Great post! You briefly touched on the way the existing guild artificially restricts supply, and that's a HUGE deal. (In the 80s the 'experts' were saying there would be a doctor glut and government must step in to protect doctors' salaries)
Certificate of Need laws also need to go. Imagine Burger King needing to get McDonald's permission before opening a new restaurant!
And finally, all the layers between the doctor and patient need to go, as they drive up price and don't actually contribute to healthcare. Going to the doctor should be like going to a fast food place: You walk in, see the price for everything right on the wall, get what you need, and pay for it yourself.
In arriving at their price list, Smith and Lantier did an end run around the whole system. They asked their fellow doctors how much compensation was expected per procedure, factored in necessary expenses like surgical equipment and medical implants, then tacked on a 10% to 15% profit margin. Since their surgery center does not employ the army of administrators that is often required to haggle with insurers and follow up on Medicare reimbursements, their overhead is smaller. The whole operation is 41 people. “Finding an average price doesn’t require complicated math,” Smith says. “It’s arithmetic.” Since posting the price list eight years ago, they’ve adjusted it twice, both times to lower rates.
I used to think that too Beach Lover . . . but the last two years have shown me that an awful lot of doctors are lazy, stupid and totally suck at medicine; and thus we need at least a few lawyers around to hold them to account.
Problem with Dr logic is these last two generations the treatment of patients is now just drug dispensing. Knowledge used to be in aligning symptoms, finding the cause(s) and educating the patient on how together they could cure. Lawyers only protect the $$$, not protecting patients.
This is a huge part of the problem in the US--if you ask a hospital or other provider about the cost of a certain procedure, the answer is--What type of insurance do you have? Why should that matter? Why do different people get to pay different prices? Why does it matter where your provider is located? It's all so ridiculously opaque--and if other industries practiced this way, people would go to prison. Yet everyone accepts this nonsense. It bothers me when politicians talk about healthcare costs but they're always referring to insurance costs. Health insurance is the financing mechanism for healthcare. The whole system is a jacked up mess which makes insurance premiums high. This area is like so many others, where lots of politicians gain favor or push agendas by pretending to do something--usually making the problem worse--like the affordable care act. I'm certainly no expert but this illustrates perfectly the havoc that can be achieved through government meddling and regulation versus letting the market do what it does on its own.
I gave birth (emergency C-section) to my second child in a private hospital in Nicaragua in 2008. Not a planned pregnancy and didn’t have US health insurance as we were living in Nica at that time. I paid for labor and delivery on my AMEX card which was less than $3K.
I agree with your assessment and solution to the problem, but conventional medicine will never allow it.
A brief perspective on alternative medicine vs conventional medicine economics:
If mediocre, robot, Merck Manual-cookbook, new-Rx-for-every-ailment docs had to compete with what we in natural/alternative medicine offer for cash pay, robo-docs would have empty offices. The main reason for our competitive advantage on a cash-basis level playing field is that cash-paying patients are more motivated to get well, rather than to be subsidized on a health-purgatory treadmill, as many of those with cadillac insurance plans are. Also, we in alternative medicine are trained to look for root cause of pathologies and eliminate that, which deprives robo-doc of yet another permanent customer, but gives us new referrals from happy former patients.
Couldn't agree more. Modern medicine will probably just collapse from lack of customers at some point. Perhaps then it could become more of what it should be: a healing art.
When my husband was diagnosed with glioblastoma, he did the surgery in the US and we pursued immunotherapy in Mexico instead. He did not survive past 1 year, but he had an excellent year, despite the fact that the tumor was very aggressive and in one of the worst places possible (right temporal lobe affecting speech and right sided movement, the latter at the end). He was fully functional that year and worked on his computer until the last month. The day before his second surgery, about 11 months after he should have been diagnosed, he cut down 7 trees in the backyard.
Simply could not control the edema after 2nd surgery and he died in under 3 weeks.
The immunotherapy (6 days a week of nutritional IVs, low dose insulin potentiated chemo, laetrile, GMCSF, Coley's toxins, etc.) for about 1/2 year cost us HALF what standard of care (radiation and Temodar) would have costed in the US. And I got the US insurance company to pay for it too (probably wouldn't work today). This was after Obamacare was enacted in 2014.
I would never undergo the dehumanizing experience of "standard of care" cancer treatment in the US for any reason. We had a pretty good longevity MD who operated on a cash basis back in Colorado that would do the low dose chemo.
