Tag Archives: health care costs

Health Care Costs Without The Parachute

We are going to do a real brain teaser so sharpen your imagination and thoughts.  The country has endured endless debate and ultimately a mind-blowingly large health care overhaul.  You will recall that one of the major arguments of the proponents of the health care bill passed last spring was that it was a deficit fighter.  That health care change with government takeover of virtually the entire sector was essential to bring down costs.  It was argued that only government could do this.   It was offered as a way to reduce the deficit, the total US debt and “bend the cost curve” down in the out years.  You heard those arguments if you were awake during ’08 and into ’09.  The cost savings was a central mantra of the pitch for that massive 2700 page bill that Pelosi promised we would like once it was passed and we got to see what was really in it.

Of course this summer several major companies reported the increases to their costs for the Bill.  You will remember the WH yelled back saying they were just playing politics with the issue and trying to embarrass the President.  Then quietly the WH backed off because it became evident that those companies were merely doing what was required by law and if they hadn’t they would have been in trouble with the SEC for not making a disclosure of material information regarding their financial condition.  Recently, several insurance companies have submitted applications for increases in rates.  They are now having to cover more circumstances and take greater risks than before so, surprise, surprise, it will cost more for those risks.  The Secretary of Health and Human Resources has already lashed out at these companies too, accusing them of unjustified rate increases.  I don’t know how much each company is seeking but it goes without saying that there will be an increase; they can’t cover additional risks without all of their insureds having to pay more to cover that or they go broke which probably wouldn’t do anyone any good.

How about a radical idea for a change. Neither liberal or conservative.  Imagine for a moment a world with no health insurance, none, zip, nada.  None for individuals, union members, retirees, government employees.  No, really think about it and what would happen as a consequence.

First, there would still be a demand for medical services.  People would need care.  Those doctors and hospitals and specialty clinics would need to pay their bills and feed their families.  The competition for patients would be fierce and proactive.   The costs would drop, dramatically.   Each health care provider would be very interested in market share and volume.  Those MRI’s that used to cost $2000.00 would suddenly  be going for $750.00.   Those $800.00 a night hospital rooms would be $200.00 a night.  Doctors and nurses would make less but it probably wouldn’t be nearly as dramatic.  But the surgeon who used to charge $15,000.00 for a pacemaker would now be doing it for $5000.00.   The drugs and all other medical devices would likewise drop tremendously in price, they would have to because the patients couldn’t afford them anymore at the higher costs.  It doesn’t do a health care provider any good if it has the best product on the market but no one can afford to pay for it.  The price would adjust to the level the market (patients) could afford.

The savings would be in the billions.  Don’t forget too that there would be enormous savings in the health insurance premiums we all have been paying and those paid by our employers.  That would also be in the billions every year, year in and year out.

Now the patients, us.  First, the overwhelming majority of us do pay health insurance premiums each year and so do most of our employers.  Let’s be arbitrary but within reason to assume a family of 4 would have been expending $10,000.00 per year for insurance.  Now they have that money in their own pocket to spend as they think fit for their health needs.  They will be good consumers and shoppers.  It is their money they are spending and they will use it much more wisely than any government program.  That facts are that many of them won’t have to spend that much in any given year and would be thousands of dollars ahead each year.  Those routine visits for the kids and regular flu treatments and arthritis, etc. don’t and wouldn’t cost that much for a visit.  You can bet your bottom dollar for sure that they would all ask questions  everytime the doctor ordered and MRI or Catscan.  They would want to know why and what it cost and if there was another way to find a diagnosis without it.  Or here is an idea, maybe just wait and see what happens.  The old Hippocratic doctrine of first do no harm.  There are millions of people like me who hasn’t cost his health insurance company but maybe a couple of thousand dollars over the last 40 years.  I am healthy and work at it.

For those really necessary and expensive treatments like heart transplants or cancer treatments we would pay those out over time.  The cost for them would drop because of the competition but when they were still too high the banks and other lenders would step in and make loans to be repaid over time.  The health care providers would likely jump into that lending market themselves.  Remember, everyone would be saving money each year equal to the old premium they had been paying.  Over the course of years that would a very tidy sum indeed and could cover even expensive procedures if utilized for its purpose.

