Thursday, January 12, 2017

Pot, Meet Kettle -- Wait, Have You Two Met?

     I guess not.  A writer in (at?) Vox muses plaintively, "The problem here is that the Republican Party [...] somehow ram through a quickly-crafted replacement that would massively restructure the health care sector with hardly any deliberation, with potentially catastrophic consequences."

     Gosh, do you suppose he was this upset the last time one party held the Presidency, dominated both houses of Congress, and "massively restructre[d] the health care sector" via legislation they hadn't even read?  Was he worried about a bill Congress was told they had to pass in order to find out what was in it?

     Or was it okay-fine as long as the Right People were in charge?

     Me, I'm still wondering what in the name of Hippocrates the Fed.Gov is doing in the health care business at all, other than Congressthings and Presidents showing up at charity efforts to raise money for those unable to care for themselves. 

     Somebody's going to call me out on that, huffing that I'm suggesting Big Business ought to be running healthcare.  (Like they're not?  Who do you think my Congressbeings are most likely to take calls from, me or Eli Lilly?  Me, or United Healthcare?)  Nope; there was a time when healthcare was mostly run by doctors and it worked pretty well.  In part, that was because they couldn't do a whole lot to keep you alive, for $$$$$ levels of "keeping."  But it was also because administrative overhead was low and medical decisions were made by (hang on, this is far-out stuff) working physicians.  Health insurance, in the form of "catastrophic" coverage, mostly for hospitalization, didn't start showing up as a workplace perk until wage-frozen WW II: if an employer couldn't pay more than the competing blivet works, they could offer other incentives, and employers did so.  It has grown from there. especially with the 1990s realization that there were a number of aliments for which prevention was much cheaper than treatment, and thus we came to where we were before the Affordable Care Act.

     At the time, Congressional Democrats chortled that ACA was "unrepealable."  Now, maybe not so much.

     We have a mess now.  Maybe there's a bigger mess coming.  Maybe it will be a huge, terrific* improvement.  Whatever happens, don't expect there to be any less paperwork or any shortage of spatting in the press and in Washington, D.C. -- and how, exactly, does the filling out of forms or spirited debate set your broken leg, treat your infection or get you on a program of exercise to squeeze a few more years from your ill-treated heart?  --And why can't I get an appointment with my doctor any sooner than the middle of next month?
* "Terrific" and "Terrible" share the same root, of course.


Blackwing1 said...

My garsh, you shure sound like one them-thar radical "libertarian" types, advocating a free market in medical care just like there oughta-be in durned near everything else.

Seriously, your post here comes the closest I've ever seen to how I try to explain to people just how badly the Fed-Gov intrusion into the market has distorted it to the point of (probably) no return. A good basic rule of thumb is, "If you tax something you get less of it, if you subsidize something you get more of it." We've been federally subsidizing massively over-priced health care for a long time now, and we've sure got a lot of it.

A perfect example is laser-based vision correction (Lasik). When it first came out it was at an incredible price (I remember it being something like $10,000), and available only to a select few. Since insurance didn't cover it (for simple vision correction glasses work quite nicely) very few people could afford it. After a few years competition stepped in and prices started to drop like a rock. Today you can see "specials" advertised of two eyes for $450, initial exam free of charge. We can only thank whatever gods you believe in that the Fed-Gov didn't have a hand in "helping" that market.

I think that (unless the next health care fiasco/bill makes it unlawful) what we'll start to see will be a lot more doctors that open shop, but flatly refuse to deal with insurance companies. "Cash on the barrelhead, and we'll give you a receipt so that you can go dicker with the idiot "gatekeepers" at your insurance company for reimbursal."

But a worse-case scenario is that you'll be dickering directly with your doctor about bartering food, seeds, ammo or other sundries for medical care, assuming that we live long enough to get to that point after societal collapse. Can't happen here, can it? Just look to Venezuela.

Rick T said...

And another: name me another market where you can NOT get an estimate for services to be rendered so you can shop around for the best price?

Then there is my favorite: balance billing. I went to my in-plan MRI shop for a fully authorized study. I paid my deductible up front like normal. Two months later I get a balance bill from the MRI center. After much back and and forth using my insurance broker as an ombudsman it became clear the center's billing department mis-coded my study and rather than fixing the problem when the medical group refused the charge they just sent me the bill..

RandyGC said...

If the current crop of Temporary Federal Employees on the Hill do nothing but get rid of the despicable, dare I say evil, individual mandate, I'll take it as a good start.

(there's probably a lot else to get rid of, but having a life and not having politics as a hobby, I haven't dug into all the other spaghetti code of the ACA/OC. The .gov telling me I have to buy something I may or may not need or want is a trigger point for me. For instance I have car insurance in spite of the government mandate, not because of it. The cost benefit has worked in my favor over the years, nice the state agrees with me, but I don't really care about their opinion)