The thing that pisses me off most about robo-docs is the whole "one symptom per visit" thing. And they want to prescribe for each symptom.
I had to go to dozens of visits over two and a half years to finally get my primary hyperparathyroidism diagnosis and get surgery to remove two huge adenomas. Why!?! I lost another 8% bone density during those two + years.
And then they try to fragment the human body, and they get so specialized that if you've got two symptoms, in different parts of the body, then at least one is "not my department." So then you have to consult with a different specialist.
Long ago someone described this as 'silo learning' w each element isolated and functionally equivalent to the blind describing the elephant.
Medicine is hardly the only area we see this it cuts a vast swath through education too. What's fascinating is that compartmentalizing information is the basic model "intelligence" orgs are built on.
An operation involving many people, each with a small puzzle piece prevents catastrophic compromise of a full plan. A select few with the whole array source input offers the highest level of certainty controlling the outcome.
It's wonderful for a SEAL Team pre-dawn rescue but antithetical to learning, informed consent and self governing.
Not only is there a revenue-side problem, there are problems on the cost side.
An acquaintance of mine was prescribed a knee-brace, which was covered by insurance. Well and good, she got her knee brace from an inventory held by the surgeon. She asked if she could have a spare, but was told the insurance wouldn’t cover it. So, she went to Amazon and got the exact same model supplied by the surgeon, and paid around $35. Out of curiosity, she looked to see what the surgeon charged the insurance company. $650. She wrote the insurance company and said (paraphrased of course) “you’re getting done”. The predicable response (paraphrased of course): “Meh”.
Why control cost, which requires staff and computers and all that crap, when its a simple matter to crank up revenue by raising prices?
The illness-prolongation industry is in desperate need of reform in this country. Sadly, probably the only way to fix it is to let it collapse of its own ponderous inefficiency. The gravy train has too many passengers who will fight tooth and fork to keep it keeping on.
I had a boss who helped negotiate with insurers for a large academic medical center. "List" prices were high because the folk negotiating for the insurance companies needed to take big discounts back to their bosses. (The negotiator's bonuses depended on how big a discount they could get.) The bottom line cost at that time was less important to the insurer than a 71% discount. The hospital would raise the "list" price so that the percentage they got was always increasing in absolute dollars. 30% of $1000 is less than 29% of $1100.
Veterinary medicine is a good proxy for what could be done for human medicine. It is more of a free market and people discuss costs with their veterinarian. And costs are a fraction of the price for humans even though the standard of care is actually comparable.
Agreed! Was checking out at the vet the other day. One guy had a $1200 bill and another $800. I have pet insurance and it’s fabulous. $30 a month, but only covers $7,000 per year. I think it strikes the right balance as far as pets go. Not sure it translates to people, but there’s something to it.
Depends on the vet. My experience with UC Davis trained vets is not so good. Midwestern U's seem to produce more compassionate vets. My anecdotal evidence from 40 years of vets in various locations.
Yes, VCA (I think that's the name of it.). They took a nice vets office, that was already fairly expensive, bought it out and ruined it. Had vets rotating in and out, so if you got a good one, you might never get to see them again. The non-rotating, good vets left. Office staff that had been there for 20 years, left. AND because it's a Kalifornia corp. we got Kalifornia prices, in a depressed area in the Eastern Mid-west. They've bought several offices in the area. It's hell finding a good vet here.
Large animal veterinary medicine model is the way to go... small animal veterinarian prices are crazy!!! I can get my goat surgically castrated at my own farm, for less than $200... includes all meds, even a follow up pain shot (which the Dr just hands me a syringe full of the meds to give the next day). I have heard of people paying $1000 to get a dog fixed. I needed a vet here last year to pull my triplet kids... she was here an hour, gave the momma goat 3 meds, and bill was $172.50. Not sure how Large animal vets make it, but they seem to do ok... they don't have near the overhead, nor the malpractice insurance to pay. That's another thing to be addressed in medicine today... malpractice insurance. I believe that is out of control!
That’s why I had Christian Healthcare Ministries as “insurance.”
It is - like MediShare - close to as catastrophic health insurance as you can get.
The misallocation of resources due to over consumption is appalling.
I know people on Medicare who go for any kind of surgery they’ve ever wanted (non-cosmetic) and are not only sucking dry the Medicare trust fund but are driving up the cost of insurance.