Yes, there would be the need for charity.  There would still be those who are down on their luck, suffer a permanent disability or whatever circumstance prevents them from having the ability to pay.  Almost every community in America already has a charity hospital and it is paid for with local taxes.  In our community it is hundreds of millions per year and there are private charities available.  There is lots of money already spent on those in need almost everywhere.  Those taxes are already baked into the cake as it were.   We haven’t covered all the issues that would arise but the basic idea of dramatically lower cost is sound.  That most people most of the time would save thousands per year from medical premiums to cover current medical needs is obvious and so is the fact that most, most years would have thousands of dollars left over to add to next year’s savings.  You think about it.  Do we really need government intervention?  Do we really need medical insurance?   The market is efficient if left to operate.  Not only is it efficient, it is fair as opposed to government picking the winners and losers based on status or political influence.

Edison, Bell and Morse all were prolific innovators.  They advanced our industrial development in an astonishing manner.  What is of current value to remember is that they did all that without any government grants or loans.  Today, the government has its hand in everything from clean energy to stem cell research believing that only it can provide the direction for the future.  Thank God it wasn’t around when those guys were at their peak.  They would have spent all their time doing grant applications rather than inventing things that changed our nation and the world.    www.olcranky.wordpress.com

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Electronic Controls, Health Care and Military Worries.

How many times has your computer “froze up” on you?  No matter the brand or type sometimes these little electronic wizards just have a mind of their own and won’t comply with the commands you give them or if they do it takes much, much longer than you wanted or expected.  Those tiny computers that are now becoming an integral part of all auto parts is concerning.  Toyota is at the top of the list now with worries about acceleration and braking but that is only the tip of a coming avalanche.  I really don’t want to be barreling down the road at 60 miles an hour and hit the brakes to discover they don’t work or else that there is a two second time delay.  Two seconds may seem like a really short time but at that speed you are covering couple hundred feet.  In an emergency you take less than a second to hit the brake.  It is a matter of life and death.  I think it is much safer to have well calibrated mechanical devices that respond directly to your body actions.  I am sure the chances of electronic failure or quite low but the brakes getting the wrong signal at the wrong time is a horrifying thought.  They now also have those keyless electronic starter systems.  First that will inconvenient as the devil when you can’t start your car and it has to be towed in just to replace a chip or reboot a system and worse what happens when you can’t get the car to turn off?  Newer is not always better.

If any form of the health care bill currently proposed by the White House passes it will lead to some truly epic Supreme Court cases down the road.   It will dramatically call into question anew the meaning of Article One, Section Eight and the interstate commerce clause.   How does my health impact interstate commerce?  Does my health status affect interstate commerce any more than my daily use of water?  Whether I use 10 gallons a day or 100 gallons does that affect interstate commerce?   If you think it does then the EPA or some other Federal agency could have the authority to specify exactly how much I can use and ration our water use.   Health and water are important matters and can have certain regulations and laws concerning their use or abuse.  But, but, but, it has been the States that have historically been granted the right to control such matters.  This is because of the limitations of the powers of Congress in Article One and the corresponding retention of powers of the States under the Tenth Amendment.  We have no national law regarding the ownership and transfer of ownership of real property in the US.  That is a matter of State law and each State has its own laws regarding real estate.  It takes no imagination to realize how important a topic property rights are.   Does my ownership of my home affect interstate commerce?  Some would probably say it does regardless of how nebulous it may be.  If anything and everything affects interstate commerce then we no longer have a Federal system of government but a centrally controlled government and the States become mere provinces of the central government, mere administrative tools for national policy to be implemented.  That was not the intent of our Founders and I don’t believe most of us would prefer that system of government.  There is also the little problem again of the Constitution.  Article Four, Section Four requires that the US shall guarantee to every State a Republican form of government.  Total control of our economy from Washington would destroy that provision’s meaning.

