Editorial
Here is a thought provoking editorial by Thomas Sowell that I thought was interesting related to our current health care situation
No "Health Insurance"?
September 03, 2007 02:00 PM EST
During the first 30 years of my life, I had no health insurance. Neither did a lot of other people, back in those days.
During those 30 years, I had a broken arm, a broken jaw, a badly injured shoulder, and miscellaneous other medical problems. To say that my income was below average during those years would be a euphemism.
How did I manage? The same way everybody else managed: I went to doctors and I paid them directly, instead of paying indirectly through taxes.
This was all before politicians gave us the idea that the things we could not afford individually we could somehow afford collectively through the magic of government.
When my jaw was broken, I was treated in an emergency room and was given a bill for $50 -- which was like a king's ransom to me at the time, 1949. But I paid it off in installments over a period of months.
Like most young people, I was lucky enough not to have any heavy-duty medical expenses that would have required major operations or a long hospital stay.
That is still true for most young people today, which is why many people in their twenties do not choose to pay for medical insurance, even when they can afford it.
They know that, in an emergency, they can always go to an emergency room. And today the idea that you ought to pay for that out of your own pocket is considered almost quaint in some quarters.
It is not uncommon -- especially in California, with its large illegal immigrant population -- for hospitals to have to shut down because so few people pay for the emergency room care they receive.
There are, of course, people with huge medical bills that they cannot possibly pay. Believe it or not, that also happened back before the modern welfare state.
Some hospitals -- whether public or private -- could absorb such costs, with the help of donors. There were people with polio living in iron lungs, which is why rich and poor alike gave money to the March of Dimes.
But that is very different from hospitals being stiffed every day by emergency room users whose only emergency is that they want to keep their money to spend on fun, instead of on doctors.
The biggest of the big lies in the "health care" hype is that a lack of insurance means a lack of medical care. The second biggest lie is that health care and medical care are the same thing.
Doctors cannot stop you from ruining your health in a hundred different ways, so statistics on everything from infant mortality to AIDS are not proof of a need for government to take over medical treatment.
Few people show the slightest interest in what has actually happened in countries with government-controlled medical care.
We are apparently supposed to follow those countries' example without asking about the months that people in those countries spend on waiting lists for medical treatments that Americans get just by picking up a phone and making an appointment.
It is amazing how many people seem uninterested in such things as why so many doctors in Britain are from Third World countries with lower medical standards -- or why people from Canada come to the United States for medical treatment that they could get cheaper at home.
Government price controls on pharmaceutical drugs are more of the same illusion of something for nothing.
People who are urging us to follow other countries that control the prices of medications seem uninterested in the fact that those countries depend on the United States to create new drugs, after they destroyed incentives to do so in their own countries.
Since it takes more than a decade to create a new drug, a politician can be elected president by hyping price controls on drugs, spend eight years in the White House, and be living in retirement before people start to notice that we no longer get the kinds of new medications that successively conquered deadly diseases in the past.
No "Health Insurance"?
September 03, 2007 02:00 PM EST
During the first 30 years of my life, I had no health insurance. Neither did a lot of other people, back in those days.
During those 30 years, I had a broken arm, a broken jaw, a badly injured shoulder, and miscellaneous other medical problems. To say that my income was below average during those years would be a euphemism.
How did I manage? The same way everybody else managed: I went to doctors and I paid them directly, instead of paying indirectly through taxes.
This was all before politicians gave us the idea that the things we could not afford individually we could somehow afford collectively through the magic of government.
When my jaw was broken, I was treated in an emergency room and was given a bill for $50 -- which was like a king's ransom to me at the time, 1949. But I paid it off in installments over a period of months.
Like most young people, I was lucky enough not to have any heavy-duty medical expenses that would have required major operations or a long hospital stay.
That is still true for most young people today, which is why many people in their twenties do not choose to pay for medical insurance, even when they can afford it.
They know that, in an emergency, they can always go to an emergency room. And today the idea that you ought to pay for that out of your own pocket is considered almost quaint in some quarters.
It is not uncommon -- especially in California, with its large illegal immigrant population -- for hospitals to have to shut down because so few people pay for the emergency room care they receive.
There are, of course, people with huge medical bills that they cannot possibly pay. Believe it or not, that also happened back before the modern welfare state.
Some hospitals -- whether public or private -- could absorb such costs, with the help of donors. There were people with polio living in iron lungs, which is why rich and poor alike gave money to the March of Dimes.
But that is very different from hospitals being stiffed every day by emergency room users whose only emergency is that they want to keep their money to spend on fun, instead of on doctors.
The biggest of the big lies in the "health care" hype is that a lack of insurance means a lack of medical care. The second biggest lie is that health care and medical care are the same thing.
Doctors cannot stop you from ruining your health in a hundred different ways, so statistics on everything from infant mortality to AIDS are not proof of a need for government to take over medical treatment.
Few people show the slightest interest in what has actually happened in countries with government-controlled medical care.
We are apparently supposed to follow those countries' example without asking about the months that people in those countries spend on waiting lists for medical treatments that Americans get just by picking up a phone and making an appointment.
It is amazing how many people seem uninterested in such things as why so many doctors in Britain are from Third World countries with lower medical standards -- or why people from Canada come to the United States for medical treatment that they could get cheaper at home.
Government price controls on pharmaceutical drugs are more of the same illusion of something for nothing.