When a middle man gets involved there are usually problems. A system needs to be set up to incentivize people to be healthy. If you knew by not taking medications, treatments etc at the end of the year you could keep that money for a vacation or to purchase something would that be an incentive to stay healthy? And when you did need a treatment you called around looking for the best deal. So that you could Kept what is left of your yearly health care cost.
LASIK surgery along with plastic surgery doesn’t involve a middleman and their cost are opposite of traditional medicine.
We see a naturopathic doctor and pay out of pocket for true health care. But it’s not covered by insurance. Therefore most people can not afford it. It’s not health care it’s disease care. The whole system is corrupt and needs to be destroyed and rebuilt.
We also supplement with vitamins since we feel paying on the front end to prevent problems is cheaper in the long run by not paying on the backend. Again, they aren’t covered by insurance.
The “elites” want us to be sick, fat and unhealthy therefore they have created a financial/medical system to achieve their desire.
So sad that America and the world has gotten to this place. But people are waking up!!!
Great comment Lucy, but are you as struck by the irony of your opening pitch as I am? Wouldn't you think good health would be enough of an incentive by itself? The thought that you need to incentivize people with visions of a vacation or new flat screen says a lot about our collective intelligence.
Don't misunderstand . . . I'm not criticizing your point because I think it's wrong. I'm criticizing our culture because I think your point is right on the money.
I couldn’t of said it better!!! My husband is self employed. We spend way to much for health insurance. And then even more for true health care. It’s a racket!!
I like your term "disease" care. So true! Was told years ago by a rheumatologist that if I was not taking medications (for my issue) and not needing surgery they had no need to see me... no info on how to best manage issues naturally... they don't care. Take a drug and hope it doesn't cause too major of a side effect. No thanks. He admitted they are not taught much along the line of natural methods, and drugs is the main focus of medicine. I don't go to the Dr very often... I try to focus on what I can do to stay healthy, take supplements I know my body needs... and went 5 years without going to a mainstream Dr... till I got covid pretty bad. Even then I avoided mainstream, ended up seeing our cousin who is a physician for the Amish community... pay cash up front, and only had to visit once, and did follow up with texts. We do not have insurance, but have Medi-Share, a Christian sharing plan... so even with needing to go to ER to get a quick CT scan, and all the blood work, heart tests they did, and meds I still paid less than $3000 for everything... they gave 40% discount for cash pay. That works for me, and that is how it should be done... many Americans would not know what to do with a $3000 bill, but we saved WAY over that in less than a year by carrying a higher deductible.
Back in the 1970s there was a joke in the USSR: Even after the worldwide revolution succeeds (i.e. that "socialism in every country" staple of Marxist ideology) we'll have to keep one capitalist country up and running ... just so we know what things cost!.
Fast forward 50 years and we find that we have no capitalist countries in any real sense and we're screwed.
Same goes for "renewable/green energy" - I heard an industry guy the other day saying (close quote): "the whole industry is driven by government mandates and subsidies... nobody knows what anything actually costs" ... we may soon find out!
We have almost all capitalist countries: crony capitalism, casino capitalism and monopoly capitalism. What we definitely don't have is a Free Market Economy. The Psychopath Parasites who run the Western world just despise free markets, except for labor.
My heart is invested in sustainable, organic, healthful ideas but the PR never matches the plans. In America lobbyists set policy and BigAg Monsanto-Gates-Bayer et al have subsidized, patent protected gmo crops as the foundation to "green energy" policy.
There's no cost benefit analysis where converting food crops to renewable energy, which is what Ethanol market is accounts for reduced food supply. Nor does crop contamination factor the impact on human health when food crops have been genetically modified to suit industrial applications not life forms. Beyond those costs are the subsidy scams that are nothing more than corporate welfare and BigAg is a heavyweight like Pharma.
Archer Daniels Midland: A Case Study in Corporate Welfare
September 26, 1995 • Policy Analysis No. 241 By James Bovard
At least 43 percent of ADM’s annual profits are from products heavily subsidized or protected by the American government. Moreover, every $1 of profits earned by ADM’s corn sweetener operation costs consumers $10, and every $1 of profits earned by its ethanol operation costs taxpayers $30.
Agrofuels are the most idiotic, stupid moronic way to produce energy. Wasting precious topsoil, fertilizer, and fossil fuel to replace less fossil fuel. A scam so bad that the people promoting it deserve a long prison sentence. Pure Evil.