The Pentagon is going through another of its internal reviews about the nature and formation of our armed forces.  The general idea is that the traditional forces are not nimble enough to meet the demands of the 21st century.  The concept is to make the forces smaller in unit size and more specialized in their method of operations.  To review the military is always a good idea.  That old saw about the military always fighting the last war is a good one with lots of truth to it.  We all tend to go with what we know and the generals and admirals know what they did when the were younger officers and will naturally bend in that methodology when faced with a new challenge.  Often the old method doesn’t comport with the new facts on the battlefield and bad results can occur.  However it is best not to throw out the baby with the bath water.  Regardless of technical and tactical changes in battlefields there will always be the danger of the large scale clash with an enemy.  I do hope the military won’t abandon completely the formation and training of the traditional forces for large land and sea battles.  We will have the need for divisions, not only brigades and we will have the need for more ships in the Navy than just aircraft carriers and their escorts.  The Chinese are rapidly building their military power on both land and sea.  Who knows where their Communist leaders will want to expand their hegemony?  Especially in a few years when the demographers predict a serious decline in their population and an aging population that will be even more demanding on their economy than ours.  Battleships for example are considered very old school.  However as recently as the Iraq War of ’92 we used the old Missouri to good effect.  Both offensively and defensively there is something very intimidating and encouraging (depending on whether you are on the receiving end or benefitting from the salvos) about those huge 16 inch guns pounding away.  We don’t have even one of those today.  Cruise missiles are great but sometimes volume is more important than pin point accuracy.  Don’t believe for one minute we have “evolved” beyond the era when an all out bare knuckle conflict is possible.  Sadly, we aren’t there yet and for the moment the US is still the best hope for a better world regardless of our shortcomings.

Of course health care premiums are going up again.  They will continue to do so until the States reform the process so that all of us become “shoppers” rather than merely users of health care.  Empowering the people to bargain for the best prices just as we do for cars or cereal will reduce prices quicker than anything.  http://www.olcranky.wordpress.com

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A Little Can Affect A Lot

I am always amused at the way some arguments are presented in political debates when one side is trying to sell their program.  The current controversy over health care costs is only the most recent example of this propensity.  One of the major arguments of those favoring a government takeover of health care insurance and health care delivery is that the costs will continue to escalate and do so exponentially until the entire economy is overwhelmed with nothing but health costs.  By definition liberals are all for change.  Change is their mantra and has been my entire life.  They have never met a situation or circumstance that they didn’t want to change.   The moss back conservatives like to take their time with change and not tinker too much and make changes in an incremental way slowly testing the waters.  The liberals like to leap right in without knowing the depth of the water but assuring everyone they know what is best because they are the elites and know better than the rest of us.  When it comes to medical costs the liberals argue that the costs will continue to increase without drastic changes and that the increases will always outpace inflation and earnings.  

Of course that argument is severely flawed.  The old adage about diminishing returns comes into play at some point and likewise the economy functions on the supply and demand concept but demand is calibrated by costs.  If someone built the most magnificient and fuel efficient car in the world and it had ever feature known to man and everyone wanted to have one it would not sell if the price was $100,000.   That price would control the demand.   If the price was projected to increase with each passing year that would not induce additional sales.  People will only pay so much for any product or service.  Forget the super rich and the totally impoverished because they won’t and never have set the bar for pricing of products and services.  It is that great sweep of the middle that drives the economic bus.   Right now I pay about $7000 a year for medical insurance for the wife and me.  I gulp with every payment but I can eke it out and I pay and frankly would pay even more if that were required for coverage.  But there is a limit.  If my  medical insurance was $17,000 a year, I wouldn’t pay.   Sure I would worry about a health issue but the bottom line is I wouldn’t pay, period.  The same analogy is true for the nation as a whole.  “We” are willing to pay only so much for health coverage.   Our betters might try to persuade us that it is in our best interest to pay more through premiums or taxes but there is a limit.  

