The Truth About Health Care

Yesterday’s post, was tangentially about health care, but it got a lot of responses about health care. It is a funny subject, in that everyone starts from the premise that everything has been the way it is now since forever. The Left has been so good at proselytizing about government run health care for the last 25 years that the public suffers from collective amnesia. We forget that no one complained about insurance very much a generation ago and no one expected miracles from medicine. Health care was just not a big topic.

After a quarter century of chanting about health care, most everyone seems to buy into the belief that it is a fountain high up on Magic Mountain. It is guarded by the twin dragons of Big Pharma and Big Insurance. The keepers of the faith sent their paladin, Barak Obama, to slay the dragons so that the people could dip their cup into the fountain of health care, getting all they need. His failure to accomplish this is proof that the dragons are mighty and therefore the most extreme weapons must be deployed.

It’s all ridiculous nonsense, of course, but that’s where we are with the topic. All goods and services are rationed. That’s an iron law of the universe. There are no exceptions. The rationing is either done though control of the supply or through price. In America, a massively convoluted system to control supply has evolved so that the people do not see the cost of health services. This lets a long list of skimmers attach themselves to the system so that prices go up, even though the quality of service often declines.

The question no one ever asks is how to make it cheaper. Follow the talking heads on the subject and they will never address making the price of services cheaper. Instead, they prattle on about access and risk pools and other terms they think sound clever. The reason is not that they view health care as a right. It is because they see it as a privilege to be dispensed by the Cloud People to the Dirt People. Allowing a free market for health services would take all the fun out of being a Cloud Person.

Even so, the goal of any health care reform should be making it cheaper, especially the common care items. The two areas where health care has gotten much better and much cheaper are dentistry and eye care, both of which are usually paid for out of pocket and have low barriers to entry. Veterinary medicine is the most obvious example of what happens to prices when you have anything resembling a marketplace. That’s also why the people in charge will never allow competition for health services. Their donors hate it.

The other aspect of health care is the quality of medicine. The truth is, the advance of medicine has been very slow and is not looking to speed up in the near future. The great leaps in health are a) diet, b) antibiotics and c) sanitation and d) a crackdown on quackery. All of these things are products of the last century. Some treatments are much better than fifty years ago, but cure rates for most diseases have not budged. Death, of course, remains a universal constant. Medical advances are glacial, not revolutionary.

As Greg Cochran pointed out the other day, a free market in medicine is probably not the answer, any more than a government monopoly has been. The truth is we don’t know a lot of about the human body and the diseases that afflict it. Genetics promises to open the door to a vast new trove of learning about human biology and medicine, but that’s not going to speed up with any government health care scheme. This is a science problem, not an economics problem and that takes the time it takes.

Finally, the problem of health insurance starts with understanding that there is no such thing as health insurance. What we have in America is an elaborate system of cost shifting. The young are forced to pay for the old. The healthy are forced to pay for the sick. The government and their buddies in the insurance business get a piece of the action. Nowhere in America can you buy insurance in case you have a stroke or just for the chance you fall off your roof.  Everyone’s plan is designed by the government.

This is a problem that is easily solved in theory, but nearly impossible to solve in reality because insurance companies have billions to spend on politicians. There’s also the fact that generations of Americans have become conditioned to having someone else pay their doctor bills. All the reforms that would work require people paying their own way and that will never happen on purpose. It’s why the current system will mostly likely stagger along until it collapses. At that point, we end up with government insurance.

That’s the truth of health care in America. The system, at its best, is a web of lies designed to shield the citizens from reality. At its worst, it is a complicated skimming operations so the people at the top can squeeze a bit more from the middle-class. It does not have to be this way, but until we resurrect the national razor, nothing substantive will change until it collapses. At which point, the “solution” will be something worse like national health care or single payer insurance.

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Steve D
Steve D
3 years ago

‘The question no one ever asks is how to make it cheaper.’

No one asks how to make pencils (or cell phones or beer) cheaper either. Funny that.

‘a free market in medicine is probably not the answer’

Neither is a free market in cell phones but that’s what we have and their price keeps going up and up and up, (until soon most Americans won’t be able to afford one) so we need to balance government intervention with the free market in communications technology and see what falls out. Hopefully cheaper cell phones.

