Sunday, February 18, 2007

Please Ignore Any Possible Double Entendres

I had to visit the doctor last week for one of those good-health check-ups you’re supposed to have annually although my last one took place during the waning years of the previous millennium. This was one of those el cheapo visits where you spend 35 minutes sitting alone in an examination room, three minutes having the doctor poke at you and make sure nothing untoward pokes back, and another half hour filling out insurance paperwork.

I had a $30 co-pay for this visit. I have no idea what it actually cost. Then I went to have my car’s oil changed, which is arguably more important to the health of my car’s engine than three minutes’ worth of doctor going “Does this hurt? [poke] What about this? [poke] What about this [poke]?” is to the health of me. No appointment necessary; I paid $25 and was out of there in ten minutes. The poky doctor appointment, by contrast, required multiple phone calls to make a reservation weeks in advance.

Could be worse. Overall my car needs a lot more fix-it care than I do, and at least the car insurance companies focus on actual accidents rather than routine maintenance. Should that change, I’ll move to one of those overpriced cities where nobody has a car.

Imagine: need an oil change? No more can you find dozens of quick-lube places competing with each other for your business; instead, you have to call your insurance company and make an appointment and fill out scads of paperwork before you qualify for coverage that leaves you with only $25 as a co-pay. Need a tire? If you call now and wait on hold for 15 minutes you can make an appointment to speak to an insurance-company mechanic who’ll inspect your old tire three weeks from next Tuesday and write you a prescription. Running low on gas? You can’t visit any of the fifteen stations in your neighborhood because you have to drive 32 miles to the gas station run by the insurance company and wait for a mechanic to write you a gas-requisition pass before you’re allowed to buy any.

All this extra paperwork and bureaucracy will make insured car maintenance a HELL of a lot harder to get than it is now. That, in a nutshell, is why basic health care in America is so damnably expensive. It's not just that it's expensive to treat some acute illness that requires months and months in the hospital; if conditions are just right even something relatively minor like a broken bone or an attack of appendicitis can run you into the poorhouse.

Sorry about the rant. Can you tell I hate dealing with my insurance company?

36 Comments:

Anonymous Grant Gould said...

My car is covered by a warranty that covers even routine care (which makes sense -- makes it less likely something big will go wrong and cost the warrantors bigger money). This is more or less a form of insurance; indeed the analogy to an HMO is quite close. And yet -- and yet there are no waits, no prescriptions, no hugely inflated bills.

The problem is not insurance. The problem is what is being insured. The structure and practice of medicine, more than the insurance of it, is what drives the insanity.

3:51 AM  
Anonymous Anonymous said...

Doctors would compete with each other better for your business if they weren't all effectively employed by the same small handful of gigundo insurance companies, which small handful moves in lockstep with each other for the most part.

Classic antitrust problem.

Deconsolidation is the best answer. Socialized medicine is the next best answer.

5:33 AM  
Anonymous Anonymous said...

And by "deconsolidation" I mean three different things:

1) the link between doctors and health insurance companies should be broken. Who the patient's insurer is should be none of the doctor's business. Doctors should not be bargaining with insurance companies or taking directives from them.

and

2) the link between employers and health insurance companies should be broken. Who the patient's insurer is should be none of the one's employer's business. Employers should not be bargaining with insurance companies.

and

3) there should be a lot more health insurance companies than there are, and they should not be allowed to collude, neither tacitly nor explicitly.

If all that sounds like the impossible dream, then socialized medicine should be the plan because we know that works at least to some degree.

5:58 AM  
Blogger rhhardin said...

I do annual dentist visits but not doctors. It's been decades. Big cost and time saving. I understand that women are much more likely to show up annually than men.

It's largely ritual. Probably most of the susceptibility of health care to the insurance scam is due to women, with some variant of the ``it's free'' and ``I already paid for it'' logic. Men detest the experience enough to avoid it even if it's free.

Structurally, the crisis is due to making health care benefits tax free when provided by your employer. That's how the third party payer gets in and destablizes the industry.

No doctor can stay in business charging more than people are willing to pay. He can if other people pay.

