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.

104 thoughts on “The Truth About Health Care

  1. Pingback: Not Being Careful About the Truth |

  2. 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 human body, including diet and genetics. But medical advancements have been real, effective and much faster than a glacier’s pace. It costs more now b/c it’s worth more now.

  3. 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.

    • We have had this for a long time. Medicaid was supposed to be for people who could not afford insurance. Medicare is for old people, who no longer have income. Everyone else is in the insurance model. The trouble is government meddling, tax farming and other rackets have made a hash of things.

      • 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.

  4. 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 a stroke in 2009. Medical science continues to advance. But now the goal has shifted from healing to “prevention”, as symbolized to the new term “Healthcare”. The new goal is to assure that the body never becomes sick or damaged in the first place. This has led to “The Aseptic Society” in which everything potentially deleterious is eliminated, including all physical risks. this is symbolized by the seatbelt and the bicycle helmet and kneepads.
    In the Eighteenth Century eating meant getting enough to fill one’s belly and silence the growl.By the Twentieth, in the Western world at least, Eating had become dining, a daily pleasure for people, an aesthetic and relaxing experience. Now in the Twenty-first meals have become a clinical procedure, with carefully measured and controlled portions, scientifically designed and constructed according to the latest dietetic fad of the week. The other day at another sites, I saw a comment that Californians are now so terrified of gluten, it is possible to rob a bank by brandishing a bagel. And almost anything which tastes sweet or otherwise pleasurable becomes forbidden. Worse even than second-hand smoke, is the risk of second-hand peanuts or gluten. No wonder people are no longer reproducing.
    While this diseasophobia may serve to minimize expenses of medical treatment, saving the insurance companies costs. It also provides a perfect, and noble rationale for the Cloud People to control every aspect of our lives “for our own good”.After all, if smoking, drinking, drug-taking, and diet can affect your health, so to can exercising too little or too much, or in hte wrong manner. Or any and every other detail of your daily life, even the way you choose to vote.

    • 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.

    • 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 bringing products to market until current patents expire.

      • 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 up practice and yet the money crunchers think they know best?

        Tell me again, why do we need doctors? Perhaps the drug commercials should conclude – “Ask your insurance company if this is right for you!”

  5. 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.

  6. 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 Sherman and Clayton against everyone, and indicting anyone who won’t post a price and charge the same price to everyone without regard to how they pay. In short we could take the monopolists in both insurance and medicine out back behind the woodshed and offer them a choice — either cut it out, right now, or go to prison under 100+ year old already-existing law and have your corporation ruined with $100 million per-count fines, and remind them that we will tally every person that gets screwed as a separate and unique count.”

  7. 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 dangers of deregulated* air travel and “protecting consumers” (AT&T).

    *as a result, air travel was only partially deregulated…the government still has a monopoly on the infrastructure. If the airports were similarly deregulated, we would see further price reductions and better service.

    I can now re-book an inconvenient flight to a more convenient – and less expensive – flight from a $400 wireless device which contains more computing power than existed in all of mankind combined until about the year 2000.

    The way to get the pharmaceutical companies and the insurers to get on board is to deregulate the crap out of them. This will massively increase their profitability (which they will LOVE) in the short run. And it will reduce barriers to entry and overall costs in the long run. That was how Obama bribed them into supporting Obamacare… $80B in subsidies and a mandatory 40,000,000 new customers. He sold them the rope that he would hang them with.

    The way you get them to flip is to offer a stay of execution in exchange for deregulation.

    We know how to do this. But it has to be done in a way that ensures the biggest opposition quickly gets on board with something that they would naturally enjoy: less government regulation which increases profitability.

  8. 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 of Carroll Quigley, the instrument of expansion that eventually becomes an institution which then becomes a burden to society.
    The problem that began with licensing physicians then becomes licensing for pharmacist, then nurse, then CNA’s, physical therapists, dieticians, barbers, beautician, dieticians, florists, electricians, various grades of engineers, etc. Passing out a privilege to one group leads to passing out more. All at a temporary profit and acquisition of more control for the government. And like the old regime in France it creation of more offices and finding ways of making the nobles of the past to pay in new ways to maintain their privilege means churning the accounts. Eventually some of the nobility begin to agitate against the regime. Maybe that’s me. But I’m certainly not a Duc d’Orleans. He is yet to come.
    When they had the local meetings of the estates before the Estates General met we know from the research of Tocqueville that some of the cahiers called for breaking up the hospital monoplies and creation of local clinics in towns and villages. They had the same problem there even without formal licensing. The problem then was in colleges of physicians holding independent monopolistic power with the backing of the crown. Essentially the same thing, maybe worse. The basic problem is privilege handed out by government. The less of it we have the stronger our republic and the farther from despotism.

