Health care thoughts part II

Part I was here. You really should read all the comments if this topic interests you even a little bit.

I got a response back from Benjamin who gave me permission to use his name:

I think I’m picking up what you’re putting down, and it all makes sense. I do have some counter questions though.

First question.
If the cost of healthcare is too high to provide adequate healthcare to all through a government run system, is there a way to encourage healthcare to cost less?

When I got what was left of my appendix out, it cost me roughly $12,000 (This was 1999 and so I just don’t remember exactly) but included an overnight stay, and extensive surgery to get the poison out of my belly. Five years later I broke my arm and had outpatient surgery to have two screws put in my elbow so I would regain full range of movement, which I never got back. That surgery cost me $6,000, and both times the anesthesiologist cost around 60% of the total cost.

While I understand that medical costs are high because the penalty for failure is high. If I lose and arm because it gets infected, the surgeon doesn’t get all the poison out of my belly and I die, or the anesthesia isn’t administered properly I might die. But it seems like the amount that it costs to get basic or complex medical procedures done is disproportionate to their difficulty or cost in materials. My $12k and $3k bills, as well as lesser bills over the years have made me believe there is a lot of waste involved purely by the number of people I have to pay. Burning through 14 checks to pay for a single outpatient surgery is not reasonable.

Second question.
You state that immortality or close to it will be achievable soon.
First by the rich and then later by the middle class. But what mechanism (Similar to supply and demand or some-such) is in place to drive the prices down and make it achievable?

It seems to me that in the small window of time I have been an alert adult, medical costs have only seemed to go up and not down. I’ve been paying for my own medical care for 11 years. The cost of stitches, X-rays, and CT scans has gone up, and not down. While I know that the medical field stretches far beyond emergency and trauma related care, my view point is not showing a drop in cost.

I want to try and say that race, socioeconomic status, what gender you choose to love, how much of an asshole you are, or church you attend (or don’t), won’t have any impact on the quality or duration of healthcare you receive. But it really hurts me to say that I know that I would be full of shit and wrong with every single syllable I strung together, no matter how beautifully I managed to do so. America rocks. I fucking love this place. But americans are ignorant, self centered, asshole cowards, on the whole. Fearful of what they don’t or choose not to understand.


P.S. Thanks for being informed and opinionated. I really like knowing that there are people out there who have an opinion for a reason, know how to share it, and do. I spend some time nearly every day listening to the two local conservative and an one liberal AM radio talk stations. Glenn Beck, Rush Vicodin, Randi Rhodes, Lars Larson, and whoever else sort of scare me.

My response:

Barb says she will write up something for me to post on my blog soon as well. She has a lot of experience with government run health care.

First Answer:
Basically, I don’t have any knock-out good answers.

Getting the government out of the health care business will help some. The price of drugs is probably 20 to 100 X what it would be without the FDA being involved. Just like anti-gun people only citing the costs of guns in society and not mentioning the benefits the FDA costs are seldom mentioned. Not only in the incredible expense to get a new drug to market but the number of lives lost because of the delays.

Requiring hospitals to give free health care to those that can’t pay raises the prices for everyone. All the paperwork required raises the price a bunch as well. This isn’t just the governments though. Insurance fraud has contributed a great deal as well. Insurance also raises the cost not just because of the extra documentation required but because they put a lot of pressure on providers to reduce the price and providers give them discounts of something like 40% over what an individual would pay.

A looser pays court system would help but I’m not entirely comfortable with that concept either.

Another thing that makes the comparison from 10 or 20 years ago to now difficult is that the quality isn’t the same. MRI’s weren’t available. Many of the drugs available now did not exist then. Lots of people that would have died or been permanently disabled a decade or two ago now go home and have many more healthful years left.

Second answer:

There will be lots of research, engineering, and failures going into the first efforts. Think of Microsoft Office–the first copy costs many millions, the second copy costs pennies. It won’t be that dramatic but drugs really aren’t that much different. The costs are weighted very, very heavily on the front end.

I hope Barb will be able contribute more.