Reply to  Steve D
3 years ago

I think you are confusing cell phones which are dirt cheap and hanging on blister packs at the drug store with those fancy devices that the teens and other mentally underdeveloped individuals whine about having at every new uptick in the version number; with built in TV, movies, cameras, web browsing computers, music and fuck-all who knows what on them.
Cell phones (simple) are so cheap they are a throw away.

William O. B\'Livion
Member
Reply to  John the River
3 years ago

This.

Heck, even the “fancy devices that the teens and other mentally underdeveloped individuals whine about having at every new uptick in the version number; with built in TV, movies, cameras, web browsing computers, music and fuck-all who knows what on them” can be had for very little money if you look around compared to what they cost 20 years ago.

What you say? We didn’t have those sort of phones 20 years ago?

**EXACTLY**.

King George III
King George III
Reply to  William O. B\'Livion
3 years ago

I’ll trade you my “fancy device that teens and other mentally underdeveloped individuals whine about having at every new uptick in the version number; with built in TV, movies, cameras, web browsing computers, music and fuck-all-who-knows-what on it” for a time machine that sends me back 20 years. I’ll throw in my life savings and the clothes off my back if it will go another 130 years extra.

NunyaBusiness
NunyaBusiness
Reply to  Steve D
3 years ago

Either you live under a rock, or you’re an idiot. Or, since those two statements are not mutually exclusive, I suppose you could be both. Whatever the case, you certainly aren’t correct. In my hand right this very moment, I am holding an Android smart phone that has more computing horsepower and useful programs in it than many of the computers I have owned over the years. It cost me $99, shipped to my door. It was not subsidized by my phone carrier, I bought it myself at the MFG’s asking price. Because of this, I have no contract which… Read more »

Member
Reply to  Steve D
3 years ago

If you draw the Demand and Supply curves, you’ll also find out the reason for why pencils aren’t being made cheaper.

When people stop ordering their life around their phones and paying higher prices for them, the increases will stop.

notsothoreau
notsothoreau
3 years ago

You should see what is happening with pet care, now that they are selling pet insurance. We see a lot of the same medications and surgeries that people have. Prices have gone up, of course. They hide the costs of the procedure. (I paid $200 up front for lab work on a cat. Cat died of kidney failure. They then tried to charge me an additional $200, claiming that it had taken that much for lab work. Their lab work cost more than lab work I had done on myself!) I do agree with the market-ticker guy that we need… Read more »

Epaminondas
Member
3 years ago

I say we go with the National Razor.

Dorf
Dorf
Reply to  Epaminondas
3 years ago

No the Chainsaw…

Dutch
Dutch
3 years ago

I spent part of the weekend at a middle class neighborhood ER. It was the stuff of nightmares. I have never seen so many morbidly obese people, people not really mentally “with it”, or people sort of hanging around without anything visibly wrong with them. The overworked and overwhelmed staff was doing their best, but it seemed that people just sort of wandered in for something to do on a weekend afternoon. They just didn’t feel well, you know? My thought at the time was if you actually billed cash money up front for these visits, most of them would… Read more »

YIH
YIH
Reply to  Dutch
3 years ago

I just listened to a ‘supplemental’ Daily Shoah: https://radio.therightstuff.biz/2017/01/17/the-sorta-shoah-well-be-back-tomorrow/ The main point was to deal with issue with one of the staff, but toward the end (27 min. onward) was an ‘0bamacare discussion’. One of the regulars likes to refer to himself as ”Dr. Narcan” and does ”tales from the ER”. The point this time is the fact that there are a lot of people who use ER’s as ”primary care”. There are a lot of problems with that, ER’s are ‘front line’ care (like ”Battalion Aid” in M*A*S*H, stabilize, get ’em ready to be moved to the M*A*S*H) and… Read more »

JML
JML
Reply to  YIH
3 years ago

The system you have described is what we have in Australia, it works ok given that nothing is perfect, you will wait a long time for something like a small hernia, and people who can afford it go private.

JML
JML
Reply to  JML
3 years ago

I should point out that unlike the British system, the public system is only available to citizens and legal permanent residents in Australia, not sure how that would play out in the USA.

MSO
MSO
3 years ago

When the doctor’s groceries are dependent upon his patient’s pocketbook, prices will find a sustainable level. There are many fine minds involved in medicine that are wasted chasing bits of colored ribbons rather than the overwhelming numbers of mundane medical problems. Finding better and cheaper methods for common surgical procedures along with the appropriate application of aspirin would do much to improve medical care.