And the more the price rises, the more people need insurance.

The victims are the people, who wind up with premiums and a vast bureaucracy to support.

PS I don't change the oil either. Typically cars last me 12 years. Another myth, apparently.

I changed the oil on my airplanes when I had them, because it actually mattered seriously in case it turned out to matter, if that makes sense.

6:42 AM  
Anonymous A Moose said...

If all that sounds like the impossible dream, then socialized medicine should be the plan because we know that works at least to some degree.

Easy way to make it happen. Since we regulate insurance anyway, make the following changes:
1) Insurers treat everyone, regardless of anything, as presenting the exact same US average risk. Thus reinsurers are buying up risk pools based on average risk for the entire US. Upshot of this, no further need to try to exclude people from risk pools.
2) Insurers cannot turn down individuals nor exclude preexisting conditions.


This would, in effect, create competion based not on denial of claims (as people would get pissed and go elsewhere), but towards what can be included. Further, it would break the bond between insurance and employment, something which is problematic. It would also shift price competition to reducing stupid overhead, a good thing.

7:08 AM  
Anonymous A Moose said...

I should have also added "keeps us in a competition for business mode, instead of socialization mode".

By the way, this idea is mine, I haven't heard of it anyplace else, so I would appreciate someone telling me where the holes are in the idea, as well as if you've heard it anyplace else.

7:12 AM  
Anonymous Anonymous said...

response to a moose:

My wife proposed exactly your idea to me last week and again yesterday in more detail. Until last week she had been a vigorous proponent of socialized medicine.

She know about my deconsolidation schemes, but prefers what you said.

I am pretty sure she got the idea from somewhere, but I didn't ask where. i think maybe this is how they do it in Switzerland, with the added caveat that the purchase of insurance is mandatory.

I see two problems with your / my wife's proposal:

1. It amounts to a gigantic transfer payment from young to old. The young people in the US already face a lot of systemic unfairness (because old people vote). Old people don't need any more coerced funds from young people than they already get. This problem could be solved if the premiums were keyed to age, but otherwise demographically neutral.

2. if you leave the big insurance companies intact, then they will buy off the politicians so that the implementing legislation will not match your vision at all. If you break up the insurance companies, and forbid them from talking to each other, then they will have more difficulty subverting the political process to their favor.

7:38 AM  
Anonymous A moose said...

I see two problems with your / my wife's proposal:

Ok...

1. This is already happening, in both medicare and uninsured people. Basically, what happens is that people who don't have insurance end up going to the E Room at a much higher cost. Those with fixed (ie-little) income end up costing more because a lot of things which SHOULD be low cost end up being emergency room issues, thus overtaxing emergency rooms also. So, while I don't disagree with you, I don't see this as anything other than what's already going on. Therefore, no, everyone pays the same per unit as an individual risk, regardless of newborn or 110 yr old.

In socialized medicine, you'd have a worse burden on the young (I have three kids, I am sensitive to it, and I'm ony in the low 40's myself) as you'd not only get the medical costs, you'd get a bloated federal burden on top with no market forces to trim it. In this case you'd have at least some measure of market forces working against overblown costs.

2. There is a balancing act between cash reserves and desire for new participants. In theory, this would reduce the barriers to entry as there would be more people (clients). The portability aspect would also reduce entry barriers.

8:03 AM  
Anonymous A moose said...

PS I don't change the oil either. Typically cars last me 12 years. Another myth, apparently.

At all (or just not every 3K)? That's pretty surprising. FWIW, I did have a friend who seized his engine due to not changing the oil. It was actually a company vehicle. Not good.

8:07 AM  
Anonymous Anonymous said...

1. This is already happening, in both medicare and uninsured people. Basically, what happens is that people who don't have insurance end up going to the E Room at a much higher cost. Those with fixed (ie-little) income end up costing more because a lot of things which SHOULD be low cost end up being emergency room issues, thus overtaxing emergency rooms also. So, while I don't disagree with you, I don't see this as anything other than what's already going on. Therefore, no, everyone pays the same per unit as an individual risk, regardless of newborn or 110 yr old.