  9. 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 and sham peer review, too.

  10. 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 redesign. Here’s is a video of what a hospital would look like without government or insurance interference, and without people showing up in an emergency room with no intention of paying for services.

    • 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.

      • 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.

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

  12. 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.

  13. 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.

  14. 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. The logic of having to drop them off beforehand means that if something wasn’t purchased the clinic could supply it and charge a premium for having to do so. No reason why we couldn’t do the same here.

    • 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.

  15. 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 health care can be such a rip off. I have worked at trauma hospitals. Once a guy was brought in by helicopter from a town that was little more than a suburb of where I was working. There was a freeway between there and the hospital. The reimbursement for using the helicopter was bigger. What could have been a fifteen minute ambulance ride ended up taking four hours. Many traumas that get helicoptered could be taken care of at smaller facilities but when these facilities don’t exist because of closure or monetary restraints on opening because of bad reimbursement policies, you end up being flown around. The big hospitals love it.
    If you live in a small town and have seen your local hospital taken over by a big one because it was on the brink of closing have you seen it improve? Not in most cases. They just did it to have some control over the referral pattern. For fucking “market share” in an industry where there is no fucking market.

  16. 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 conservative figure of four billion dollars nationwide for that one simple reg. That cost is passed on to you. Four billion with one swipe of some bureucrat’s pen. Most offices will still engage in overkill for some time because this is the way they were trained, but sooner or later common sense jumps in .
    Equalize payments to physicians and facilities regardless of location. Most people don’t realize that urban hospitals and providers get a thirty percent premium based on their location and wonder why there are no doctors in small towns and rural hospitals are dying. This bullshit should stop, but who will speak up for the peasant? The peasant is the ultimate victim of all planning. This is where your white genocide starts. The whites are the peasant class. This is why libertarian economics should be of importance to the alt right.

  17. 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 for your health. Exercise daily, avoid processed carbohydrates, keep your weight under control.

  18. 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?

    • 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.

  19. 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 degree.
    The whole idea is that if you dilute the benefit of licensing to a great degree, taking away the benefit to the profession that it gained by licensing in the first place, you both punish the profession, and drive it down to the point that it regrets licensing in the first place. I’m already there, I just want everyone else to catch up.

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

    • 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?

  21. 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 ways. When I was a kid most hospitals would not give privileges to podiatrists because the orthopedists debarred you see them everywhere. The problem is that podiatrists were cheaper before they got privileges and before they were accepted by insurance. Funny that. But they did have a downward pressure on prices for a while. Nurse practitioners do the same thing. The problem is in incorporating them into the system at large, inflating their prices. It may be that having less direct control over providers that have limited prescibing habits would help. More independence of NP’s and PA’s.
    As for insurance, getting rid of highly politicized state boards would help. Being allowed to buy across state lines might help drive down costs. This is one area where invoking the commerce clause would be a big deal, and where state level oligopolies would be broken up. Mandating that people be able to keep any insurance plan for themselves and their families after changing employment would help to quickly break the bond between employment and insurance. Employer provided insurance is a relic of wwii wage and price controls and makes for a kind of serfdom binding people to their employer. Being able to purchase across state lines would facilitate this.
    On the provider side, I would allow for providers to have sales.believe it or not, while there is no law against it, having a sale is de facto barred by Medicare regulations. If CMS ever catches a doctor or health system charging a lower than usual rate for a service or procedure they then lock you into it and will only pay at that rate in perpetuity. That is a big reason as to why the price ratchet in medicine only sale is one way. It is idiocy, but the rest essentially mandate constantly rising prices. My understanding is that retail sales in some European countries are stricly regulated and can only take place on certain days and for certain periods. The wisdom of doing something like this in a highly regulated environment is that it gives the regulators a peak at what might actually be happening if there is a real market.
    Again, this is provider side. Eliminate all mandates concerning electronic medical records. No incentives either way. Watch how fast independent offices drop them. The big systems will keep theirs, but requiring everyone to have them was a way of forcing the small providers to subsidize the big ones, because it put more money into the pockets of the developers who then pass on the savings to big clients for big contracts.
    Privatize the FDA. Make it like Fannie Mae and Freddie Mac. A government sponsored enterprise. Have it staffed by industry researchers and karate that it be composed of numbers of them from various companies such that no one company has a majority. They are then all paid by private industry.
    I’m old and I need to go pee. I can’t think so well now. As you can see things can be tweaked. I could go on all day.