LetsPlay
LetsPlay
Member
Reply to  MSO
3 years ago

I believe this is where tort reform comes in. When the regs have doctors and staff spending so much time on paperwork and on CYA procedures, well, the costs just keep on going up and up and up. Cost to the doctors in insurance premiums for malpractice and to patients where all that is passed along. But to lawyers and bureaucrats … who gives a rats ass!

Member
3 years ago

My single suggestion and recommendation to improve healthcare (insurance) and it’s costs would be to prohibit it being provided by an employer. When I think of the money that I’ve paid out in payroll deductions but be denied any duty of relationship or control with the insurance or medical groups involved in the spending of that money over forty years…
…what a waste.

Drake
Drake
Reply to  John the River
3 years ago

The only reason that employer paid healthcare became popular were the sky-high New Deal era income taxes. Employers were looking for ways to compensate employees without paying them more since upwards of 50% was taxed away by the feds. So they started buying them insurance.

I agree that it would be an improvement to decouple insurance and insurance and put force people to take some responsibility.

Brother John
Member
3 years ago

We forget that no one complained about insurance very much a generation ago and no one expected miracles from medicine. Health care was just not a big topic.

Perfectly true — but, government-run/single-payer/socialized-medicine/whatever-bastardized-monstrosity has been a wet dream of the Cult and their Marxist, Fabian, etc forebears for several generations. The question was how long it would take them, and what methods — apart from ignorance directed by media and public education — they would employ to foist it upon us

LetsPlay
LetsPlay
Member
Reply to  Brother John
3 years ago

They won’t quit. It is all about CONTROL. Just like gun CONTROL. You WILL be assimilated. Resistance is futile.

Ripple
Ripple
3 years ago

Quackery of all kinds has been on a steady increase ever since the cultural upheavals that started in the 1960’s. If you want to talk about “entryism”, look what’s going on in even the most august institutions of modern medicine under the name of “integrative medicine.” It’s very much tied into multiculturalism and postmodernist thought, i.e., believing that “western” or “allopathic” medicine is no better than Chinese medicine, or Ayurveda from India, for example. Cultural imperialism, you know. Then there’s the whole postmodernist solipsism aspect: “It works for me, who are you to say otherwise?” And while Big Pharma certainly… Read more »

Member
Reply to  Ripple
3 years ago

Hmm, let us examine the reasons why the iatrogenic death toll continues to take tens of thousands of lives each year. Which bears more responsibility? Quackery or allopathy?

Ripple
Ripple
Reply to  Libertymike
3 years ago

“Allopathy” is a derogatory term coined by practitioners of the Western-based quackery known as homeopathy. Of course modern medicine is imperfect, full of errors, and full of imperfect and even incompetent practitioners, but the solution is not to throw it out and replace with worthless non-scientific quackery.

Buckaroo Banzai
Buckaroo Banzai
Reply to  Ripple
3 years ago

Ripple, year in and year out, Iatrogenesis is the third leading killer behind cancer and heart disease. These idiots take an oath to “do no harm”, and then go out and kill hundreds of thousands every year. That’s a system that flat-out doesn’t work. If antibiotics hadn’t been invented, western medicine would look a lot less attractive.

UKer
UKer
3 years ago

Everyone wants to be healthy, everyone fears a bad death. Thus healthcare matters, though perhaps as of yet the US doesn’t have the issues we do here whereby people fly in to this country for free (for them, but not the British people who are taxed for this service) medical care and bugger off home — probably having given a false address and avoid paying anything for the service. Right now the search is on for a Nigerian woman who racked ups £350,000 bill on the NHS for the birth of her two sprigs and has flown away not having… Read more »

LetsPlay
LetsPlay
Member
Reply to  UKer
3 years ago

Do European hotels hold foreigners passports until their bills are paid? Maybe that is just from the movies. It has been too long since I have been to Europe. But the hospital shows no common business sense in releasing the Nigerian (or any patient) that hasn’t made payment or adequate arrangements for payment before being released. Or is that considered “profiling” like in the U.S.? A bill is a bill for services rendered and there should be a way to keep these scofflaws from leaving the country as in this example. Well, shouldn’t be too difficult to track them down… Read more »

Member
Reply to  thezman
3 years ago

Yet, you appear to endorse Greg Cochran’s progressive point of view? The free market is always to superior to technocratic rule, healthcare being no exception.

