Thursday, April 30, 2009

"Rationed"

I was reading a Leftish blog the other day -- he'd love to be mentioned by name -- and the auteur was whinging about universal (mandatory) health care and how the Right just didn't get it, since after all, waaah, health care is already rationed based one's insurance and ability to pay or the lack thereof.

Suuuure, you're right -- just like houses and cars are "rationed." Just like food is "rationed." Or for that matter, like insurance is "rationed:" if you can pay for it, you can have it. (In the case of employer-provided health insurance, it's actually a part of your pay).

Here's the deal: just as you are not entitled to free food, free housing, a free car or even free potable water, you are not entitled to free health care; each of those things is the result of someone else's labor and if you claim it is yours by right, you are claiming a right to enslave the people who provide it to you. Some friend of the workin' man you are!


IMO, one of the things wrong with the high price of health care is the overhead involved; an awful lot of that appears to be CYA and direct costs involved in malpractice insurance, thanks in part to a quirk of our legal system that turns physicians, hospitals and related businesses into a sort of low-risk pinata filled with money. This game requires lawyers and by the most amazing coincidence, guess what profession is best represented in the United States Congress? --Don't look to them to fix this any time soon.

Another contribution to the overhead of doctoring: the record-keeping requirements of health insurers and governments. This tends to drive doctors into large groups, where staff costs can be shared; but the groups often become medical "factories," trading personal interaction for volume. If you think handing government control over them will change matters for the better, you've never spent time dealing with the IRS or your state BMV/DMV.

Health care is not a right. Neither is efficiency. That doesn't keep fools from trying to claim they are. Or from trying to take my money to commit acts they deem good against others. Funny how they never want to dig into their own pockets, isn't it?

19 comments:

Joseph said...

Roberta,

I believe you are correct in the idea that one of the major costs is CYA...it has become a necessity because of those same lawyers you mentioned. I'd like to point out, too, that insurance companies have a lot of input, and these companies are for profit entities. I sometimes wonder if anyone knows what the actual cost of a procedure is anymore.

Kelly said...

Yes, health insurance is a mess. But I still believe in the power of the consumer to change things by making a stand, in numbers great enough to matter to a company, and saying, "This is unacceptable." And I don't believe handing the system to the government is the answer. That's like saying, "It doesn't matter if I leave you here to bleed to death or go ahead and strangle you... you're going to end up dead either way."

My husband is a disabled Marine. My goal is to get us to a point financially where we can afford for him not to need VA treatment. I say that and people remind me that he deserves to be cared for without cost to us. I know that. I know what his sacrifices were, and not just the physical ones. I also know he deserves to get decent medical treatment... not just have papers pushed around and doctors incorrectly address everything other than the biggest problem. (His legs are messed up, and a doctor did nothing to get him in with orthopedics for over a year, but kept prescribing him allergy medicine because his "headaches were probably caused by allergies". There was no evidence of that, and even though we expressed reasonable concern about his blood sugar and a family history of diabetes, his blood sugar was not tested. Guess what? The headaches were being caused by slight blood sugar issues... not allergies.)

I've done my time being a Medicaid patient, and that was hell. I didn't like knowing someone else was paying my medical bills, but I figured my choices (at that point in my life) were to accept it for the time and get myself together so I could take control of my own life, or don't accept it and just watch things get worse. Things got worse anyway. Because of the restrictions that are in place on Medicaid spending, my health was going downhill and no one knew why. Tests that could have identified problems early on, treatments that could have reversed things, were not covered by Medicaid and went undone. The end result? I now have a nuerological illness that has the same effects as a brain tumor, except with no tumor being present. The effects are caused by the fluid in my skull suffocating my brain. I went to doctor after doctor with symptom after symptom for several years. The warning signs went undiagnosed and untreated because Medicaid wouldn't approve what doctors wanted to look at.

Just like they won't pay for someone to see the dentist, but they will pay thousands of dollars for the treatment of conditions that could have been prevented through regular dental check-ups. That is irresponsible on several levels.

Talk to people who have been on Medicaid, or been "treated" by the VA, and you'll see these are not isolated things... this is the norm. People who think the government will do better than private health insurance are ignorant fools. And if they know the government won't do better, why do they want the government to do it at all? That just makes no sense.

Roberta X said...

Kelly, that is one of the most heart-rending indictments of the failings of government-run health care I have read.

Thank you.

Robb Allen said...

As a former Marine, let me tell you that military health care (as close to what the lefties want) is about as horrific as it gets. You can't have a doctor that knows you and your history, you get a random one from a pool of officers. Never the same doc twice.

Another problem with our health care system is employment being so closely tied to insurance. Because my employer takes money he would normally put in my paycheck and spends it on health care, I have no say so in which plans I can take part in. Oh, I get to choose from a few options, but not my provider.

