Re: Recent commentary: cutting health care costs

So.......a "single-payer" system sort of takes care of all that, doesn't it? Floors, ceilings, walls, you name it. If you're will to endorse the milk price support system (which, BTW, is based on how far the producer is from Eau Claire, WI - look it up!) you must certainly be on board with a single-payer system.

The health care cost thing all went to hell when IMHBDAO we stopped paying out of our pocket for health care and prescription drug services (save for the "emergency room" or, as it used to be called "major medical" or "catastophic coverage"). You went to the doc's office complaining of a belly-ache. You paid the receptionist $20 or $25 for the privelege of seeing the doc. (Later, this cost was rolled into your Blue Cross - Blue Shield health insurance policy - another step in the wrong direction.) The doc said "you have a gut-ache. Here's a script for some gut pills." You took the script to the pharmacist, who counted out the gut pills, and dispensed them with directions on their use. Then he/she said "that'll be 38 dollars." At that point, you either paid the $38 (and later submitted the paid invoice to your insurance carrier for "reimbursement") or you said "38 bucks - my ass! That's redonkyoulous; keep the damn pills; my gut doesn't ache 38 dollars worth!"

It was when the evil idea of having a CO-PAY sprung up - you paid $5, $10, or whatever, instead of the FULL RETAIL PRICE (free enterprise, Doctor) and your insurance company did a back-door deal with the pharmacist for a reduced price to pick up the balance of the negotiated cost....that's when the whole thing started going to hell.

People stopped being aware of how much their drugs and their doctor visits really cost. They didn't care; a small co-pay and we're on our way with the gut pills.

Then the insurance companies REALLY got into bed with the docs and big pharma, and that's when we lost the battle.

I'm certain you'll recall the WSH/WTL softball team playing at Sportsman's Park - at one of the games, I took a hard fall on my arm and it hurt like a bitch. So, after we'd had a few beers at the picnic tables next to the beer dispensary at the Park, I tooled over to Mercy Medical Center and presented myself for examination for a possible broken arm. Never had a broken bone; didn't know what it felt like; just wanna be sure. X-rays ensued (yes, my Blue Cross - Blue Shield policy covered "X-Ray and Diagnostic Procedures" - said so right on the card I had to present before being allowed to cross the Emergency Department threshhold) and the E-R doc came around a half-hour later and said "you know, your primary care physician (whose name, BTW, was....get this...Schoenbechler) is in the hospital tonight, and I've asked him to come take a look at your radiology". I said, "but doc, is my arm broken?" and he said "naw. Dr. Schoenbechler will be right with you". Old Doc Schoenbechler soon hove into view, said "your arm's not broken, you're OK....now, get outta here and make room for people who really need our help." (This was said in obvious jest, with a smile on his face.) I said "thanks, Doc....I'm outta here".

The detail of the insurance bill arrived in my West 9th Avenue mailbox several weeks later. A charge for emergency admission, which BC/BS paid. OK, fine...THAT part of the bill is over. A week later, another bill arrived....from BC/BS....this one for the PROFESSIONAL SERVICES. Both the E-R doc AND old Doc Schoenbechler had billed BC/BS for a "consultation and examination fee"....and both of those sonsabitches were about to put $150 APIECE into their pockets. I told the story to BC/BS, being a good consumer and thinking that I might help us all save a few bucks by squelching this double-billing bullshit the docs were doing...and, I'm sure you can imagine how many times I was put on hold and dead-ended trying to get the insurance company to understand that it was a scam; that they never would have had a charge from Schoenbeckler if he hadn't by complete chance happened to be in the hospital at the time I was there, blah blah blah.

In retrospect, I guess as an informed consumer I should have said to the ER doc "I call bullshit - you don't need to have old Jim Schoenbechler stick his nose into this to claim an exorbitant fee. Just tell me if my arm is broken, and if so, YOU do the appropriate treatment".

Sorry I've rambled so. But my point is, when we, the consumers, got so far removed from the ACTUAL COST of medicine, whether it be for a gut ache or mass trauma, we shifted control of the health care system from we, the people, to them, the big med and big pharma.

In your example - snow removal - we know zactly how much it costs - per hour, per "snow event", per month, per season, or whatever. If a guy in a pickup with a plow passes by our home after a huge snowfall, we can wave him over, say "how much to do the driveway", and if we don't like the response, he either lowers his price or drives on. WE have control.

Not over big med and big pharma.

Re: Recent commentary: cutting health care costs

Colonel,

Well! I'm flattered that you "rambled so." There are a couple of things to clarify.

First, this piece is quite tongue-in-cheek. Perhaps not obviously so, granted, since my libertarian leanings are not known to all and sundry. My tongue-in-cheek premise is that since health care costs go up when government-imposed price ceilings are in effect causing service shortages, perhaps health care costs would go down if government-imposed price floors were in effect and thereby cause service surpluses. I know that the ceiling/floor pricing reversal will never be implemented by the good folks in the government bureaucracies; because what's "good" for farmers isn't necessarily "good" for sick people.