Member
Reply to  thezman
3 years ago

Are you holding your breath?

James LePore
Member
3 years ago

Once you have a third party payer, the skimming starts. In one sense, this is just free enterprise at work. What complicates the healthcare/health insurance enterprise are the tremendous advances in pharma, diagnostic and treatment technology and medicine in general in the last fifty years. What you died of quickly fifty years ago you survive today, sometimes fairly easily. People don’t want to die. There is money to be made in this simple concept.

ErisGuy
ErisGuy
3 years ago

With insurance, come the medical emergency against which insure, you expect to be hospitalized and treated. With health care, treatment is rationed, be prepared to wait nine months for an MRI, or if all the ICU rooms are filled, be abandoned in a corridor for days (and no more will be built unless and until politicians and their allies can claim graft). The two are not compatible. If I have insurance and have a heart attack, I expect to be treated immediately. That’s what I’m paying for. If I have health insurance, I expect to be put in the queue.… Read more »

meema
Member
3 years ago

Z-man, when Trump opens up pressers to bloggers, will you apply for a pass? If not, why not?

meema
Member
Reply to  thezman
3 years ago

Good answer.

Cilla Mitchell
Cilla Mitchell
Reply to  thezman
3 years ago

Anymore than I would trust any judicial system that would have me serve as a juror.

Member
Reply to  Cilla Mitchell
3 years ago

Trust me. The lawyers will sniff you out and send you packing. I’ve been in a jury and I’ve been rejected from one. Sometimes they don’t want the unbiased or the honest…only the ignorant.

BillH
BillH
Reply to  Samuel_Adams
3 years ago

Military officer, retired for 41 years. Been called to jury duty at least eight, maybe a dozen times. Put on panel six or eight times. Struck every time. Been told on good authority that a military career dooms you for jury duty, that the defense will always strike you.

Aggie
Aggie
Reply to  thezman
3 years ago

https://www.youtube.com/watch?v=xHash5takWU

Whatever it is – I’m against it!

Teapartydoc
Member
3 years ago

This is the most pessimistic column I think I’ve ever read on this site. The best we can hope for is a dystopian BMV government health care in the future. Just because a libertarian came up with an idea means it’s utopian and not reasonable. I’m the one who talked about getting rid of licensing and funny thing is I’m a physician and both Z and the guy he referred to apparently are not. Maybe it is politically impossible. Whenever I’ve posted the idea even on libertarian sites where you would think it would get some traction it gets ignored.… Read more »

LetsPlay
LetsPlay
Member
Reply to  thezman
3 years ago

And then there is the rip-off Funeral Industry that keeps on taking from your loved ones at their weakest moment (if you haven’t provided your own plans that is!), even after you are cold.

Dan
Dan
Member
Reply to  LetsPlay
3 years ago

L.P. There’s an old saying in the funeral business, “If you can get them crying, you can get them buying”.

Teapartydoc
Member
Reply to  thezman
3 years ago

Back in the nineties when HMO’s seemed to be taking over the world the entire community of physicians in the town where I was practicing looked at forming a third party payor to offer an alternative to HMO’S for local employers. Things were getting real complicated and at one point I said, “If we want to save people money why don’t we just have price competition?”
Have you ever had an entire room stare at you blankly for five seconds and then go back to discussion as if nothing had happened? It’s an interesting experience.

Peary Brown
3 years ago

The patients today are mostly obese and don’t exercise. The health care regulating treatment is defined by monies available. Qualities & Cures is to be avoided in many cases so the patient is always a cash register. Medicalmals are at an epidemic level and the coverups prevent the general public from being aware. Tort reform supports real quackery. Avoiding treatment, saves lives. The American health care system is a joke, and the ones laughing are at the cash registers. The American consumer is in the middle if a massive crime wave and doesn’t have a clue.

Cilla Mitchell
Cilla Mitchell
Reply to  Peary Brown
3 years ago

Mr. Brown, your comment is spot on.