That is probably the biggest flaw with the current proposals coming out of the House and those being discussed in the Senate–costs.  The politicians misjudge our willingness to pay.  They believe they can set the costs and then we will all fall in line like lemmings.   I trust the collective wisdom of the people.  They know that it doesn’t matter if the cost is called a tax, fee or premium, a cost is a cost.  Those costs will come out of our pockets one way or the other.  The hospitals and doctors aren’t going to close their doors if none of us had coverage.  In fact that might be the best way to go.  No insurance and start all over.  The  hospitals and doctors have to make a living.  Even though that heart surgery might normally costs $50,000 dollars under today’s insurance coverage scheme, if there were no insurance company to pay for it and you offered them $15,000 for the surgery and everyone else was in the same boat, I think you would find that many of them might accept your offer.   I offer this as a point of departure for discussion.  The costs of insurance and health care will not overwhelm the economy because we won’t pay for it at some level.  There is a limit to what each of you would pay whatever that limit is.   The costs will come to a level the people are willing to pay or else all the health care professionals will be out of work.

We can work on the little things that make such a big difference when multiplied by over 300 million people.  Mostly we need economic incentives for consumers and providers to improve care and costs.  People will respond to that much more willingly and efficiently than  they will to the lash of higher taxes.   Slight improvements can have big consequences.

During the Amercian Revolution one of the biggest problems facing the American army under Washington was something as mundane as gunpowder.  Both the quantity and quality were lacking.  A Frenchman, named Lavoisier was a famed chemist of the age and was put in charge of the munitions of France by the King in the mid 1770’s.   He had learned a lot about the subject from James Priestly (a close friend of Ben Franklin).  Lavoisier within a couple of years had greatly improved the quality of the French gunpowder.  Franklin arranged to purchase this improved gunpowder for the American war.  France was our arms dealer and sold and shipped over a 1000 tons of it to the  Colonies.  Washington was elated.  Our cannons had not been able to compete with the British, they simply couldn’t shoot as far as their cannons and the same was true with our musket, we were out-ranged.  The gunpowder made a difference, our fighting forces were more effective.  Likewise later the rifled barrel of the cannon made an enormous difference in cannons and thus battles.  During the War Between the States the Yankees had the Parrot cannon which was a much better weapon than the smooth bore cannons in the South.  Their artillery could hit a target from farther away and not be hit with counter battery fire.  Small changes, big effects.  We can and should make the necessary small changes to our medical care to have big effects down the road.   The current proposals are much more about ideology than economics or health care.  The left wants Government, Inc. to run health care so they can have one more goodie to distribute to the little people in exchange for votes and perpetual power.

The crossbow was an innovation that finally ended the era of the armored knight.  For several centuries the armored knight ruled the battle fields of Europe, but the metal tipped bolt from the crossbow could penetrate even that armor.  The knight became a target rather than a weapon on the battle field and the knights became  historical pagentary rather than an actual fighting weapon.  http://www.olcranky.wordpress.com

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Health Care Reform–Crimes, Costs and Choice

The papers and TV news are filled these days with several stories each day about the current debate and proposed legislation to expand the scope of Nanny Government into another major area of our lives with so-called health care reform.  It seems that every day one committee or another of Congress is passing or proposing or marking up a bill to completely change the health system in the US.  It would be great if they would focus on just the issue of how to reduce costs without the knee jerk reflex of the left to expand government power.   Our we getting a change in health care costs with the proposals on tap or are we getting the old bait and switch once again?

First, we were assured over and over that everyone would be able to maintain their health insurance they now had if they were satisfied with it.  That promise is as solid as the one about no one having to pay more in taxes if you earn less than $250k per year.  The Cap and Tax proposal will tax everyone that lives, breathes, watches TV, washes their clothes, drives a car or public transportation or flips the light switch, not to mention the costs of every single product we buy going up in costs.  Those products have to be shipped to us and that takes energy.  All energy will be taxed under the cap and tax system.  If you look at the House proposal you will see that you really don’t have complete freedom about how you select your health insurance.  The Government will create three levels of health insurance policies. You will be able to buy it from the private sector but only those programs chosen by the government and only at the premiums and benefits approved by the Government.  It of course remains to be seen if any of the private insurers will even want to participate in that process.  After all they are in the business of making money and contrary to the Government they can’t print money.  We WANT them to make a profit so they can pay our claims when we submit them.  If you have never had insurance you will have to participate in this three tier system; there is no option.  Likewise, if you are employed but lose your coverage due to lay off or you quit then  you also MUST participate  in the three tier program. Only those already insured can keep their existing insurance and if they ever drop that coverage they must go into the new three tier pool.   Naturally, due to aging that pool of people with private insurance will decline every passing year.  So that in a matter of a few years everyone will be forced into the three tier program.  Then of course since the Government doesn’t have to make a profit and can print inflated money the Government option will become the only one that people can afford.

