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Archive for June, 2013

Why hello blogosphere, it’s been some time.  Sorry to have neglected you so, I’ve been trying to survive and all that.  But I’m at home sick today and have thus had a little time to internet (yes I used it as a verb) and OF COURSE posted something political that caused a friend to respond which caused me to want to respond back which led me to learn more about the subject with all the copious spare time I had this afternoon.  (That would be a couple of hours.)  So.  Here is the product of said interneting (Mommmmmm, she did it again!) and I hope not only that you will enjoy it but that you will in fact respond.  Because as it turns out (SPOILER ALERT) the end is a great big question mark.

With no further ado, I present “Several Reasons Why Health Care is So Expensive in America.”

 

1.  We’re living longer.

Not only do you pay for the statins that delay your heart attack, and the angioplasty that deals with it when it does happen, but then you also pay for the cancer and the knee replacement and the Alzheimer’s that you wouldn’t have lived long enough to get in an earlier age.  None of these treatments existed in the past; you often got ineffective care and then died.  D’oh!  Modern medicine can do wonderful, nearly magical things – gene therapies, transplants, and more – which simply didn’t exist twenty or fifty or a hundred (or two!) years ago.  So of course with more options for treatment available, there’s more spending going on.  And the older we get, the more spending goes on per person.

What do we do about it?  Well nothing directly – living longer is a good thing!  We don’t want to stop that, it’s the entire point of medicine, right?  But we wouldn’t get some of those diseases if we lived better (ate healthy food and stayed active) in the first place.  Unfortunately overcoming this will take a herculean effort to change the entire food system – a system that has convinced people that just because a company’s food isn’t fried, it must be healthy.  (I’m looking at you and your processed meats, Subway.  Eat fresh, my ass.)  So even an indirect solution seems unlikely in the immediate future.  Incremental improvement?  Possible.  But self-driven for the most part, and therefore entirely unpredictable IMHO.

 

2.  Medical administration is inherently inefficient.

Self-insured companies pay a percentage of their fees, not a flat rate, to the companies that process their employees’ claims.  Just as in any other cost-plus system (like NASA) this leads to the generation of artificial costs that do nothing but drive up costs and therefore profit.  Who cares if you’re spending twice the payroll to administer costs, if you’re getting paid three times what it actually costs you?  Cutting your payroll at that point will actually cut your profit, because if your costs go down so does your pay!

That’s right, the more they spend, the more they waste, and the more they ultimately make.  Ain’t nobody gonna change that from the inside.  Efficiency expert, thy name is Mudd.

 

3.  We pretend that we have a free market, but we really don’t.

A free market presupposes that the buyer is able to make judicious and rational decisions based on the costs and benefits of various options.  By balancing the cost you’re paying with the benefit you get, you can choose the product that’s right for you.  Seems legit.  But wait, when was the last time you were told the cost of a medical procedure before you decided to have it done?  When was the last time you found out how much of that particular procedure your insurer would cover?  The doctor tells us, “You need this done,” and we generally say, “Okay.”  Some few people ask, “Is that expensive?  Is there a less costly – or less invasive – option?” but these folks are few and far between.  And in most cases, the doctor’s office doesn’t even know how much the procedure is going to cost.

Try it.  Next time you go to the doctor, ask him or her point-blank how much the procedure is going to cost you out of pocket.  Ask the desk attendant how much the visit will cost you before you go in.  If you have an insurer that they work with a great deal, they’ll probably give you a number for the visit itself, but they’ll qualify it.  “It should be around $XXX or so.”  Don’t want to be too sure and end up wrong, do we?  If you want anything more than that, they’re likely going to say they don’t know, and heaven help you if you have an insurance they aren’t familiar with.  If you’re lucky the staff is very friendly and will be willing to do some research for you to find out, and hopefully you’ll get an answer in a few days.  You know, after you already spent the money.

