same city or town, charging ten’s of thousands of dollars difference, to perform the exact same procedure.
Where do so many of wildly varying dollar figures for the exact same procedure come from?
Dr. Otto Yourass, that’s where.
In our great American “Free (anything but) Market System,” people charge what the market will bear, and then add a few digits.
We pay hundreds of dollars per month, for the same medication that people in other nations, pay in single digit sums.
We pay ten’s, if not hundred’s, of thousands of dollars difference, for the same operation.
Why?
I suspect part of it is, that after all of those years of uber-expensive education, Dr. Otto Yourass, and DDS. Louis Molar, don’t want to live near the riff-raff they serve – after all, they’re better, and more educated, than we are.
And the drug and health care companies know that we’ll pay anything to keep ourselves, and our loved ones, alive.
And that’s why they hate Obamacare – it will give people access to insurance that weren’t eligible before. It will give everyone access, regardless of prior conditions. And it will regulate pricing – instead of letting Dr. Otto Yourass pull some arbitrary number out of his rather ample kiester, and grab as much money as your wallet or purse can spare – and then some – and do a “Wallet-ectomy,” transferring money from your thin wallet, into his, the health care “providers,” bulging pockets
And this is the system, our Reich-wingers want to preserve.
Where we’re all contestants on life’s game show – “Wheel of Misfortune.”
Where we feverishly roll the wheel until Dr. Otto Yourass laughingly stops it, and Vanna says you have to pay that amount, and if you want to protest, the Doctor and Vanna will tell you, that the only consonant you’re allowed to buy, is “F,” and the only vowel, is “U.”
Which is exactly what I wanted to tell that idiotic new Tea Party Congressman, from some Midwestern state, whose entire 2010 candidacy was based on opposing, and wanting to repeal, Obamacare.
And then, when told that, as a new Congressman, he’s have wait until the next month before his US Government, “Cadillac,” health care plan kicked-in, openly bitched and moaned on the House floor about it, asking, “What happens if someone in my family gets sick, or has an accident?”
Indeed, Congressman.
Here’s my reply:
F-U!
F-U, you lying, thieving, grifter, and your whole feckin’ eedjit grifter family!
F-U!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Time magazine did a cover story on this a couple of months ago called Bitter Pill. John Stewert also interviewed the author. The article is lllloooooonnnnngggg, but well worth the read. He came to the same conclusion, hospitals and insurance companies can charge whatever they want, and so they do. There’s no rhyme nor reason why they come up with the prices they do. The simple fact is that if we don’t get ahold of these costs, we’re all going to go bankrupt either to the hospitals or the insurance companies. And Obamacare does nothing to address that. Read the Time article, it’ll motivate you to get the pitchforks and the mob organized to hang the insurance and hospital administrators in the town square.
I have been pretty lucky in the medication department so far. I take a statin, which costs nothing because my insurance company figures that the small cost of taking the statin greatly reduces the probability of some bigger problem later. I think they would probably use the same strategy for birth control pills, a modest expense produces a large reduction in liability.
But, I have had two problem medications. One suddenly, was unavailable due to inadequate production and the second went out of production. In the first case. there were only two or three companies sharing the market. One moved on to greener pastures, so there was a shortage in production. In the second case, the drug was very cheap and didn’t generate enough profit. It was too cheap and effective, so the market had no use for it and it was discontinued.
The drug companies play the game of changing a medication just so they can get a patent on it. It may or may not be an improvement over the drug it replaces, but, it is free of generic competition. So, out with the old, in with the new. If the new drug is more effective that is secondary to its ability to produce profit.
“What a revoltin’ development this is.â€
My feeling is that certain things should not be done for a profit, and health care and education are at the top of the list. I’m willing to accept the argument that a market can harness certain individuals’ desire for obscene wealth and use it for the greater good. But I think one of the basic fallacies of the libertarians is that they mistake an argument that free markets can be useful for an argument that a free market is the answer for everything. There are many other ways for human beings to interact with each other besides buying and selling.
Health care doesn’t work in the free market because you really can’t do any serious comparison shopping while having a heart attack. We go to doctors “in the health care network” who may or may not be the best in the business. But, even in a network, if something comes on you quickly, you don’t make a dozen doctor appointments to find the best doctor for that particular ailment. The health insurer would not let you. Our system will suck until we get the insurance companies out of the health care “business.”
Good article. I heard recently that the pharmacy at CostCo is the place to go for prescription meds. Best prices by far. You don’t need to be a member.
I think the free market arguments that are made are entirely too simplistic to the reality of our economic system. Does anyone believe that the free market has produced the best computer operating system, but yet, most of us are stuck with using Windows and Microsofts’ over abundance of influence. Or that we really have an influence over what type of energy we use and what we pay for it. Our infrastructure is entirely based on cars and oil and outside of some select eastern cities, you have to own one. The price of gas impacts everything, and yet the oil companies are allowed to make decisions that impact all of us, with impunity. And the people that extoll the free market explain it in terms of getting better soda because coke and Pepsi duke it out. But who cares? The things that really impact us are controlled by either monopolies or an agreement amongst major companies. The free market no longer exists, it has been replaced by neo-feudalism. Only when you were a serf in the old feudalism The Lord would protect you. These days, the lords can’t wait to take away what little the serfs have.