I think you are confusing two separate issues.

One is that older people have much, much, much higher medical expenses than young people. therefore, if everyone pays the same, then the old people make out like bandits and the young people are crushed. It is nice to believe that increased competition and/or efficiency will outweigh this actuarial burden on the young. I don't think it will. However, insurance companies already grossly overcharge young people and grossly undercharge old people, from an actuarial standpoint -- so maybe your / my wife's proposal would not change things in this regard. Maybe the transfer payment I worry about is already being made, and we just don't realize it because the whole process is so opaque right now.

The other problem is people who can't pay the premiums, regardless of whether they are young or old. As near as I can tell, you seem to think that the increased efficiency and/or competition of your plan will solve or greatly reduce that problem. then again, I think the efficiency and/or increased competition of my plan will solve or greatly reduce the problem. it might be that we are both correct. It might be that one of us is correct. It might be that neither of us is correct. Right now, in the US, the problem is solved by giving people who can't paid some socialized medical care, but presumably crappier care. To a greater or lesser degree, this would probably continue under either of our proposals. One of the selling points of socialized medicine (at least in wealthy countries) is that nobody gets substantially crappier care and people seem to live longer on average because of this. Hopefully either of our plans would decrease costs to the point that few would need to resort to crap-care, and that USians would start to live as long as those in other countries. Only time would tell, I guess.

8:26 AM  
Blogger rhhardin said...

I dont' change the oil at all. The current car I've had since 1988, but it's not a good test because I hardly drive at all now (bike commuter).

I _add_ oil if necessary - you do need oil - but leave the old stuff there.

If you trade in your car at 12 years, you'll get $50 for it regardless of condition, so I suspect the oil doesn't actually matter, as to changing. Based on 3 cars now.

10:10 AM  
Anonymous A moose said...

I think you are confusing two separate issues.

No, I understand what you're saying...My point is that the majority of people who are currently on MEDICARE are subsidized by my tax $, and as the boomers get older it will get worse. However, due to the care sucking, there would be some who would purchase care, presumably all of it. Furthermore, "Medicare" as it currently exists would become obsolete, just give people a welfare type allotment or pay for their care outright such as Section 8 pays for rents.

I understand that most people's last few years of life cost, medically, the same as the first 50 or so. My point is that we're paying either through taxes or increased rates for the expense now.

The other problem is people who can't pay the premiums, regardless of whether they are young or old.

True, they are an additional class of people for whom we are paying. I, for example, am currently gambling with COBRA. I left a prev employer, got a "to the extent we pay for insurance" for the first two months, then I'm covered under the new employer. I'm gambling that the $575 (per mo) I get from the new will be more than my med bills, so I can pocket the diff. My alternative is to pay roughly $2600 (for two months, family coverage) to the ins company. I have it good, I have until March 9 to make the call, but I'm covered as of March 1.

However, if I didn't have the new job coverage, I'd be screwed. If I didn't have an income of sufficient level, I'd probably gamble as the family is typically very healthy. If I lost, y'all would be paying for me, as I don't have enough assets to cover being hospitalized long term.

This would obviously be taken care of either by socilization of medicine or by my solution. My hope is that we can eliminate multi billion dollar bonuses to HMO presidents, as well as overblown federal regulated bureaucracy (sp?...that engineer thing again...spellingnazi, help!) through compeitition.

10:29 AM  
Anonymous a moose said...

I _add_ oil if necessary - you do need oil - but leave the old stuff there.

Interesting. I wonder if it's like an old Toyota I had, ran for 300K miles. It was a good vehicle, but it started leaking oil so badly I kept having to chase it. As it went along, I figured I was changing the oil dynamically as it was leaking out.

Filter would be more problematic to my thinking, but if it works for you, great.

10:59 AM  
Anonymous spelling nazi said...

[bureaucracy (sp?...that engineer thing again...spellingnazi, help!)]

(sigh) You got bureaucracy right, but spelling nazi should be two words. :-)

11:54 AM  
Anonymous a moose said...