And since my employer gets to choose provider, they're going to go for the cheapest thing they can find, which doesn't necessarily equate to what I or my family need.

If employers would stop 'providing' benefits, people would pay for their own, be able to better customize their plans, and insurance companies would have to become even more competitive.

Another problem is that we don't have health insurance, we have health insulation. When you break a window in your house, you don't use your home owner's insurance to pay for it. When you get a cold, you shouldn't use insurance to pay for a doctor's visit. When it's only $10 out of your pocket, you'll end up going for every little sniffle and scratch. Which takes up more of the doctor's time, causing him to have to raise his price in order to try to limit the number of patients he sees. Which the insurance covers. Which cause rates to go up. Ad naseum.

Kelly, tell your husband thanks, from another Marine. I 'lucked' out in my 8 years, never being deployed, and I have nothing but the greatest respect for my fellow Marines who have given everything they have. Semper Fi.

Rob K said...

The worst thing that ever happened to health care was the tax exemption for employer provided health care benefits. Getting rid of that would be a good first step in fixing whatever anyone thinks is wrong with it.

Lorimor said...

I work in VA facilities and privately run hospitals on a routine basis. The difference between the two is night and day.

And having spent six years in the Navy and witnessing first hand the incompetence of state sponsored "free" healthcare, you can have it.

Back to Roberta's points. Yes, there is MUCH defensive medicine practiced nowadays. I see the darndest cases come in for MR and CAT scans. Totally ridiculous but the Docs are in full blown CYA mode.

Paperwork. My wife is an RN in a nursing home. The overwhelming majority of her work consists of doing paperwork no one will use or even look at, naturally all mandated by the Feds and their zeal for documentation.

P.J. O'Rourke got it right. "If you think healthcare is expensive now, just wait until it's free."

Idiot Left.

Best o' luck to you and your hubby Kelly!!

og said...

why reach into their own pockets when the .gov already has a vacuum attached to yours?.

I'll gladly reach into my pocket to help a serviceman. I dislike anyone else there.

Blackwing1 said...

Your phrasing, "...just as you are not entitled to free food, free housing a free car or even free potable water, you are not entitled to free health care; each of those things is the result of someone else's labor and if you claim it is yours by right, you are claiming a right to enslave the people who provide it to you." is one of the most concise refutations of the collectivist mentality I've seen in a long time.

Nicely written.

Turk Turon said...

Speaking of “rationing”...

I seem to recall seeing a TV report some years ago – maybe “60 Minutes”, maybe not – in which the reporter described how the American Medical Association (AMA) instructed medical school admissions offices about how many first-year medical students they should admit for the upcoming academic year. The AMA claimed that the purpose was beneficial to the public: to make sure that there was an adequate supply of doctors. But the reporter took a “consumer-advocate” view. He claimed that the AMA was mostly interested in limiting the supply of doctors in order to keep demand high, and medical fees high.

There are lots of areas in the U.S. where there are doctor shortages (mostly rural areas) and lots of areas with too many doctors (big cities), and if anything, doctor's fees are lower in rural areas than in urban areas, but I wonder if there are “side-effects” to limiting the supply of doctors, if that is indeed what is happening.

For one thing, it would raise the fees of both rural and urban doctors, so the fact that urban doctors have higher fees than rural ones doesn't mean that there is a healthy “market” for physicians.

For another, it would tend to line the pockets of doctors, as a class, and make them more inviting targets for lawsuits. So the doctors pay more and more for malpractice insurance; the insurance companies know the doctors can afford it – the AMA has seen to that! The doctors add the cost of their insurance to their fees.

There are lots of other things wrong with health care in the U.S.: incompetent doctors kept in business by clubby or ineffective state licensing boards that seem bound and determined to keep doctors seeing patients unless they are so profoundly dangerous that even the press begins to sit up and take notice. Extravagant and shocking malpractice settlements produced by “venue shopping” - lawyers like to find clever ways to have their suits moved to states (I think Mississippi or Alabama) where there are no limits on medical awards.

I think the answer lies in a free-er, more competitive market. I have heard nothing but bad things about Medicare and Veteran's Administration treatment. My own experience with an HMO, years ago, gave me no reassurance.

P.J. O'Rourke was right!

Aaron said...

Never dealt with Medicaid, but I know first hand why the VA's tales of incompetence and neglect are legendary.

Has there ever been a case of the government doing a better job than private industry?

Asphyxiated Emancipation said...

Again and again, I hear calls from the left for "free", government run health care. I can't wrap my head around it. We should turn over our health care system to the people who lost money running a whorehouse?

Ulysses said...

