Why health care is so expensive

[tvashtarkatena]

Just heard another gem. This one was from Michael Medved. At least now we're getting at the real value system in place here and which is being foisted daily on the masses of mouth breathers:

 

 

Caller:

I think we already have healthcare rationing

 

Medved:

Ok, I agree, but I would rather have free market elements rationing my care than some big government entity.

 

Caller:

But that's still rationing and it's still making it very difficult for people to obtain coverage

 

Medved:

Look, at least with the private sector in control, if you don't like your current insurance you can just switch to another. And if you don't like any of the options being offered, you also have the freedom to choose to pay for your medical bills yourself! Unlike in Canada where you're not allowed to not use the government plan! The free market rations lots of things, like cars and houses...everyone buys the best product they can afford!

 

 

 

Right. So you can just switch plans if you don't like it! That is, unless you are:

 

-old

-sick

-have a family history of illness

-have ever been sick before

etc.

 

Better to have some insurance industry goon bending me over than a government bogeyman

 

The second point he makes is even more obvious. I definitely feel better knowing that if my insurance sucks, I have the option of just paying for, say, heart bypass surgery out of my own pocket! Thank god I have the option of shelling out that extra 150,000 I had laying around for a rainy day, I mean that's why you save money, right? Just in case?

 

Yep, the best product they can afford, beautiful system- to each according to his wallet. Just like, you don't get to buy that BMW until you make enough money, in this case, you don't get the good treatment until you work for it. If you make less than $40K a year, at least you have the freedom to buy a plan that will help delay your bankruptcy for a year or two in the event you get sick or have multiple injuries. That is, if they decide to cover it. And just bask in the freedom to switch to an equally expensive plan of a competitor that will offer equally incomplete coverage for you, AND your family! Best of all, you don't HAVE to support these insurance companies if you don't WANT to! If that doesn't sound good, then maybe you just need to work harder!

 

 

 

 

 

Is it really true that all insurance plans offer equal value for money? That there's no way to expand the number of options that people have nor the ease of changing from one plan to the next other than via the government creating a health insurance company that they own and operate? Or that this is the only conceivable mechanism for providing coverage to folks that can't currently get it? Sufficient - perhaps. Necessary? I'm not so sure. That it represents the optimal mechanism for doing so is even less clear.

 

I lived right next door to a hospital in NZ from October through March, and conversations about who got treated for what and how were a staple of daily conversation. This doesn't make me an authority, but it's not like I'm speaking from a position of complete ignorance when it comes to the merits of one system versus the next.

 

Different people will take away different lessons from hearing the details of a gazillion different cases in a single-payer environment vs the environment we have here, but my observation was that if you have an accident or illness that mostly requires labor-inputs to fix, and the diagnosis/treatment are obvious - the system over there will be pretty good at taking care of you. If you have extreme trauma - all things being equal, you'd be more likely to survive the experience in the US. If you have a chronic condition that requires expensive diagnostic tests or treatments, especially imaging or expensive drugs, and/or your disease has some subtle manifestations and/or requires seeing a specialist - I think you're quite a bit more likely to suffer more and die sooner than you would here. If you have a premature/sick fetus/baby - my sense that it's less likely to survive in NZ than it is here, particularly if you're located a long way from Auckland. It didn't look like prevention was a particular strength of their medical system either, given the regularity with which advanced pathologies that showed up in the ER. Also not a terribly good place to be if you're over a certain age and have a condition that'd be particularly costly to treat - although New Zealanders did seem to be considerably more stoic and philosophical about calling it quits than we are.

 

Also on the plus side - everyone was covered. I don't mean to understate the significance of that. Just to suggest that, at least from my perspective, it wasn't free from some fairly substantial tradeoffs that came along with the particular mode of providing that coverage via single-payer/provider model. Part of that stems from the fact that if forced to chose I'd rather be broke than dead, but I realize that not everyone shares that opinion.

 

 

You are understating, grossly so, the significance of universal coverage verse the sorry state in the U.S. And the 'trade offs'? Nothing more than unsubstantiated conjecture on your part.

[JayB]

Just heard another gem. This one was from Michael Medved. At least now we're getting at the real value system in place here and which is being foisted daily on the masses of mouth breathers:

 

 

Caller:

I think we already have healthcare rationing

 

Medved:

Ok, I agree, but I would rather have free market elements rationing my care than some big government entity.

 

Caller:

But that's still rationing and it's still making it very difficult for people to obtain coverage

 

Medved:

Look, at least with the private sector in control, if you don't like your current insurance you can just switch to another. And if you don't like any of the options being offered, you also have the freedom to choose to pay for your medical bills yourself! Unlike in Canada where you're not allowed to not use the government plan! The free market rations lots of things, like cars and houses...everyone buys the best product they can afford!

 

 

 

Right. So you can just switch plans if you don't like it! That is, unless you are:

 

-old

-sick

-have a family history of illness

-have ever been sick before

etc.

 

Better to have some insurance industry goon bending me over than a government bogeyman

 

The second point he makes is even more obvious. I definitely feel better knowing that if my insurance sucks, I have the option of just paying for, say, heart bypass surgery out of my own pocket! Thank god I have the option of shelling out that extra 150,000 I had laying around for a rainy day, I mean that's why you save money, right? Just in case?