Rurik
Member
Reply to  Peary Brown
3 years ago

Back in the 1970s I was dating a lady doing her residency in Dermatology. She joked that it was an ideal specialty because there was never an emergency call during dinner or at midnight, and the doctor never risked losing a patient either to death or cure.

fred z
Member
3 years ago

I’m in Canada, single payer land. I have a small hernia needs repair. Diagnosed approx November 15, met with surgeon approx December 15. He said, “Yup, we need to cut, I’ll have my secretary call in the first two weeks of January with available dates.” I hauled out my smartphone, looked significantly at his and said “Why not just use our calendar apps to find dates for me, you and the surgical suites that match?” We both laughed, and laughed, and laughed. They use a paper based scheduling system. Paper based. No computers will sully their hideous, slow, inefficient scheduling.… Read more »

meema
Member
Reply to  fred z
3 years ago

Nothing like truth from the trenches. Gather up enough truth and some resourceful forward thinkers make plan b. Perhaps underground health care services? shhhhhhh

Member
Reply to  meema
3 years ago

The trenches recognize that Mr. Cochran’s progressive prescriptions are never the answer. Medicine is not immune to the superiority of the free market. Only the arrogance and hubris of an allopath would argue otherwise.

King George III
King George III
Reply to  thezman
3 years ago

Cochran is a Progressive still stuck in the year 1970. Or any year after 1935, Roosevelt, and socialized medicine, and before perhaps 1980; it hardly matters which year specifically.

So are you, though you might precede 1935 by a decade or two.

Member
Reply to  King George III
3 years ago

If we accept James Ostrowski’s definition of progressivism as he articulated in his recent book, Progressivism: A Primer on the Idea Destroying America, Greg Cochran is, indeed, a progressive and any asseveration to the contrary is nonsense on stilts. As Ostrowski recognizes, progressives (1) favor the use of democratic government force to solve human problems and (2) insist that government force will produce a better result than voluntary society and the market. Ostrowski writes, “[p]rogressivism stands for the proposition that freedom, liberty, voluntary cooperation and the free market are not enough. To best improve life, the state must intervene with… Read more »

King George III
King George III
Reply to  thezman
3 years ago

I know of an easy way to get a rough estimate of just how Progressive you are: given the choice, which would you choose to repeal:

A) No one’s suffrage?

B) Woman suffrage?

C) Suffrage for land-owning white men?

D) Suffrage altogether?

King George III
King George III
Reply to  King George III
3 years ago

C) Suffrage for everyone but land-owning white men?

james wilson
james wilson
Reply to  King George III
3 years ago

There were times when a man’s measure was taken by his land, or the number of horses or cattle he had, or wives. These days a man’s property is not so likely to be in land. Here’s a good suffrage test–
E) White man with no debt who has cut the head off at least one chicken.

Member
3 years ago

Medical care in the US baffles me, given that I’m from another era, one when doctors made house calls, ER costs were reasonable for such things as stitches, dislocated this or that, etc. Now I live in a country with a mix of national health care and private plans. The national health care service operates the free clinic in town; free even if you have a private health care plan, as I do. They’re supposed to charge me, but they don’t. Short of a major issue (fracture, serious disease, operation), I never use my health plan because of all the… Read more »

Rurik
Member
Reply to  Montefrio
3 years ago

My father was a young doctor starting out in the late 1940s, at a time when housecalls were still routine. I remember one night he came home telling he had been ambushed for drugs at one of his housecalls in a poor part of New Orleans, and had barely escaped out a side window. These days such an occurrence would be routine in almost any American city. It is not only the better facilities of clinics and hospitals which ended the housecall.

Teapartydoc
Member
3 years ago

Z is being realistic about where we are heading. I have to admit that I tell people the same thing. While we are on the road to perdition we can fiddle with the system to delay the inevitable. It’s all civilizational death and taxes. The main problem is that it is a monopoly or oligopoly in the main, but we can make little markets within the big monopoly to achieve some savings, and we can do things to weaken the monopoly. Weakening it is already being done with the addition of other providers into the mix. But it cuts two… Read more »

LetsPlay
LetsPlay
Member
Reply to  Teapartydoc
3 years ago

I like your ideas Doc but when you get to using Freddie Mac and Fannie Mae as examples, I almost choked! They are the worst examples where political appointees and those who only know graft and corruption go to twerk the financial instruments that the public depend on. They should be closed. But in general, I still say COMPETITION is where things need to go. Take out the roadblocks and special interests and let the markets work. Let the professionals offer their services and let the customers choose. With today’s technologies, there are ways to “rate” providers so the public… Read more »

teapartydoc
Member
Reply to  LetsPlay
3 years ago

If you are going to talk about altering how things are done in practical terms, which is what I think Z was asking for you have to look for structural models on which to base your ideas. The idea of a privately funded GSE as a replacement for the FDA would not entail the kinds of money exchanges and potential for corruption at the same level as a Fannie Mae. People wouldn’t be using it as a vehicle for anything like a mortgage.