(sigh) You got bureaucracy right, but spelling nazi should be two words. :-)

Darn the bad luck.

12:13 PM  
Anonymous Anonymous said...

No, I understand what you're saying...My point is that the majority of people who are currently on MEDICARE are subsidized by my tax $, and as the boomers get older it will get worse.

Yeah, I guess what I am saying is take away Medicare, except for need cases and make the Medicare coverage crappy enough that oldsters will opt to buy insurance, at something over its actuarial costs, in a truer, more competitive market.

Aggressively libertarian, but probably politically unrealistic.

12:24 PM  
Anonymous a moose said...

Yeah, I guess what I am saying is take away Medicare, except for need cases and make the Medicare coverage crappy enough that oldsters will opt to buy insurance, at something over its actuarial costs, in a truer, more competitive market.

I'm presenting my thoughts as an option to socialized medicine, so this wouldnt' be a player.

If we were to do something this agressively libertarian, there'd have to be some kind of transitional period. Basically, one would have to save their entire life to get to the point to afford it, so you'd have to allow time for people to change.

Kinda like social security ;>

I will say that socialized would be easier. Healthcare when older is one thing which really concerns me.

12:57 PM  
Anonymous Anonymous said...

Basically, one would have to save their entire life to get to the point to afford it, so you'd have to allow time for people to change.

I am very against young people making transfer payments to old people.

To me, that is screwy, even though a LOT of that happens in the US.

I have to say, Moose, I do like your / my wife's plan more than socialized medicine, notwithstanding a bit of overgeneralizing early in the thd.

1:01 PM  
Blogger rhhardin said...

You always transfer wealth from young people to old people. The old people stop working, so everything is necessarily supplied by the younger people. You just can't have too many old people suppored by too few young people.

The solution is raise the retirement age until it balances (rather than reducing benefits once you reach whatever age that is).

Basically you want social insurance for outliving your savings, which the ``lucky'' long-livers will prohably do otherwise. Few can save enough to live to a hundred on the savings, but most can save enough to live to 75.

2:59 PM  
Anonymous A Moose said...

Few can save enough to live to a hundred on the savings, but most can save enough to live to 75.

(looking at a Jiffy Lube bill...) Let's see, one oil change every 3000...200000 miles per vehicle....

Yeah, I think 75 should be easy ;>

4:07 PM  
Anonymous smartass sob said...

"Please ignore any possible double entendres" !?

Hell, Jennifer, how is a wag supposed to have any fun? With subject matter like women getting poked for their health every now and then - well shoot - the jokes just write themselves!

7:27 PM  
Anonymous smartass sob said...

;-)

7:29 PM  
Blogger Jennifer said...

Poke, lube--you can see why I feared to make that post without first appealing to people's better natures, Smartass.

Thank God my car didn't have problems with its pistons.

4:19 AM  
Anonymous GinSlinger said...

As to changing/not changing your oil, I can supply an anecdote. Locomotives have something like 320 gallons of engine oil in them. Not a cheap oil change. So, the oil maintaince fo a locomotive consists of replacing the oil filter at the end of every trip. Only whn an engine is refurbished is the oil removed, and even then it is recycled as much as possible. Now locomotives aren't under the same strains as an automobile, but they do put on the equivalent of 500,000 miles (on average) before refurbishing. No oil change, no "molecular breakdown" as claimed by lube makers.

Of course, a car is engineered to make it virtually impossible to change the filter without draining a significant amount of oil.

1:47 PM  
Blogger Anne O'Neimaus said...

Doctors would compete with each other better for your business if they weren't all effectively employed by the same small handful of gigundo insurance companies...

I don't think it's doctor fees that are the problem. These days, most doctors are not getting rich. In fact, I know many who are having real problems paying off their student loans.

Maybe hospitals are overcharging? But if that were the case, why are so many of them closing down?

Clearly, insurance companies are making money hand-over-fist. They are an essentially-unnecessary middleman in the process, which would be ameliorated or eliminated by socialized medicine. But socialized (or heavily regulated) insurance might do the trick too - force insurance companies to run basically as utilities or not-for-profit entities, so their actuarial tables are regularly audited to reflect reality.