People who are urging us to follow other countries that control the prices of medications seem uninterested in the fact that those countries depend on the United States to create new drugs, after they destroyed incentives to do so in their own countries.
Since it takes more than a decade to create a new drug, a politician can be elected president by hyping price controls on drugs, spend eight years in the White House, and be living in retirement before people start to notice that we no longer get the kinds of new medications that successively conquered deadly diseases in the past.
Labels: healthcare
posted by Anonymous at 5:57 AM
7 Comments:
This comment may not be exactly on target with the subject discussed in the blog...but it is relevant.
It has angered me for quite some time that the price charged for medical care to the individual who pays privately because of no insurance is escalated due to the "price fixing" made by the insurance companies and providers.
Let me explain for those who may not know.
Whenever a provider (MD, hospital, nursing home, etc.)negotiates a contract with an insurance company...or even Medicaid or Medicare...the fee is determined by the private pay patient's fee as well as "expenses". Insurance companies, as well as the government through Medicaid and Medicare, expect a reduced fee for services rendered. THEY WILL NEVER ACCEPT THE SAME RATE CHARGED TO A PRIVATE PAY PATIENT. As a result, the provider typically inflates his/her charges to a huge fee, knowing the negotiated fee will reduce that private pay rate by about 25%.
As a result the rate charged to the private pay patient is always an inflated fee. And here is the kicker. The provider cannot discount to the private patient because that becomes the new private pay rate and therefore the basis from which the discounted insurance is then determined.
I can't afford to seek medical care because of this game. It would be wonderful if the private pay rate could be kept out of the loop when calculating the rate agreed upon between the provider and the insurance companies.
HB, is it a Pollyanna idea? Could this be pursued? Could changes be made at the legislative level to address this practice?
The author of the article you posted on the blog uses an experience he had with an emergency room charge. I am certain the fee he paid privately did not contain an artificially inflated cost basis. I believe firmly that more people would seek health care before complications set in if the the fees were more reasonable...even if they had to pay privately.
Excellent points and the majority of what you stated is correct.
Physicians can discount services for private paying patients and most primary care physicians do this routinely if the patient inquires about it.
Physicians cannot charge a medicare, medicaid, or third party payer a lower than negotiated fee as that would cause legal problems.
But anyone paying out of pocket because they have no coverage can negotiate a fee without affecting the other contracts.
Completely eliminating office visits to primary care offices from medicare, medicaid, and 3rd party payers would allow primary care physicians to lower there fees by more than half.
We could eliminate the need to file claims (saving thousands in employee and related billing costs) and patients would know that it would cost 25-30 dollars to come to the office.
HB are you saying that if a patient chose not to use their insurance when visiting an MD's office and payed privately, they could expect to pay about $25 - $30 a visit? For someone who typically does not utilize the medical system enough to meet their deductible annually, they could purchase a very high deductible insurance policy for catastrophic protection, save money and just pay privately for office visits by not filing their office visit. Is that an option that can be done legally?
That is exactly what the new MSA's and HSA's allow you to do.
We do this routinely at our office.
20 years ago, their was no "allowable charges" establish by health plans, they paid whatever the doctors charged. The doctors decided why just be a millionaire when they could be multi-millionaires and began to accelerate their charges at 2 - 3 times the rate of inflation. That's how we've gotten to this point. Do you think anybody believes your assertion that the doctors would now drop what they're reimbursed for office visits by half?
Ha, ha, ha, ha, ha, ha, ha, ha
I am not a physician, but my career was in the health care field. I speak from experience of management. As part of my job, I negotiated contracts with the insurance companies, and did cost reports to establish Medicare, Medicaid rates.
To anonymous 5:27 pm, you are way off base. And you owe Dr. Eichenberger and all other physicians an apology. The insurance companies are the ones who have gotten greedy. They are the ones who demanded excessive discounts that drove charges. (Their strategy is that they bring a large list of clientele to the table and can therefore control the quantity of patients who utilize an individual physician's practice.)
Obviously there are other factors that have influenced the cost increases we now realize, such as technology, cost, etc.
But providers were forced to raise their charges to offset the leverage the insurance companies enjoyed. If you doubt my information, I suggest you look at the annual reports of insurance companies. Did you ever wonder why the immensely successful Humana flipped from provider side of the coin and is now excusively on the insurance side? Some of the readers of this blog may not remember that Humana started in the nursing home business, moved to hospital ownership, and is now only insurance. They didn't abandon the position of being a provider to being one of the largest insurance companies in the nation simply because it was different.
And Anonymous 5:27 pm for your info, I have asked my personal MD for a discount since I had not acquired insurance after retiring, and the bill was discounted drastically. Don't bad mouth the physicians in this area just because you are too distrusting to discuss this issue with them. It is your fault...not theirs that you are quick to think the worst of people. Is there a lesson to be learned here as well about being a Christian?
Does the author, Sowell, realize we are pitiful when compared to Scandinavian countries, France, etc. in overall healthcare and satisfaction with the healthcare system in our country. What is the difference in paying a tax to the federal government and a payment to a private insurance company. Insurance companies and drug companies lobby all day long against universal healthcare and spread rumor and worry with comparisons of countries that are not good models for government controlled medicine. Anyone who is out in the real world and has to deal with a serious health problem can vouch for how it can ruin you financially. To be content with our current system is nuts.
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