Biden Cynically Uses Ukraine to Cover Food Sabotage, by F. William Engdahl:
"...At the same time, the Biden gang has announced a fake remedy for record high gasoline pump prices. Washington announced the EPA will allow a 50% increase in corn-based biodiesel and ethanol fuel mix for the summer. On April 12 the Secretary of Agriculture announced a “bold” initiative by the US Administration to increase the use of domestically-grown corn-ethanol biofuels. Secretary Tom Vilsack claimed the measure would “reduce energy prices and tackle rising consumer prices caused by Putin’s Price Hike (sic) by tapping into a strong and bright future for the biofuel industry, in cars and trucks and the rail, marine, and aviation sectors and supporting use of E15 fuel this summer...."
"...Only the capitalized “Putin Price Hike” is not a result of Russian actions, but of Washington Green Energy decisions to phase out oil and gas. The energy price inflation is also about to go vastly higher in coming months owing to US and EU economic sanctions on export of Russian oil and likely gas. However the central point is that every acre of US farmland dedicated to growing corn for biofuels removes that food production from the food chain, to burn it as fuel. Since passage of the 2007 US Renewable Fuel Standards Act, which mandated annually rising targets for production of corn for ethanol fuel blends, biofuels have captured a huge part of total corn acreage, more than 40% [95% of feed grain] in 2015. That shift, mandated by law, to burning corn as fuel had added a major price inflation for food well before the covid inflation crisis began. The USA is by far world’s largest corn producer and exporter. Now to mandate a significant increase in corn ethanol for fuel at a time of astronomical fertilizer prices, and fertilizer rail shipping are being blocked reportedly by White House orders, will send corn prices through the roof. Washington knows this very well. It is deliberate..."
And covering precious agricultural land up with idiotic solar farms that produce no useful energy is just one more example of the green energy scam, deliberately trying to destroy the middle class and create a poverty stricken world. A feudal society.
I added the part about Biden announcing a 50% increase in agrofuels & E10 to E15 gasoline ostensibly to alleviate the high cost of gasoline. (by causing a much higher increase in food prices).
This analysis gives a good estimate of what wind & solar really costs in Europe. There is a linear price relationship between wind/solar grid penetration and price of electricity by Ken Gregory, P.Eng, graph Euro/kwh by country 2019: Conclusion: European Wind Plus Solar Cost 6 Times Other Electrical Sources
I finally had to look up a word! : impecunious. Nice. Ty,gato. Repeated thanks, because you have broken this down and described it in ways I failed to when trying to explain to my 25 year-old son why the medical system. In this country can bankrupt people. Insurance.
You're halfway there on this one, but I think you're too much of a free market guy to see the other half of the problem.
Free markets only work out well when both buyer and seller are free to walk away from a bad deal. This is in large part why prices for cosmetic surgery have bucked the trend. If boob jobs cost too much, people won't get them, and that exerts downward pressure on prices.
For the life-saving/life-prolonging aspect of medicine, that isn't true. Diabetics will willingly pay their entire income and even go into crushing debt to buy insulin at any cost.
Yes, this is a situation where we need an intervention. Essential healthcare should be treated as a public utility. If a city wanted to jack up the price of drinking water by 300% its citizens would never go for it, and the city has a mandate to provide water at an affordable rate so that never happens.
The biggest problem with government intervention/Medicare for All/etc. is, of course, that the government is in the pockets of the medical and pharmaceutical companies who would be happy to negotiate a pork-barrel bonanza for themselves behind closed doors using public funds. So that is not the answer either, however much the left might want it.
The free market is not the answer here. The best I can come up with is establishing local clinics and hospitals that are organized as public utilities rather than for-profit entities, and eventually generating the political will to crack down on exploitative for-profit healthcare.
Agree that a totally free market is not a good answer for a society structured as the US is structured. Essential healthcare, long term care, hospitalization, etc. should be a community service in any society that truly believes 'we're all in this together.'
Also, self-insuring is an option only for those with the financial wherewithal to self-insure. Try it with a middle-class family with a mortgage and three kids. Or an unemployed single mother.
I do not think it is any coincidence that just about the time that people started saying Social Security was in trouble that there was also a big push to legalize assisted suicide just as I do not think it is any coincidence that most abortion clinics are located in or near low-income neighborhoods. When I hear a woman say, "I had an abortion but I did not feel I had any choice," then I wonder what role does choice play in the matter and WHOSE choice? Hers, or society's? Is this something that low-income women, especially Black women, really want? Or is it what the rest of us want for them?