However, I think the worst driver of medical expenses in the U.S. is the Medical Technology companies - especially the Pharmaceutical industry. They have very effectively manipulated the legislative process to favor large, well-established companies, with ever-renewable patent-based monopolies. They very publicly complain about the "high cost of testing" to bring a new product to market - but assiduously defend and support this process, as it is a bar to entry to upstart entrepreneurs. They actively solicit government grants for "basic research", but patent any resulting new technology so they can charge exorbitant prices.

The much-lower cost of medicines in other countries is a clear indicator that something is wrong. When I was out of work a while back, I started purchasing one of my medications from France. The manufacturing facility was clearly marked on the package, and was the same as what I got from my local pharmacy. So, this drug was manufactured here, shipped to France, shipped back to the U.S., and sold to me for about 1/10 the price I normally had to pay. Clearly, nobody in this chain was doing it altruistically, so there must still have been a profit in the process. I had to stop, because the U.S. government started confiscating the shipments - ostensibly to protect my safety against "untested drugs". This, even though it was the same manufacturer at the same facility!

I think that, in the U.S., our medical technology (especially pharmaceuticals) gets amortized over the costs of the rest of our medical care. Since this is mostly covered under the umbrella of medical insurance, we (as individual consumers) don't see this cost-shifting, and the truly obscene prices/profits involved in supporting meditech.

Sure, now I can hear the old refrain: "but the profit-motive is what spurs innovation and gives us the best medical care in the world!" Hogwash. If that were true, we really would have the best medical care in the world. But, by many measures, we are far from the best.

An analysis of the WHO's World Health Report 2000, in fact, shows we rank near the bottom among "developed" nations in many key areas, such as infant-mortality and disability-adjusted life-expectancy. This, despite paying far more, both per capita and as a percentage of GDP.

Something is drastically wrong with our Health-Care System. Maybe "Socialized Medicine" isn't the "best" solution - but existing evidence strongly suggests that it would be far better than what we currently have.

On thing we all (even Libertarians) have to beware of is the old adage: "Better is the enemy of good enough." In this case, we fall afoul of the even more extreme version: "Best is the enemy of better."

10:14 AM  
Anonymous a moose said...

Anne-

I was, in 'another life', a procurement officer for the US Navy. It was interesting, and educational. After watching the purchasing system of our federal government, I simply cannot see how socializing medicine would be cheaper. Too much political grandstanding involved, with added layers and layers of regulations to catch crooks that we only know about because the previous regulations caused them to be caught.

3:39 PM  
Blogger Anne O'Neimaus said...

@Moose: After watching the purchasing system of our federal government, I simply cannot see how socializing medicine would be cheaper.

Honestly, I can't see it either. However, many European states, and Canada, have some form of socialized medicine, and it demonstrably works better than our system.

Sure, most of these countries have higher tax-rates than the U.S.A. - but their total medical spending per capita is still significantly less than ours.

I don't know how it can work "in theory", but it clearly does "in practice".

7:12 AM  
Anonymous Anonymous said...

Me: Doctors would compete with each other better for your business if they weren't all effectively employed by the same small handful of gigundo insurance companies...

Anne: I don't think it's doctor fees that are the problem. These days, most doctors are not getting rich. In fact, I know many who are having real problems paying off their student loans.


I didn't say doctors were getting rich and that was not my intended meaning.

8:24 AM  
Anonymous a moose said...

Honestly, I can't see it either. However, many European states, and Canada, have some form of socialized medicine, and it demonstrably works better than our system.

::looking carefully about hoping to not run a-fowl of any spelling..wait for it with a space...nazi's about::

I am unfamiliar with the Canadian govt practical workings. Are they as dragged under by pork barrel spending as we are? I just can't buy that our spending would go down under a socialized medicine program, based on my experience in govt. In other words, though there is a current disparity, it would get worse.

6:05 AM  
Blogger Anne O'Neimaus said...

@Anonymous: I didn't say doctors were getting rich and that was not my intended meaning.