My wry point is that there'd be a whole heck of a lot more health care available if price floors were implemented...but since that would never happen, there's really no point at all. What's NOT tongue-in-cheek is that price floors result in surpluses. Agricultural price supports ensure that there's no shortage of milk. That being said...

Second, I am opposed to price supports for agriculture, just as I'm opposed to all of the various forms of corporate welfare. Milk price supports did nothing to preserve the "family farm". I recall that when I was married to a farmer's daughter (you stood up for me at our wedding, remember?) how amazed I was at the number of farm auctions that there were. Government price supports don't help farmers, IMHYDAO.

Third: "a 'single-payer' system sort of takes care of all that, doesn't it?". [Shudder!] No, it doesn't. How it is that otherwise smart folks such as your good self can believe that government can effectively manage 1/6 of the economy via bureaucratic fiat is completely beyond belief. I refer you to the article written by Donald Boudreaux for the Wall Street Journal that I highlighted in one of my recent blog posts about improving the schools: http://www.thetowncrank.com/Home/tabid/153/EntryID/420/Default.aspx . In Boudreaux's op-ed he floated the idea of the government taking over grocery stores and running them like it runs public schools. We don't let government control grocery distribution for an excellent reason: it would suck at it! But health care? We have wilfully blinded ourselves to government's inaptitude for the task because health care is somehow viewed as a "right". And since most people believe that only the government can confer rights (speech, gun ownership, search & seizure...all of them), why, it's only a short step from there to believe that those "rights" can be evenly distributed, fairly administered, and endlessly augmented by the same people that have brought us the savings and loan crisis and the mortgage loan debacle.

As soon as it starts to look like government control is failing in critical areas -- which it will as surely as a dog returns to its own spew -- what do you think will happen? A bigger budget will be approved to "save" government-run health care. We will simply spend ourselves into bankruptcy that much sooner.

We already have constantly rising budgets for Medicare, Social Security, Medicaid, and interest on the national debt. It doesn't seem to register with anybody that soon ALL of the government's revenue will be spent on these items with nothing left over for defense, schools, etc. Not that the federal government should be involved with schools, but that's another hot button topic for me.

Now I'M rambling!

Your point about health care costs going into orbit when "we stopped paying out of our pocket for health care and prescription drug services" is well taken. Your illustrative examples make me shake my head in wonderment; that is, fire insurance, auto insurance, life insurance, etc., are all very cut-and-dried. It's only health insurance in all its various forms that has us making fools of ourselves. Why? Because the government figures that it can control the economic balloon animal of health care through regulation. Sure, there are laws and regulations covering those other forms of insurance; but they're not being taken over by government as health insurance is.

The Town Crank

Re: Recent commentary: cutting health care costs

Great response, Doctor, and I do indeed recall the nuptial event referenced. I was honored and flattered!

Single-payer may not be the answer. But it's "an answer" to a lot of people who, like me, have grown weary and disillusioned of the present health insurance system. I get damn good health care; my wife has a sweet health insurance policy. But the costs are skyrocketing for reasons I admit I don't fully understand.

In my "snow plow guy" example, and in my grocery store example, they're both necessary things that we have a great deal of control over - not only because we know what the cost/value is, but because there are so many other sources - in other words, if we don't like Copps prices, we can shop the Pig or any one of a dozen other big-box grocery vendors.

But health care and health insurance "shopping" is nigh on impossible. Like whole life insurance, if you actually officially apply for a policy, and get turned down, you'll NEVER be able to buy whole life without being "rated" into the stratosphere. Sort of like trying to get health care for a major medical event, without insurance coverage: you're gonna pay, and you're gonna pay for the rest of your life.

It's like a utility: take the case of electricity for your home. Even though I don't live in the city of Madison, Madison Gas and Electric is the ONLY choice I have; I pay my water bills to the Madison Metro Sewerage System; etc. If I'm unhappy with my gas/electric rates, my choice is to generate my own or continue to pay MG&E.

I guess what I think I'm thinking is that somehow, the whole enchalada of health insurance needs a great deal more REGULATION (there, I said it!) like a gas, electric, or water utility. We agree, Doctor, that the government can't "run" health insurance; even though it actually does a DAMN good job of running Medicare and Medicaid (we may differ on this). I happen to think that the government also does a good job of ADMINISTERING Social Security - it's the god-damned politicians, NOT the bureacrats, who f everything up.