 

Yep, the best product they can afford, beautiful system- to each according to his wallet. Just like, you don't get to buy that BMW until you make enough money, in this case, you don't get the good treatment until you work for it. If you make less than $40K a year, at least you have the freedom to buy a plan that will help delay your bankruptcy for a year or two in the event you get sick or have multiple injuries. That is, if they decide to cover it. And just bask in the freedom to switch to an equally expensive plan of a competitor that will offer equally incomplete coverage for you, AND your family! Best of all, you don't HAVE to support these insurance companies if you don't WANT to! If that doesn't sound good, then maybe you just need to work harder!

 

 

 

 

 

Is it really true that all insurance plans offer equal value for money? That there's no way to expand the number of options that people have nor the ease of changing from one plan to the next other than via the government creating a health insurance company that they own and operate? Or that this is the only conceivable mechanism for providing coverage to folks that can't currently get it? Sufficient - perhaps. Necessary? I'm not so sure. That it represents the optimal mechanism for doing so is even less clear.

 

I lived right next door to a hospital in NZ from October through March, and conversations about who got treated for what and how were a staple of daily conversation. This doesn't make me an authority, but it's not like I'm speaking from a position of complete ignorance when it comes to the merits of one system versus the next.

 

Different people will take away different lessons from hearing the details of a gazillion different cases in a single-payer environment vs the environment we have here, but my observation was that if you have an accident or illness that mostly requires labor-inputs to fix, and the diagnosis/treatment are obvious - the system over there will be pretty good at taking care of you. If you have extreme trauma - all things being equal, you'd be more likely to survive the experience in the US. If you have a chronic condition that requires expensive diagnostic tests or treatments, especially imaging or expensive drugs, and/or your disease has some subtle manifestations and/or requires seeing a specialist - I think you're quite a bit more likely to suffer more and die sooner than you would here. If you have a premature/sick fetus/baby - my sense that it's less likely to survive in NZ than it is here, particularly if you're located a long way from Auckland. It didn't look like prevention was a particular strength of their medical system either, given the regularity with which advanced pathologies that showed up in the ER. Also not a terribly good place to be if you're over a certain age and have a condition that'd be particularly costly to treat - although New Zealanders did seem to be considerably more stoic and philosophical about calling it quits than we are.

 

Also on the plus side - everyone was covered. I don't mean to understate the significance of that. Just to suggest that, at least from my perspective, it wasn't free from some fairly substantial tradeoffs that came along with the particular mode of providing that coverage via single-payer/provider model. Part of that stems from the fact that if forced to chose I'd rather be broke than dead, but I realize that not everyone shares that opinion.

 

 

You are understating, grossly so, the significance of universal coverage verse the sorry state in the U.S. And the 'trade offs'? Nothing more than unsubstantiated conjecture on your part.

 

I thought I made it clear that I was stating a personal opinion and sharing my own impressions based on what I observed. The fact that I was actually there to make the observations, discuss the merits of the system with native physicians, docs from overseas, etc doesn't make them any less subjective - but it makes it quite unlikely that my conjectures on this front are derived from a base of ignorance that's larger than your own.

 

I'm pretty sure that if there's a apples-apples data-set that'd allow for a comparative evaluation of things like age-adjusted survival rates for cancer, heart-attacks, strokes, specific vehicle trauma's, etc that they'd bear out my conjectures - but if you can get your hands on data that proves otherwise, I hope that you'll share it.

 

[KaskadskyjKozak]

Just heard another gem. This one was from Michael Medved. At least now we're getting at the real value system in place here and which is being foisted daily on the masses of mouth breathers:

...

The second point he makes is even more obvious. I definitely feel better knowing that if my insurance sucks, I have the option of just paying for, say, heart bypass surgery out of my own pocket! Thank god I have the option of shelling out that extra 150,000 I had laying around for a rainy day, I mean that's why you save money, right? Just in case?

 

 

Michael Medved is a very smart and level-headed guy. I don't think he's spewing out BS, toeing some line, or being some kind of corporate tool. He's speaking from his own experience, most likely, which is not necessarily anywhere near the "average" experience (if there is such a thing).

 

In that light, I'll speak my experience, which is different from his.

 

Most (but not all) jobs I have had included some form of health insurance coverage. The quality of the coverage has varied in terms of physician choice, how much I pay out of pocket per paycheck, deductibles and copays. In every case, I had no *choice* as to the provider, but some choice for the plan (historically, either an HMO, POS, or PPO). I have never looked for a job and based the decision on joining the company or not merely on the specific insurer, but have asked about out-of-pocket (per-paycheck) cost to me.

 

No employer I have had has offered to me to forego company-funded coverage in exchange for cash. Some have offered some payment if I decline coverage, but usually not. So really there is no "choice". I take what I get from my employer. If I don't like my coverage, I can "choose" to decline it and pay on my own and lose a few hundred bucks per semi-monthly paycheck.

 

So, no, there is not much "choice" even if you get company-supplied insurance. Unless, of course, you are rich enough to buy whatever the hell you want.

 

When I have bought insurance, because it was not covered by my employer, it was costly, and there was little choice (not many companies in WA state will allow you to purchase health coverage on your own), and you have to jump through hoops to prove you have been insured up to the present, have no preexisting conditions, etc, etc, etc. Cost for a family of 4+? At least $800/month (depends on the copays and deductibles).

 

Over the past years I have noticed the general trend is for higher copays, and deductibles, and employers having trouble keeping up with the increasing costs of insurance they provide to employees due to premium increases each year. It is definitely not sustainable for long.