Member
Reply to  Teapartydoc
3 years ago

Notwithstanding the urination imperative, you are thinking well – free enterprise is better than any state regulated racket.

bgarrett
bgarrett
3 years ago

The question no one ever asks is how to make it cheaper. —Post prices so consumers can comparison shop

Teapartydoc
Member
Reply to  bgarrett
3 years ago

Why post prices when they are controlled, and if you make a mistake and make one lower than it should be CMS will hold you to it forever?

Teapartydoc
Member
3 years ago

One thing I should have made clearer in an earlier post is that the classes of providers now referred to as “physician extenders” should be allowed to have independent practices without physician supervivision with somewhat limited prescribing ability. This would mainly hurt family and internal medicine practices but would helpmtomdrive down costs. I also think that people who practice pediatrics should not have to do all of med school and residency. There should be specific training programs for them that are independent of the usual course of medicine, say a combined six years of college and medicine with a single… Read more »

Member
3 years ago

A Canadian asks: Why don’t Americans just buy health insurance at the earliest legal age they can do so, when it would be cheap and they couldn’t ding you for “preexisting conditions”? If people aren’t smart enough to think ahead and do this practical “duh” thing, why should the rest of you have to pay for it?

Rurik
Member
Reply to  kshaidle
3 years ago

This would be a very reasonable suggestion in a system where policies were transportable when changing jobs. However in the USA, changing employers usually means changing to a new insurance plan. And loss of a job, for whatever reason, means becoming suddenly uninsured. This is one reason “portability” has become an important issue.

kokor hekkus
kokor hekkus
3 years ago

The truth is that the progress in medicine is much slower than people even imagine. Almost all of the increase in life expectancy in the first half of the twentieth century was due to improved sanitation and food safety. Since 1965, sd Nassim Taleb points out, most or perhaps all of the increase in life expectancy in the US is attributable to the decline in smoking rates and tobacco use. So medical research, much of which is so shoddy that it has spawned the” reproducibility crisis”, has provided very little return on investment. The truth is that you are responsible… Read more »

Teapartydoc
Member
3 years ago

Some ideas about office regs. Repeal the CLIA 88 law and allow physician office laboratories and independent labs. That law facilitated the current near monopoly system of labs we see now where everything is hospital, large practice and Labcorp. Repeal universal precautions via OSHA for offices and clinics outside hospital campuses. This was a reaction to the AIDS hysteria and was enacted without any prior studies showing that lives would be saved. When it went into effect, I did gross calculations on the cost of simply having a biohazard trash can in every exam room and came up with a… Read more »

Teapartydoc
Member
3 years ago

Create a separate GSE for rural hospitals to replace the Joint Commission on Hospital Accreditation for hospitals in communities of less than fifty thousand residents. The current JCHA acts in ways that are prejudicial to smaller hospitals and jeopardizes their existence by holding them to standards that only larger facilities can keep up with. This would make for people in small towns able to have their babies locally and perhaps not die of acutely bleeding ulcers because their local hospital has closed and now they have to take a helicopter ride to get care. Few people know how centralization of… Read more »

Teapartydoc
Member
3 years ago

Allow people to buy their own hospital or outpatient surgery disposables. I once knew a doc who told me his dad had gone to India to have a surgery. May have told this story here before. His dad figured out his out of pocket expenses and had a $10,000 operation done in India for $240 and visited relatives in the mean time. Before his surgery he was given a list of things to buy and deposit with the clinic a week ahead of time. He went to health care supermarkets, bought the items and left them with the facility beforehand.… Read more »

LetsPlay
LetsPlay
Member
Reply to  Teapartydoc
3 years ago

Like auto accessories and options … that is where the real money is!

JML
JML
Reply to  Teapartydoc
3 years ago

It surprises me that medical tourism is not more common in the Us, given the out of control price issues, you’d think there would be a line of cheap clinics and hospitals along the Mexican border, perhaps Mexican regulations are just as onerous, or the security issues?
Many people in Australia now fly to Asia especially for dental work. But increasingly for medical as public waiting lists get longer.