Somewhere in the debate there has to be a discussion of what the insurance crooks call "pre-existing conditions", and while Obama's reforms answered that question simply by doing away with pre-existing conditions, the "mandatory purchase" part is what troubles me and a lot of others. I don't have to buy whole life insurance, or term life - I can simply set the money aside so that when I kick the bucket my wife gets a pot of money to bury me, pay off what's left on the mortgage, etc. But it's much more convenient to be able to buy stuff like mortgage insurance, etc. than whole or term life, because you don't have to "pass a physical".

The deeper you get into this quagmire, the harder it is to see the way out, and I guess what annoys me the most is the constant preaching (Rush and his ilk) that "we have the greatest health care system in the world". Perhaps, but what's screwed up so badly is this whole health INSURANCE thing.

Re: Recent commentary: cutting health care costs

Colonel,

>> In my "snow plow guy" example, and in my grocery store example, they're both necessary things that we have a great deal of control over...

>> Sort of like trying to get health care for a major medical event, without insurance coverage: you're gonna pay, and you're gonna pay for the rest of your life. <<

These two things are connected to what you said in your first message:

"The health care cost thing all went to hell when IMHBDAO we stopped paying out of our pocket for health care and prescription drug services..."

Snow plowing and groceries are "necessary things". Getting a major medical procedure performed may, indeed, be "necessary" to the continuation of one's life, but paying for it is another story. The fallacious logic piles up when we consider "necessary" snow plowing versus "necessary" surgery.

Do we have a "right" to snow plowing? Clearly, no. Do we have a "right" to food? That isn't so clearcut for some people.

Government has a hand in both, though:

1) Snow plowing of streets and roads and highways is provided as a service to residents of a city or county, paid for out of property tax revenues.

2) Food stamps are available to those who meet low income guidelines.

As you said, both snow plowing and groceries are "things that we have a great deal of control over". One big reason is that government doesn't control them -- except to the extent that government controls the level of snow plowing service provided to property tax payers or the flexibility of food stamps.

But if government did NOT provide snow plowing to tax payers or food stamps for the indigent, would our roads get plowed or would the poor be fed? Going a bit further, COULD the roads be plowed or the indigent be fed without government help? I think that you would agree that the answer is "Yes" to both questions...for the very reason that you provided: "we have a great deal of control over" them. The standard way is for some bright boy to figure out a way to make a buck from snow plowing or providing basic food to the poor. Another way is for churches and civic organizations to take up the slack.

Of course, government comes up as the "answer" more and more frequently for a variety of reasons. Sometimes the reason is that government can do the best job, hard as it is for me to admit that!

I have the example of Menasha, WI, when I consider the role that cities play as providers of public utilities. You may know something of the steam plant debacle in Menasha, Colonel. The city decided to build the plant some years back based on the projected number of commercial/industrial customers. The construction cost started to ramp up just as the cost of producing steam with natural gas heat started to go down. The number of projected commercial/industrial customers was never fully realized. The plant lost money from day one. The bonds the city issued to pay for the plant went T.U...Menasha defaulted on principal/interest payments. City was sued by bondholders. It continues to limp along paying the costs of the shutdown/default.

Anyway, my eye is permanently jaundiced when it comes to paying for health care. Your point about "the god-damned politicians" is spot on. However, what other mechanism do we have? Politics exists to allow disparate groups to co-exist without starting a shooting war. "The god-damned politicians" have the power to do what they do because we have allowed their power to do so to increase without let or limit. The Constitution is no longer a limiting factor.

Since we've allowed the politicians to influence practically every aspect of our lives, we now naturally, organically, trustingly turn to them to "solve" the problem of health care costs. Depending on who's in power between the two parties, slightly different aspects of the health care behemoth will be dealt with at any particular time. The net effect, however, will be that costs will increase without let or limit over the long haul as long as politicians are granted the power to meddle.

Your points about the deals struck between pharmaceutical companies and insurance companies are spot on, too; but those deals are made possible by collusion with government. Monopolies cannot remain monopolies without the sanction of government (don't you love words that can mean opposite things in different contexts?). Cartels of any stripe cannot maintain their hold on their industries without the implicit support of government.

So, the upshot of THIS long ramble is: get government out of as much as humanly possible. If we remember that laws are there to clean up after messes are made and NOT to prevent unsavory behavior, we'll be better off.

The Town Crank

Re: Recent commentary: cutting health care costs

As usual we agree on more than we disagree, and much of it is philosophical. You make great points about the gubbmint allowing the cozy relationships big pharma has profited from. One of my many disappointments with Obama is he continues to allow the same crooks to run the money system. I'm with your man Ron Paul: abolish the Fed.

On the snow plowing example I should have been more specific. Of course I expect my township to plow my road in a timely fashion; my taxes pay for it. But my driveway is my own domain and my own responsibility (yup, a Dane County lefty acknowledges responsibility!) and the method I employ and the amount I'm willing to pay to connect my driveway to the town road is my bailiwick alone.