But, you did say:

Doctors would compete with each other better for your business if they weren't all effectively employed by the same small handful of gigundo insurance companies, which small handful moves in lockstep with each other for the most part.

My point was that, if the doctors aren't taking a particularly large cut of the fees, and the costs are not directly under their control, what good does it do to have them competing with each other?

In fact, under our current system - but without some sort of managed care institution controlling and (mis)organizing the doctors, they would probably charge more. After all, they demonstrably represent a scarce commodity (there aren't enough to go around, especially in fields like OB/Gyn) in a market with high demand (people keep getting sick).

Not that I favor anything like our current managed-care/intrusive-insurance system. I do agree with you that this is probably a very harmful abuse of anti-trust behavior, and contributes heavily to the problem.

I just don't really see the relevance, one way or the other, of having "doctors compete with each other" in our current situation.

Maybe if they, we, and the market as a whole, weren't already in this situation, general competition between practicing professionals would work OK. Clearly, it mostly worked for decades, in the past.

But wait...wasn't it the operation of the "unregulated free market" that brought us to this very point of a few ultra-powerful corporations controlling access to health-care? Wasn't that the exact situation we had, when all of this started?

It seems to me, that the burgeoning power of insurance industry, the managed health-care (HMO/PPO/Etc.) industry, and the pharmaceutical industry, didn't really take off until just after the Reagan/Bush wave of "general deregulation". Pressure on (and acquiescence of) the AMA to allow medical advertising, and similar relaxations of traditional "professional standards" was part of that process.

A "Free Market" (whatever that means) is exactly what got us here in the first place. It is basically the "Tragedy of the Commons" writ large. Some clever, ambitious people figured out that they could make a killing (almost literally) by cornering the market on health care. They maneuvered public opinion and (more importantly) both professional standards and government regulations to ease the long-standing restrictions on such monopolistic abuse. Heck, they were even careful to ensure that there was always "viable competition" within their ever-shrinking coterie, so it couldn't be called a true monopoly.

But, that's what it really is. Blatant market manipulation through overwhelming dominant control of resources, services, and/or access.

Sure, a lot of this has been made possible by abuse and manipulation of government-protected and promoted monopoly laws (patent, trademark, and copyright, for example) and licensing schemes (you can't practice medicine, sell drugs, etc., without government-approved licenses). I think, however, that we would have eventually arrived at a similar state, even if we didn't have this "government interference". Historically, professions have been self-regulating to the extent that they effectively form government bodies (i.e. guilds - which can be very militant in repressing non-member practitioners) when there was no "official" government regulatory body to set and enforce "standards" and limit spheres of interest.

With health care in particular, it is not the true "health care professionals" (doctors, nurses, scientists, etc.) that are driving this abusive trend towards consolidation and control. It is uncontrolled/unregulated ambition by businessmen who are literally "just doing their job" the best they can. Their job is to "make more money". If this is as the expense of others, or society as a whole, so be it - that's NOT their job. In Western societies, anyway, monitoring and mitigating the "at the expense of" aspects of business falls to the Church, or Government. We in the U.S. have basically emasculated the Church in this venue (and a good thing, given their overall track-record), which leaves the Government.

This may not be a nice "Libertarian" stand, but I hold that Government does have a place in a modern, stable society. It is (or rather, should be) the "corporate tool" of the public, which defines, enforces, and protects the systems and rules (laws) essential to the maintenance of that society. Some things are "core infrastructure" that help sustain and enhance as society. A "rich" society has many of these (public schools, good roads, effective communications, etc.), while a "poor" society has few or none (think Somalia).

The "richer" you want the society you live in to be, the more of these "commons" MUST be provided, controlled, or at least regulated by a government - and paid for. It need not be a traditional government - it could conceivably even be a corporate monopoly, so long as it was broad-based enough that the welfare of society at large was of key importance in its decision-making processes. Of course, in the latter case, they would also be actively shaping society to further their own business goals, and there is no evidence that consideration for the rights and well-being of the individual (except the corporate executives themselves) would be part of their consideration.