Why are we so eager to write blank checks for our medical care?  Maybe because this is a place the free market *shouldn’t* rule?  Maybe because our medical decisions are too fraught with emotional impact to make logical decisions and live by caveat emptor?  Maybe because it’s ridiculous to think a patient’s family can make sensible financial decisions and negotiate prices when their parent is dying of cancer, or their child is injured in an accident, or their wife has an emergency in the middle of labor?  Hmm…

 

4.  We get care we don’t really need.

By “we” I mean people with excellent medical coverage who have doctors more concerned with malpractice suits than patient care; doctors who order tests that are unnecessarily expensive, or effectively duplicate results, so that they can “prove” that they did their very best by the patient.  How about you spend more time with the patient instead?  How about you more carefully review their personal history for possible causal factors?  How about you “doc up” and tell them that they’re sick because they eat terribly and don’t exercise?  (No, they’d probably find another doctor who sugarcoats them lies.  “It’s not your fault, you have a glandular problem.”  For every person who really does have a genuine problem in that area – and there are plenty – I have no doubt that there are three who use it as an excuse.)  Nope, the only thing that impresses some people is dollar signs.  And with all the medical advertising that goes on (“Ask your doctor if XXXX is right for you!”) and the kickbacks doctors are getting from the drug companies (Notice those branded pens around your doctor’s office?  They don’t appear magically, you know!) I guarantee the care you get is strongly influenced by factors OTHER than your best interest as an individual.

I won’t even get into the fallout from false positives and rabbit-track diagnostic distractions, but they add significantly to the problem as well.

 

5.  We don’t get the care we do need.

In this case “we” refers to people with substandard or no medical coverage; people for whom a visit to the doctor for a minor sickness or injury gets put off because of the high cost, leading to a more severe, or even chronic health issue.  Head cold turns into pneumonia; puncture wound goes septic; etc.  When people have to decide between paying the power bill and going to the doctor, or between eating and going to the doctor (which is a rising problem among seniors), they buy another bottle of aspirin every time.  Then, when they finally get desperate enough to seek medical care, they end up in the ER – and after filling out financial aid forms they learn that they still owe several thousand dollars.  (See #3 above.)

 

6.  We pay more for procedures than anyone else does.

I don’t even have anything more to say about this; just check out the link and see what I mean.

 

So what do we have then?  A system where the people with no coverage get no care, where people with average coverage get too little care, and where people with good coverage get too much care that often is of the wrong kind and costs too much anyway.  The extra costs generated in the system are magnified by the inefficiencies inherent, and we are treated as children rather than informed consumers able to make our own decisions.  In fact, we’re indoctrinated to not make our own medical decisions by the mystery that shrouds the entire profession!  “Well are YOU a medical professional?  Then why are you telling me which procedure is better for you?  Trust me, I’m a doctor!”

The system is broken.  It’s really, really broken, busted beyond repair as far as I’m concerned.  The Affordable Care Act does seem to be having an impact as of February, but IMHO it’s too little too late.  If we wanted to fix the real problem, we’d have to overhaul every level of it from top to bottom and rework the way every bit of it is done.  From “Ambulatory Surgical Centers” that step people up from office procedures by telling them it’s cheaper than a hospital stay, to those stupid commercials with lists of side effects that sound worse than the condition being treated, everything would have to change.  Complete overhaul of a multi-billion – oh, I’m sorry, did I say billion?  I meant TRILLION – dollar economic juggernaut?  I don’t think so.

Not to mention the fear-mongering.  Oh yes, any proposed change gets branded as BAD FOR US.  Terrible, in fact, and to be avoided at all costs.  Death panels!  Socialized medicine!  Waiting lines!  Malpractice!  God help us if anything changes – and by “us” I mean the corporations whose controlling officers paid over 5 billion dollars to lobby Congress between 1998 and 2010.  By comparison, THE DEFENSE LOBBY spent less than a third of that during the same time period.  How on earth do we dislodge an industry that makes so much money, and that has us so thoroughly under their thumb?

 

That wasn’t a rhetorical question.