There is also a mandate there everyone have health insurance coverage.  If you don’t there is a fee, fine or tax of 2.5% of gross income, that is gross, not taxable income.  You will be required to list it as a line item on your annual tax return.  If you don’t then you have filed a fraudulent tax return and that is a crime.  You may recall that was one of the reasons Hillary-Care never worked because they wanted to make it a crime if you didn’t follow the rules they were going to establish.  Here the Dems have been very clever.  They have made non-compliance with their health program criminal but without passing a specific crimianl provision.  But that tax return requirement will work just fine for them.  It will be a crime if you don’t participate and report it on your tax return.  

A whole new bureaucracy is being created to determine the best and most cost efficient methods of practicing medicine.  That is really scary.  You can be assured that the three tier health coverages required by the Government will have exclusions for any treatment that is not approved by that bureaucracy.  That will also lead to the Government being in charge of research and development for new drugs, medical procedures and medical equipment advancement.   If you are a research doctor you will have to not only satisfy your peers with new techniques and the FDA but now you will have to make an application and get clearance from the bureaucrats who are watching the cost factor and which group in society is benefitted the most.  The profit incentive will be inviscerated.  I mean the Government approved programs will be setting the fees and costs for everything and what is the reward for an individual or company do develop a new drug or procedure.   Obviously, they think that profits are nasty things.  That is until there  are none and then Government, Inc. realizes there is no one or no entity left to tax. 

I believe we do need serious revision in the way we pay for medical care.  We need to give incentives to consumers to bargain and negotiate prices with doctors and hospitals so they pay attention to all fees and costs.  Our current system has perverted the competitive factor in health care.  The new system proposed will eliminate it altogether in a matter of a few years and that can’t be a good thing.   If you are one of those who blindly believe in big government and central planning you will love the new method.  If you want choice and more freedom then the proposals will ring not the Liberty bell, but the tocsin calling in the serfs from the fields of the collective.

Is anyone surprised that the CBO said the proposal would add to the deficit?  You don’t reduce costs by spending more and even expanding coverage for those that aren’t even US citizens.  I don’t pay for a Frenchman’s health care, why am I expected to pay for a Mexican here illegally?  http://www.olcranky.wordpress.com

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Physician Heal Thyself

We have a new nominee for Surgeon General.  Her photos have now been flashed across the screens of cable TV and elsewhere.   The job of Surgeon General isn’t to actually be out there treating patients on a daily basis but to serve as an advisory for the general health policies of the nation.   Their role is to lead those efforts against diseases and conditions that affect the general health of the nation.  They also project an “image” of our nation to the world as the spokesperson for all of us on those issues.   They should serve as a role model in some form.  Those role models are not the be all and end all but they have a significant place in a modern society founded on communications.  Words and pictures communicate all kinds of messges.

Be honest, when you saw those pictures of the new nominee what was your immediate reaction?  Mine sure wasn’t of someone who is the picture of health.  That lady must be at least 75 pounds overweight.  Merely standing there without saying a word she sends the wrong message to everyone.  She is a professional and knows more than I do about the dangers of being overweight yet she carries around lots of extra heft.  Her mere presence says to the young people it is ok to be way overweight, you can still become an important person.  She is the poster child for saying that weight doesn’t matter and that it is ok to be like that and have a much higher chance of developing those debilitating diseases and conditions and others will pay all your expenses.  I think she is a terrible choice.  She is a living negative about everything wrong with modern health issues and self control and taking responsibility for your own life and well-being.  The Surgeon General doesn’t need to look like an Olympic champion but they sure shouldn’t look like that lady that sings at the end of the opera.