My father is a doctor, and has be for over 40 years.

He lamented to me just last week that he can no longer afford to retire.

Between the costs of insurance (over 50% of his gross income) and the added costs of paperwork (he has a staff member whose only job is to fill out insurance forms at $4000+/month) he is buried in work and expenses which in no way assist him in his primary goal of treating his patients.

To add injury to insult, the state of Illinois has stopped paying their medicare bills for over a year now.

Many doctors are now finding themselves at the break-even point, and in some specialties (such as OB/GYN) the cost of insurance and paperwork has reached a level where doctors are losing money. You will only find these specialists working at hospitals now, where the hospital can spread the cost out, and where they can require that interns and residents fill these positions as part of their training.

Potential medical students are not stupid people (one would hope) and they can see the writing on the wall. There is a reason that enrollment is down and it is becoming hard to find a primary care physician. Who wants to enter a field that requires 12+ years of higher education, hundreds of thousands of dollars in student loan debts, high stress, long hours, and the certainty that you will be sued repeatedly each year, if you won't receive adequate compensatation.

Socialized medicine will only accelerate this trend, as medicine will become a minimum-wage government position. Just look at Canada and England where a trip to the doctor is the rough equivalent of a trip to the DMV, only with your life in the balance.

TJP said...

Well, at least someone on the economic left is acknowledging the existence of market forces and rationing. Everything is rationed, but there's a difference between a bureaucrat dictating the choices and a market participant making her own. The market participant has the best chance of knowing what exactly is needed, and the bureaucrat is ruining it by propping up market failures.

The argument over insurance neglects the fact that there still exist many types of coverage, and many ways to deal with the costs. Where I work, you either take the damn $13,000-a-year HMO plan, or you work somewhere else. That's outrageous. If I had put those premiums in a MSA, I would have been able to pay all my medical bills for the last decade and also buy a small house.

I wish people would stop using health insurance to enforce their particular brand of "behavioral economics" on me. I don't need an insurance plan to cover office visits, Codgerall pills, or sex change operations. Most deductibles are actually affordable. What happens between me and my dentist should be a private business transaction.

James said...

I work in dialysis and that therapy is already under government universal health care. While some get their treatment paid for by private insurance, everyone ends up on Medicare/Medicaid eventually. No one is ineligible, all can qualify. Now the reimbursement does not cover the cost of treatment to the provider, but no one can refuse a patient if you take any government money.
You have to pass state inspection to qualify for M/M money and this give the inspectors incredible power, along with such national groups as JACHO and AAMI. One of our units was fined and cited because the inspectors decided that the trashcans were too big (42 gallon) and had to be immediately replaced with containers no bigger than 32 gallons. This is only a small example of the unnecessary nonsense we are burdened with. The bureaucrats must find new problems on a regular basis to justify their jobs. The money for the time and unnecessary equipment come out of our operating budget and patient care gets the short shrift.
The more the government gets involved in health care the worse the nightmare gets.

karrde said...

This blogger has opined long about medical practice from the MD-side of the field.

(See this entry, as well as this series.)

Most of his comments about Medicare are duplicated here by others, as well as his long complaint that the average insurance company will find several ways to trim costs by claiming that certain pieces of additional work aren't part of the "usual package" for that disease, and so won't be paid for.

staghounds said...

When the people who sell a commodity or service decide how much of it you need, the answer is

ALL OF IT.

And if we can find more to sell you, that too.


The medicine sellers have created a situation where no one is legally permitted to compete, and where their own "ethics" forbid giving any but the maximum amount of the service they provide.

"Health care as a right" means bankruptcy, as it will eventually swallow everything else.

"Housing, food, and a little pocket money as a right" are doing fine already

Transmission repair as a right would, too, it would just take longer for platinum and diamond transmissions to be essential in every 1979 Chevy Nova.

Joseph said...

In reference to what Kelly said...

Medicare indeed does not cover dental. My gf, on disability (due to lupus, diabetes, RA) is on Medicare. I ponied up $2k to pay for dental work for her...no choice, she was in agony. Fortunetly, I had the credit to get the loan. But it would be really nice if people with common sense would look at these programs, people in business and not in politics.
By the way, paying in cash for care usually is a lot more expensive than it is with insurance. My gf found a dentist who was kind enough to charge insurance rates for the work.

Rick R said...

I read that more and more Doctors are going to a cash only practice. No insurance accepted. The costs for both the doctor and the patient are MUCH lower. The doctors don't need all that staff to do paperwork and get their money up front instead of in 3 months and the patients get $35 office calls.

MaddMedic said...

Great Posts, Great Comments!!
Now if we can only get the left to open it's dang eyes and "see" what is going on with Government run anything!!