Teapartydoc
Member
3 years ago

Repeal the Stark Laws which outlaw physicians referring to facilities they have an interest in but require that 75% of the ownership be other than medical practitioners and require that the outside shares be bought at public auction.

Teapartydoc
Member
3 years ago

One thing you haven’t seen me do is call for tort reform. Tort reform is the DR3 argument in medicine. Lawyers aren’t the problem, they simply take advantage of what is there. The problem is that too many dollars are tied up in health care and there are too many deep pockets and the pockets keep getting deeper.

Teapartydoc
Member
3 years ago

Repeal HIPAA and say that punishing people for leaks and bad record keeping is a state problem to be handled by state courts.

Drake
Drake
3 years ago

I’m in the health care industry so I have to self-censor here. There are lots of projects going on to make aspects of health services cheaper and more efficient – just like most other industries. Due to the chaos caused by Obamacare, there are at least as many efforts going on to simply get paid for those services. We spend more time trying to figure out if the government, an insurance payer, or (heaven forbid) the actual patient has to pay – and actually extracting that payment upfront. I wouldn’t dismiss free-market reform out of hand. Hospitals are ripe for… Read more »

james wilson
james wilson
Reply to  Drake
3 years ago

Great link, Drake. This is a simple seven minute demonstration of voluntary markets vs. everything else. And it should be simple to understand that in such a system the cost for carrying the poor, the helpless, and the slackers would be a smaller fraction as well paid by a wealthier citizenry.

King George III
King George III
Reply to  james wilson
3 years ago

Yes, James Wilson, surely if you simply adequately demonstrate the excellence of “voluntary markets”, you’ll convince the people who are currently sticking their hands into your pockets to stop sticking their hands into your pockets.

james wilson
james wilson
Reply to  King George III
3 years ago

It is not the finger that needs an education, it is the pocket.

Teapartydoc
Member
3 years ago

Regs give protected industries something to hide behind. They get a quasi-monopoly and have to put up with regs, but they end up writing them themselves via lobbying. I say that public protection makes them public industries. Make all medical societies have their meetings in public buildings and allow the public in. All meetings are to be recorded. No secret executive meetings. I would even apply this to hospital committees. They are getting public protection so let them be open to the public. If there’s a problem doctor on staff everyone should know. And this would clean up punitive credentialing… Read more »

Member
Reply to  Teapartydoc
3 years ago

Why not just jettison the whole rotten regulated regime and let free enterprise carry the day?

teapartydoc
Member
Reply to  Libertymike
3 years ago

That’s what I said yesterday and why we are having this discussion today.

LetsPlay
LetsPlay
Member
Reply to  Libertymike
3 years ago

That’s what I keep saying … get government out of it and let competition run things.

Teapartydoc
Member
Reply to  LetsPlay
3 years ago

Not possible to get govt out without abolishing licensing.

Teapartydoc
Member
3 years ago

Droning on. The main problem I have with medical licensing is that it is the dispensation of privilege by the government. Ultimately, resentment of privilege is the driving force behind all democratic revolutions. If we use the French revolution as our model we realize that in some instances fighting against centralization and privilege can in some cases backfire and you end up not only with a despotism but an even more oppressive bureaucratic regime than you began with. And dispensation of privilege can be addicting for governments. The more you have the more you get. It becomes, in the model… Read more »

el_baboso
Member
Reply to  Teapartydoc
3 years ago

Doc, you have confirmed many of my worst fears today.

Member
3 years ago

Two of the biggest changes in my lifetime – the democratization of air travel and the entire internet and wireless telecommunications revolution – resulted from massive government deregulation in the 1980’s. In today’s dollars, air fares have dropped 25% in the last 25 years. There are more routes, more services, and more choice than ever before. It’s also safer. Breaking up Ma Bell quite literally resulted in the nearly simultaneous explosions of both the wireless telecomms and the internet within 10 years…both of which changed the world. Opposition to both largely revolved around trying to scare the public about the… Read more »

guest
guest
3 years ago

It’s interesting how you managed to cherry pick the worst of both worlds in the US, you took the worst elements of socialized medicine, the worst parts of private medicine, and merged it into one big cluster fuck, bravo Obama! This is how your buddy Karl would save the system: “One thing that will actually fix the problem: Enforcing 15 United States Code against all medical and health-insurance related firms. We could start by enforcing Robinson-Patman, which federally bans price discrimination for buyers of like kind and quantity, against pharma firms and hospitals. We could enforce the anti-collusion components of… Read more »