We have been advised in recent years repeatedly that obesity is the major cause of at least four of our deadliest and costliest medical issues: heart disease, high blood pressure, diabetes and cancer.  Those by far consume the bulk of our national health care cost.  If you reduce obesity you dramatically would reduce the incidences of those four medical conditions and the attendant treatments, medicines and hospitalizations associated with them.  We know and our common sense tells us that obesity is self imposed.   I realize that they are few medical conditions that can cause obesity but those are quite rare.  The overwhelming majority of obesity is caused by over eating.  In spite of those hundreds or thousands of diet books on the shelves at the book store and promoted on TV or radio, the issue of weight is really very simple.  It is chemistry and physics.  It is gross calories in and gross calories out.  If you consume more calories than your body uses each day then for sure you will gain weight.  That isn’t opinion but science, facts, physics and the laws of chemistry at work.  If you are taking in on average 2900 calories a day and your body’s metabolic rates and the additional exertions you make on your body are burning up on average 2000 calories a day then, yes, you will become obese at some point.   The simple solution is to stop eating so much and/or ramp up your burning of calories.   When you burn more than you consume the weight will drop.  There is nothing magic about any of that.

Why are so many of us having to pay for the self indulgence of so many others?   I know you can make the argument that if you don’t even have a car why should your tax money be spent on the highways.  But I think this issue is very different because it is a problem that is self induced and then the problem has to be paid for by others.  I think that is a quite a different kettle of fish.  My behavoir shouldn’t cost you money and likewise I don’t want to pay for your bad mistakes and choices.  When folks choose to indulge in harmful behavoir that is their right and freedom but I shouldn’t have to bear the risk attendant to that behavoir.   As those politicians ramble about health care costs I hope they will consider both incentives and downsides for those who wish to lead risky life styles.  I have enough government on my back already to carry and I don’t need a bunch of overweight folks with high blood pressure expecting me to pay for their medication.  Lose weight.  That doesn’t require any medicine or diet pills or frankly any expense.  Just eat less.

I guess before they appoint a health czar they might want to check into how that is working for Rattner.  The car czar is gone.  He came in to do Goverjnment, Inc’s dirty work and did fire lots of people at GM, hand picked new board members, ignored all shareholder rights, and strong armed the creditors into submission.  Submission is the right word. Those weren’t bargaining sessions, they were platforms to deliver threats.  After all Mr. Rattner represented the creditor,  new shareholder, regulator, labor negotiator, banker and car designer extraordinaire.   It seems he forgot some of that “luggage” from his past in his hurry to feel the rush of pure power.  I predict he will lay really low.  Let’s see if the investigation goes anywhere into his company’s dealings.  It won’t unless it is so obvious that it can’t be swept under a really big rug.

Bulgaria is the latest European nation to join the list of those that are leaning to the “right” as the US runs downhill to the left.  Those progressive folks across the P0nd are trying to send us a message but Reid, Pelosi and that guy don’t  read their mail from over there.  www.olcranky.wordpress.com

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Old Solution for Health Care

Let’s do a thought experiment today about health care.  Those experiments worked really well for Einstein and maybe we can do some good with the same approach to a quandry.   Of course the very phrase “health care” already frames the argument in favor of doing something radical because the use of that phrase implies clearly that there is a problem with our health care system and that we are not getting adequate  medical services.  That is not correct.  We don’t have a health care problem in this country we have a cost problem for medical services.  We have without a doubt the best medical care in the world.  Our research and training hospitals are the best in the world.  The standard of medical training is second to none.  The actual medical treatment we receive is superb.  Our pharmaceutical firms are the best and do the most advanced research anywhere and produce wonder drugs like Mother Nature produces rainbows.   We have excellent doctors for the most part.  I know that there are glitches in the practice.  I recognize that sometimes the doctor or hospital makes a mistake.   I have personally been witness to that in my own family.  Some of those mistakes were almost tragic and each was the result of human error and improper communication.  I don’t pretend to argue that our medical services are infallible but on the macro scale they are at the top of the chart.