I want to share this on FaceBook, but can’t use your “like” button as it doesn’t open up fully for me. I hope you will share it, Barbara.
The reality is that, as I’ve said many times, a free market is *impossible* for health care. A free market is possible only when there is alternative sources of the commodity being bargained for. But what you’re bargaining for, when it comes to health care, is your *life*. And you only get one of them — you can’t buy another life if the doctors tell you, “you need to get this treatment or you’ll die.” That’s not a market, that’s a *mugging* — the health care system is holding a gun to your head telling you, “your money, or your life.”
Once upon a time doctors and drug companies didn’t take undue advantage of that gun pointed at your head. Oh, they took your money, sure enough, but they were in business to save lives, not to make themselves millionaires by pauperizing their patients. They made a good living, but they didn’t go crazy with their power over life and death. But today’s crop of doctors are in it for one thing and one thing only — getting filthy rich at the cost of their patients. And the drug companies are even worse. They’re no longer embarrassed to say “your money, or your life.” They say it with glee, and if you object, tell you “Fine, go die.”
There is no free market in muggings. Just sayin’.
I don’t do medical. Due to financial constraints I have the same accessibility to medical care that Lewis and Clark had when they were out exploring the Northwest territory. Basically its a reliance on hope.. hope that nothing goes wrong, and if it does, I’m hoping for the big one.. the trusty old myocardial infarction.
Two little stories that might be of interest….When my oldest daughter’s adult teeth came in they came in like a picket fence. my wife and I knew that we were faced with a situation that we had to deal with as responsible parents. We researched to find a good orthodontist and to find out what costs we would be facing to get her teeth straightened out. When we took her in for an assessment we were told that we didn’t have the luxury of time to begin the work or to save for the cost of the work. The cost was $4,000. At the time I had three other children, and my wife was a stay at home mom.
At he time I was a carpenter living in Florida when $7.50 was considered a top wage. I didn’t have the money to pay for the work my daughter needed, nor did I have insurance. I was in a tight spot. It might as well have been 4 million dollars because I just didn’t have it. Fortunately the Orthodontist was a human being and cared enough for my child to agree to do the work, and I would pay what I could when I could. Just a look in the eye and a handshake with the exchange of trust.
To this day I still hold gratitude to that man for his excellent work and his spirit of kindness. It’s a quality that’s very hard to find in this day in age.
My second story…When my youngest son was about to be born my wife and I decided that we could save some expense( no insurance) by going through the birthing process by use of a midwife. The idea was that a doctor oversees the pregnancy while the midwife does the prenatal exams and delivery. When my wife’s due date arrived and her water broke we went to the birthing center where they administered a pitman solution ( the pitts) to induce labor. After about 10 hours they decided to send us home and wait for her contractions to be timed to a certain rate. The next morning we returned to the hospital but instead of going to the birthing center( in the hospital) we went into a regular delivery room. Then they started wheeling in all sorts of monitors that normally don’t accompany a normal childbirth and several doctors started showing up. I sensed that something was going wrong because the midwife( an RN) seemed rattled. One of the doctors to show up was an anesthesiologist. I was introduced to him and got to shake his hand. He just walked in and walked out.. less than a minute.
The delivery was rough because my son was over 10 lbs. When I got the hospital bill there was a charge for the anesthesiologist for $300. When I questioned the charge I was told that he kindly had only billed me for one half hour when normally I should have been charged for a minimum of an hour. Just to pay for his availability should they have needed him.
Regarding the Libertarian take on this:
I remember a video that was made, as I remember, by the folks at “Reason”. A young Libertarian was arguing that medical insurance policies covered too many contingencies and that he should be able to choose the precise coverage that he needed.
During the course of my career, I worked with hundreds of people, post traumatic injury, I never had a single person that told me, “Fortunately, I knew that one day I would sustain a spinal cord injury and, as a responsible and self reliant individual, I purchased specific insurance for SCI. I saved a lot by not buying additional TBI insurance. I knew I would never need that. That’s the free market way!”
I often wonder what the Libertarian planet is like.
Swami, as you probably know already, there are basically two types of midwives. Some states allow lay midwives to practice, sometimes with restrictions, like requiring that they maintain insurance. Most midwives now are Certified Nurse Midwives. That requires a master’s degree in nursing and addition coursework and certification in midwifery. In general, they have better outcomes than obstetricians at less cost.
I often wonder what the Libertarian planet is like.
Somalia, or anything with warlords and strongmen. Feudalism. Darwin’s survival of the fittest. My experience is that the biggest fans of Libertarianism are young guys of some means. Facebook’s Zuckerberg or Whole Foods Market’s Mackey come to mind.
Sheltered, in other words.
Testosterone, too.