    • 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 is more aware (compared to today) of what they get for their buck. And of course, as in any market, if you want the best, it will cost you more.

      • 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.

  22. 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 paperwork, long waits and co-pay; I keep it for catastrophic care, although I could get that free as well if I were willing to go to a public hospital, not the wisest of moves. The clinic attracts its share of those who aren’t sick but simply killing time watching the teevee in the waiting room (which forces me to sit outside), but if one goes toward the end of the morning, there´s usually no wait. The doc and nurses are all acquaintances or friends, so in this small village on the clinic level at least, the national health care system works. Would such a system work in the US? I doubt it.

    • 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.

  23. 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. All of this took place in a new hospital that cost me and mine $CAD1.3 billion in revealed costs and probably the same in hidden ones.

    I spoke to the doc’s secretary a week ago, enquiring. She says she had to contact all of the people the doc diagnosed as needing surgery in November and early December, before he saw me, to offer them surgery dates, first come first served. No problem, that’s fair play. She said it would take two weeks.

    Two weeks to contact maybe 60 people? This hospital opened in January 2013 and the administrators are too stupid and/or lazy to get calendar the software given away for free by Google and the other bigs. They have never asked me for my email. They sent me my appointment notice by snail mail at a minimum cost of $3.00 a letter. I expect they think fax machines are suspicious modern witchcraft and have never heard of email and would face some medical inquisition if they dared to use it. I am surprised they even use phones – apparently, because they have never called me, though they claim they will.

    We have not only single payer healthcare, but a system fully moderated and controlled by the government, with a huge, expensive and apparently useless central computer system. Despite that, every single time I see a doctor or have a test I have to fill out a form, always different, put together by the facility secretary, photocopied multiple times so it’s crooked, in pen, telling them I have no medical allergies, no recent surgeries, no heart condition etc., etc. et endless cetera.

    It’s January 17th and still no word. I expect that ‘”first two weeks in January” mans “first two months of 2017, maybe”.

    But the joke’s on them, and me, because I’m booked at a private clinic, out of their jurisdiction, for surgery on February 6 at a cost, in addition to my taxes, of $CAD5,000.00. I can afford it. What about the poor schnooks who cannot?

    There is nothing, absolutely nothing, that the leftiness inherent in us all will not use to enslave us.

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

      • 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.

        • You keep using the word “progressive.” It does not mean what you think it means. Calling Greg Cochran a Progressive is the sort of thing stupid people say.

          • 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.

          • 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 men and women carrying guns and willing to use them against resistance and break up those voluntary relations and impose its will by brute force to achieve different and presumably better results. At the bottom of progressivism is a quasi-religious belief in state action (force) over individual choice.”

            If one accepts the definition of progressivism offered by the likes of Tom Woods, Butler Shaffer, William Norman Grigg, Murray Rothbard, Walter Block, and Thomas DiLorenzo, one readily concludes that Greg Cochran is a progressive.

            If one favors rule by the administrative state, one is, by definition, a progressive. Thus, those who favor the licensing of occupations by the state are progressives.

          • 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?

          • 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.

  24. 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.

    • 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.

  25. 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. The idea that libertarians are backstabbers is true. They get one good idea and when you pick up the ball and start running with it they trip you.
    There are other ways to attack the problem, but they are convoluted. Easier to cut at the root. So I’m a radical.
    I’m going to make a separate post about other things.

    • If I were dictator, I’d repeal all government regs on health services. I’d round up the health care policy experts and have them shot. maybe exile their families to an island somewhere far away.

      But, there’s too much money to be made in ripping off sick people so it will never happen.

      • 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.

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

      • 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.

  26. 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. If the same hospital treats both the insured and the cared, if I, the insured, have a heart attack, where in the queue will I be put? Being put first in line will anger the patiently waiting. Being put at the end of the line angers me (before killing me), which angers my relatives (maybe).

    People like health care because it hides the heirarchy of privilege. No one politically connected will ever wait in line, while everyone “the people” know waits in line like themselves.