Our problem is how to pay for our medical services.  They are very expensive these days.  I don’t deny that.  We expect world class medicine and regrettably we have allowed ourselves to become enmeshed in a world class explosion of medical costs because we expect miracles everything granny or our child gets sick.  When someone we love is sick it is the old “cost is no object” syndrome.    So many of us expect to live our lives without any regard to healthy habits or diets and then expect the medical profession to fix us with a pill or treatment when the body revolts against our excess.  The cost of a hospital stay can be enormous.  Those ICU days are off the chart.  The hospitals charge for every item and then their billings are incomprehensible to even an educated person.  They charge one thing then show some discount or credit and you can never ascertain what anything cost or what exactly you were being charged for.

Just imagine for a moment that tomorrow there was no health insurance for anybody for anything–not for the doctors or the hospitals or the rehab clinics  or those scooter chairs.  Nada, insurance.  What would happen?  Well, the doctors and hospitals would all still be there.  They wouldn’t disappear like a will-o-the-wisp.  They would still be in business and the doctors would need to make a living and the hospitals would have to operate at a profit or at least make enough money to break even for the non-profits.   Most doctors I believe do like to earn a good living but additionally they are devoted to their profession.  They enjoy practicing the art of healing.   It is not only money that motivates them but the passion for their work.  That is part of the classic definition after all of a profession.  Today that term has been mongrelized to the point it has lost its esteem.  A professional is someone who practices their craft because of a passion for it and coincidentally it provides them with remuneration.   That is why historically there have only been four recognized professions–doctor, lawyer, teacher and preacher.   There are no “professional” house painters.

So on that day with no insurance people would still be sick and need treatment.  Without any insurance you would take your sick child to the doctor and ask for help but you would also ask about his fees.  If he wanted $700.00 for splinting a fractured forearm but you couldn’t afford it you would ask if he could take $200.00 down and the rest over a few months.  He would probably accept that.  Likewise if you had to go to the hospital with your child you would ask about the cost of a room and every treatment they were going to perform.  You and the hospital would work out a payment arrangement.  Remember the doctors and the hospitals need you as much as you need them.  It is in both of your best interest that you work out an agreement for costs and payments.  There would be immediate competition between the doctors for your business.  They would be sensitive to what the “market” price was for their services.  Same is true with the hospitals.  They would want you to come to their facility.   They would offer cut rate deals to some.  They might even bring back the old idea of the ward for the not seriously ill to lower costs rather than the semi or private rooms that are the norm today.  We would all still be receiving treatment but the method of payment would be different and we would be paying a lot of attention to every item.   With the way our health insurance is structured today the overwhelming majority of us never even ask about cost of the doctor or the hospital.  Other than our deductible we know it is covered by the insurance and we have no incentive to haggle over costs or even keep an eye on them.  Be honest when last you and or a family member needed treatment did you even ask about any of the treatments or procedures?   Did you know in advance how much that MRI would cost?  Did you inquire if there were cheaper methods to make a diagnosis or if by waiting a while things might improve?   We watch or co pays and deductibles and that is it.  We have allowed a Rube Goldberg crazy quilt system to evolve over the last 50 years.  The government with the best of intentions has fomented this system with Medicare, Medicaid and then the push for HMOs and PPOs.  Those after all were only created under extreme government pressure to lower costs but all those programs have done nothing to create more cost.

We must go back to a system that makes each of us responsible for our own costs and to have an incentive to seek the best prices we can for our medical services.  The latest proposal is nothing more than an extension and expansion of what we already have and will  increase the cost even more.  There is nothing in the new proposal that will make each of us sensitive to costs and have a real reason for shop for best prices. 

We will discuss another day some thoughts on how to implement a medical insurance program that will enhance competition, not among the insurers so much as between the medical service providers.  That is where we need the competition and where we need to the government to stand down, not up.  We individually and as a group can make a medical market place function more efficiently than any government bureaucrat.  www.olcranky.wordpress.com

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