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