6 thoughts on “Health care thoughts part II

  1. Don’t forget that a bunch of what he paid went to cover the costs of all the “free-loaders” in the system; the ones riding the ambulance 50 or 100 times a year down to get their “free” drugs and such.

  2. This is actually a fairly easy question to answer through a comparison.

    Do you have pets?

    Have you ever taken them to the vet?

    Why is it that a dog can get an x-ray for less than $100? Why does an office visit for my dog cost less than a visit from a plumber? Why can dogs get anesthetized, surgeried, bandaged, post surgery cared for etc etc etc for a fraction of the cost of humans? Are dog bodies that much less complicated than people bodies? I don’t think so.

    You can easily figure out where the costs come from in Human care simply by comparing the differences in Veterinary care.

    With veterinary care:

    1. All expenses are out of pocket. Price matters so competition comes into play. We shop around, find the vets that offer the best combination of quality of care and price that we can afford. There is incentive to be efficient and effective.

    2. How many times have you heard of a 100 million dollar malpractice suit against the vet that amputated the wrong leg on a dog?

    3. Are all vets legally required to render care for all animals regardless of ability to pay?

    There are plenty more that I’m not mentioning. The costs of adhering to federal regulations for people medicine is not inconsiderable as well.

    Some of the differences between medical care and veterinary care are not necessarily a bad thing. I’d hate to think that my wife could have just had me put down because she didn’t want to pay the doctor bill involved in my hernia surgery last year…but those things add to the cost of care.

    If we as a society insist that doctors and hospitals be required to treat those who can’t pay, we need to be prepared to absorb those expenses in one way or another. Under our current system, those expenses are absorbed by increased costs to those who CAN pay. Under Obamacare, with federally mandated caps on what can be paid, those expenses will be compensated for through rationed care for everyone…well, everyone except the “elite” like politicians, the politically connected and the very rich.

    Medicare and Medicaid are progenitors of Obamacare. Look no further than them to see how medical care will run under the new program: Payouts will be capped at well below the actual cost of the care, life-saving procedures will be considered “elective” based on age and overall health, quality of life issues will not be considered sufficient justification for treatment, etc.

    The most efficient system in the provision of any goods or services is one that is market based and subject to robust competition. Government involvement beyond simply ensuring that no one commits fraud, attains a monopoly, or otherwise gains an unethical advantage, CANNOT increase efficiency. Because the government IS a monopoly and, so, has no incentive to be efficient.

    I’m starting to ramble so I’ll stop. Once again, I’ve said in probably 1,000 words what someone else will be able to sum up in 100. In summary, our system is “broken” primarily because it is a “system” and not just a bunch of people engaging in free trade in an effort to obtain and provide a desired service. Adding more system level, governmental layers is not going to “fix it” but only break it worse…to the point where it will become basically non-functional.

  3. Dogs can’t sue. Reason number 1.

    Reason number 2; no govermental programs that pay $11 dollars for an aspirin, etc. thereby injecting artificial inflation into the delivery system.

    Reason number 3; A vet can volunteer services to a pet who can’t pay and he won’t be charged with a crime. A doctor of humans who does so, will be charged with defrauding the government if he does the same for patients who can’t, but has accepted payment of customary charges for medical service provided under any government program, such as Medicare, Medicaid, etc.

    Hope this helps.

  4. I’m not sure if you’re agreeing with me or arguing with me.

    Dogs can’t sue, but dog owners can.

    The other two points are the result of government interference in the human health care industry…which reinforces my point…that governmental influence in the human health care “system” is the problem…not the solution.

  5. On your conclusion we agree. I was just opposing your view that a valid comparison can be made to veterianism. It cannot. I can remember when doctors came to your home. Had purple tail lights on their Buicks and could park anywhere. You could also afford to pay them, until government got into the field and set up a payment schedule that screwed up everything.

  6. I disagree.

    It’s those differences…like the ones you pointed out…resulting from government interference that makes human health care more expensive than veterinary care.

    You’re points supported mine, they didn’t refute them.

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