Skilled businesspeople (whom we generally laud and admire for their ambition, innovation, and ability to "get things done") have manipulated our existing system in order to profit heavily from controlling access to (any and all levels of) health care. Enhancing profits in a closely-held market can very effectively be done by withholding products/services until an arbitrarily-higher price is met. There is a clear point of diminishing returns at which so many people are unable to buy, that the extreme prices paid by the few don't make up for the loss in volume of sales - so the price normally won't go "too high" in a business sense; it will stabilize at a point to maximize profits.

From a purely-business/financial standpoint, this is all well and good, and essentially "efficient". From a social viewpoint, however, this profit-driven equilibrium may be so high as to effectively deprive "too many" people of the product. This will, unfortunately, always be the case - no society has unlimited resources. However, the question that we as citizens must continually revisit is: what is "too many" to deprive of a given product/service/resource?

I guess the (eventual) point of this long-winded and rambling rant is that I think I want the society I live in to view (some level of) health care as a "common"/utility/right. Currently, in the U.S.A., it isn't. Leaving it to the "private sector" clearly won't change this - it is the "private sector" that got us here, and maintains the current situation, in order to maximize profits (as this is the corporate executives jobs).

I apologize again for this lengthy and rambling post. It is a way for me to explore and evolve my own understanding of a complex subject, and explain my (current - it can easily change) stance both to others and myself.

1:05 PM  
Anonymous Stevo Darkly said...

But wait...wasn't it the operation of the "unregulated free market" that brought us to this very point of a few ultra-powerful corporations controlling access to health-care? Wasn't that the exact situation we had, when all of this started?

Not really, Anne. There hasn't been a free market in health care for quite a while -- just layer upon layer of regulations trying to "fix" the unintended mess of the previous layer.

Apparently the mess got started when the AMA asked for the government's help in regulating the behavior of some doctors -- who, as it happened, as the result of competing for customers, were selling their services "too cheaply." You may find this interesting: "How Government Solved the Health Care Crisis:
Medical Insurance that Worked — Until Government 'Fixed' It."

1:38 AM  
Blogger Anne O'Neimaus said...

Thanks, Stevo Darkly, that was interesting reading. I fully agree that "in practice" governmental intervention tends to not work as well as we'd like. Especially since our system of government (most systems of government, perhaps?) seems so vulnerable to manipulation by well-heeled special interests.

I guess I was waxing a bit utopian in my vision of what I thing government "should" be, rather than remembering clearly what it almost always actually becomes.

But, the overall fact still remains that most Western countries with socialized medicine "scored better" than the U.S., in both overall "health-results" and cost-benefit ratio, in the WHO analysis. I am in no means qualified to judge any inherent biases or agendas in and behind that report - but it is still an interesting data-point.

6:49 PM  
Anonymous a moose said...

I guess I was waxing a bit utopian in my vision of what I thing government "should" be, rather than remembering clearly what it almost always actually becomes.

Which is why I was thinking to let the profit motive drive it instead.

5:46 AM  
Blogger David said...

My point was that, if the doctors aren't taking a particularly large cut of the fees, and the costs are not directly under their control, what good does it do to have them competing with each other?

competition drives down costs to the consumer. that is true regardless of whether it is doctors or insurance co.'s who are taking the lion's share of above-market profits (or "rents").

I think Stevo Darkly has a good point about government's role in the consolidation of healthcare providers, but I think he misses that much of the impetus to consolidate comes from the private sector too.

This is a case of big business and big gov't working hand in glove over the decades in myriad ways to the detriment of consumers.

Beyond price and money considerations, doctors who compete will give qualitatively better care. One example of potential qualitatively better care would be if doctors (or at least some of them) behaved more as Jennifer recommended in the post that kicked off this thread. If two doctors charge equal, but one gives better customer service, then she will take more business (and pay off her student loans quicker).

see you all next week at the HnR!

11:33 AM  
Anonymous NoStar said...

Jennifer,

Where are you? I need my fix of Feral Genius.

8:44 AM  
Anonymous A moose said...

Jennifer,

Where are you? I need my fix of Feral Genius.


Concur.

9:02 AM  

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