  27. 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.

  28. 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 paid anything.

    But when Farage talked the National Health Service here not being an International Health Service and costing the people of there UK zillions he was roundly attacked by the assorted virtue-waving lefties, greens, commies and hangers-on, many of who would probably now like to see this Nigerian cough up what she owes.

    Pretty much a case of stable doors and bolting horses.

    • 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 and make them pay, one way or another. ;>)

    • We have a similar problem. Frost backs from Canada sneak over to use American health care as they get tired of ten month waiting lists for maternity wards. We also have the added burden of Big Pharma. The rest of the world imposes cost controls on medicine, so the cost of inventing new drugs falls on US consumers. It’s not an accident that the big pill makers do all of their work in the US, even the ones that are technically European companies.

      All of it is a massive shell game. The NHS cooks its books by parking patients in idling ambulances so they can pretend to hit their service numbers. This is just a form of rationing. Of course, Tony Blair will never be subjected to such treatment as there is a separate system for the wealthy and powerful.

  29. 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 deserves criticism, much of that criticism comes from promoters of various types of quackery. Of course, the solution for modern medicine’s problems is not to revert to per-scientific nonsense.

    While lefties of all strains go for all kinds of this stuff, there are certain Christian populations that go for “alternative” medicine.

    The anti-quackery movement also tends way liberal, although not crazy-left. While being pro-scientific medicine they’re all big believers in Gorebull Warning, and “deniers” are on par with medical quacks.

    • 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?

      • “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.

        • 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.

  30. 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

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

  31. 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.

    • 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.

  32. 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.

    • 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!

  33. 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 just go away. A lot of people would have something better to do on a Saturday afternoon. That is callous, I know. Just because there is nothing visibly wrong, doesn’t mean that there isn’t something wrong. If you don’t treat it now, it will only be worse later. I get all that. But what I see is real world rationing of health care, simply by the virtue of not being able to fit any more people through the door. Not in the hours I was there did I see one person in obvious danger being rushed in the door by paramedics or an ambulance staff. No, just a lot of people with boo-boos and the staff serving some sort of babysitting function.

    When there is reason for multiple people to be rushed to the ER for true lifesaving treatment, all of this other stuff will be pushed aside. And some of the people being pushed aside will not be happy about it. Because health care is a “right” and they want their share. After all, it is not real money. It is paperwork and health cards and physician referrals, not cash on the barrel head.

    The cloud people would not come within a million miles of a middle class ER. They have their own system, and they drop cash on the desk for it. The rest of us are encouraged to pound sand.

    • I just listened to a ‘supplemental’ Daily Shoah:
      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 they have to deal with everything from the sniffles to bleeding gunshot wounds.
      One of the theories of ”0bamacare” (and ”Hillarycare” and ”Romneycare”) was to help take the load off ER’s – but there are three problems with that:
      1. There aren’t that many General Practitoners, the financial/carreer incentives discourage doing that (and have for decades).
      2. Many folks don’t live in the same area long-term. Many people move every 3-7 years, and like all the other factors of moving, that means finding (if possible) and establishing a relationship with a ”gatekeeper” GP (again, if possible) and doing it all over again at the next move. IOW, for more people than you think, next to impossible.
      3. The 24/7 culture, something rather unique to the US. Want a Big Mac, to fill up your car, or general shopping at 3am? Quite a few McD’s, all 7-11s, and most Wal-Marts are open ’round the clock. That’s something that really can’t be said of most countries. So you can’t get ahold of your doc and you’re sick or hurting at 3am? Guess what else is open 24hrs?
      The sugesstion ”Dr. Narcan” provided, and one I think will eventually shake out, is like Italy, a combo public/private system not unlike US education: You want ”take any and all comers, no matter what” (and do, at best, mediocre with them) there’s the *ahem* ”free” public system. If you want quality, and are willing to pay for it, (and they don’t have to ”take any and all comers, no matter what”) there’s private healthcare.

      • 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.

        • 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.

  34. 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 to have pricing up front. And we could use things like tort reform and health savings accounts that carry over.

  35. ‘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.

    • 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.

      • 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?


        • 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.

    • 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 I must honor for years at a time. I pay by the month, and if I want to quit and go elsewhere, I can do so at any time.

      Tell me again how the market has failed when it comes to cell phones and communications.

    • 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.

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