Ned2
Ned2
Member
3 years ago

The health care industry in this country is a criminal scam, perpetrated by drug companies, insurance companies and government. If they were selling anything else, they would all be in jail for violating any one of dozens of laws against racketeering, price fixing, kickbacks and collusion with elected officials.
The only ones benefiting from this unexpectedly transparent charade, are the architects of it.

teapartydoc
Member
Reply to  Ned2
3 years ago

The scam all began with medical licensing. That was the camel’s nose under the tent.

Rurik
Member
3 years ago

There was a subtle but fundamental change in the second half of the last century, denoted by a change of language. IN the first half of the century we considered “medicine” and “healing” to heal wounds and accidents, and cure disease, Infections began to fall to penicillin, sulfa, and other antibiotics, but heart disease, stroke and cancer still remained the great death sentences. Then in the latter half they too began to fall to medical progress. Some cancers have been curable, many patients survive three to five or more heat attacks, and I not only survived, but completely recovered from… Read more »

Drake
Drake
Reply to  Rurik
3 years ago

Now that the collective “we” has to assume the financial burden of all risky behavior, of course that behavior will be frowned upon and eventually outlawed.

LetsPlay
LetsPlay
Member
Reply to  Rurik
3 years ago

Maybe “medicine” has changed to “prevention” mode but Big Pharma has gone from curing to “maintaining” and developing revenue streams based on the annuities of prolonged use of expensive drugs. There is no motive to cure anything when profit growth is the motive for the bottom line of the corporation and not curing diseases. As Zman says, the rate of cures has dramatically fallen off while the cost of research has skyrocketed. Like climate research, it is an industry in and of itself using the “public safety” as the excuse for extended and costly development and testing, and delays in… Read more »

meema
Member
Reply to  LetsPlay
3 years ago

Three words – follow the money. Recently went to my check up after cataract surgery. Doc and I chatting about the hope this also corrects my glaucoma, which led to how expensive the meds are. I said my insurance company tried every angle to get me to switch to generic. I tried but they hurt my eyes. Doc said she fights the insurance companies all the time. She had one patient that had great success with a med but the insurance company kept insisting she prescribe another one. I said – so you go to school, learn the skills, set… Read more »

Teapartydoc
Member
Reply to  meema
3 years ago

Great comment Meema.

J Clivas
3 years ago

Want to know what government health care will be like? Visit a VA Hospital.

jdallen
jdallen
3 years ago

Clivas is correct. That’s the only solution. It’s the solution now, and it has been for a long, long, time. Two tiers of care. The free, or low cost, variety that most anyone can afford, or the high quality, excellent care from them as has the wherewithal. We just play at providing everyone with the same level of care. We should face facts and proceed from there, rather than pretend that someone like me with get treatment equivalent to a Representative, Senator, President, or other rich and worthy person.

Buckaroo Banzai
Buckaroo Banzai
Reply to  thezman
3 years ago

Except we don’t really have it, because we have one medical system serving four different constituencies– Medicaid users, Medicare users, Insurance users, and cash customers. We need four different systems, one for each constituency: free clinics for Medicaid customers, special gerontological services for Medicare uses, insurance clinics and specialists, and cash clinics and specialists. Hospitals can be cash-only, or can work on a contract/wholesale basis with any number of the other three feeder systems.

DrTorch
DrTorch
3 years ago

You seem to be concentrating on medical treatment of disease. Medical treatment of trauma is quite good. I had a car accident some years ago and the follow up surgeries were well done and effective. I know several people who have had hip or knee replacements done in 2016, and they are elated at the results. Success like this was not a given in the 1980s, and not even reality in the 1950s or earlier. You also look past diagnostic equipment which complements treatment of both disease and trauma. You are absolutely right there is much to learn about the… Read more »

trackback
3 years ago

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DFCtomm
Member
3 years ago

the current system will mostly likely stagger along until it collapses.

It’s closer than you think.

http://market-ticker.org/akcs-www?post=231764