Well allowing assisted suicide is a good thing. Debatable that some provinces are actually encouraging it. It becomes a mute point in any case the way they are deliberately killing people by preventing therapeutics for Covid and administrating intubation and remdesivir in hospitals to the sick. Add to that killing 10's of thousands with toxic vaccines.
Whether 'allowing' assisted suicide is a good or not good thing is debatable. Many countries allow it under specific conditions. But to actively encourage people to kill themselves because they're healthy but poor is another bill of goods entirely. You could also encourage upper class people to 'cull' the underclasses by killing them. Just as some countries kill or imprison dissidents. These are cans of worms that most people probably don't want to see opened.
You are using the Straw Man & Slippery Slope fallacies. I don't know anyone saying we should actively encourage the poor to commit suicide. Although I think in many cases staff in hospitals all over the World will nudge the impoverished infirm to overmedicate, mainly morphine, to precipitate their early demise. That's a long way from allowing the rich to kill the poor as right now the uber-rich are murdering the underclasses with their vaccines, remdesivir and intubation. Amazing how many good Catholics are participating in that slaughter. A good paycheck is amazingly effective at causing most people to look the other way.
Wow that’s a cynical take on people who tend to the sick and vulnerable. As a nurse I witness the idiocy and barbarity of the system every single shift. Yeah there are often discussions about the absurdity of frail 90 year olds being full codes, which is human idiocy on par with systemic idiocy, but actively speeding up a human being’s death? Dude you live in a dark place. How much time have you spent at the bedside of suffering people? Have you ever been in an hour long code trying to resuscitate someone? The system is barbaric. Most of the people doing the actual caring aren’t, though some are pretty damaged. I hope you remain open to reevaluation. Be well.
Spot on. My dad is a retired dermatologist. Back in the 70’s, he would remove moles and say which he thought needed biopsies, go over the costs, and the patient would decide how much they wanted to spend. Once employer-sponsored insurance became the norm, every mole was biopsied every time. One because the patient didn’t have to make a cost decision. And two to protect the doctor in case he was wrong. The second point is important as well-better to be safe and order that additional test in case you missed something. The threat of malpractice suits needs to be addressed, as we all know, lawyers have driven up the cost of everything. Let’s get rid of them too while we’re at it.
I agree tort reform is needed. We all have stories of zebras found by practicing shotgun/ defensive medicine but the waste is ridiculous. The potential for harm from unnecessary testing/procedures is real as well.
Another disturbing development is the RaDonda Vaught case. The criminalization of medical errors will be counterproductive.
Agree. She did everything right after the mistake was made. Came forward, admitted what happened, spoke with family, but then the government via CMS came in and audited the hospital and decided they didn’t like how the situation was handled and charged her criminally. It will result in a lot less people being honest/whistleblowers and admitting mistakes, that’s for sure.
2. Allow insured to choose any doctor as long as the cost is not over 'negotiated' network prices. This is important because doctors can't be independent operators today. Otherwise they are locked out of the healthcare market.
3. Publish all prices
4. Make it illegal to charge prices that deviate by more than 15%. It is ridiculous that blood test can cost anywhere from $5 to $100 depending on your insurance status.
5. Get rid of 'free' Obamacare. That is simply a transfer of cost to the paying group.
Yup. Any time you ask what something costs, the initial response is always the same question: “What insurance do you have?” That should be irrelevant and is explicitly illegal for good reason… but those laws aren’t enforced or even acknowledged when it comes to the medical industry.
IM Doc, a contributor to NakedCapitalism, is a respected (anon) doctor who mentors and teaches new doctors. This is what he wrote a couple days ago -
"I will say it again – Obamacare has done nothing to make health care more affordable in any way. Indeed it is the exact opposite. I have never in my life had so many “insured” going without needed care. And who would have thought we would have needed so many “GoFundMe” pages for patient’s health issues after Obamacare.
It is just another example that if you wait long enough – the truth will eventually come forth.
Obamacare has been the single biggest debacle/disaster in politics in my lifetime. I see multiple patients daily suffering under the load. It is one of THE big reasons why this life long Dem will no longer vote for any Dem again until there is a major clean up."
Who are you Gato Malo? You must be a clouder of big brained felines to have so much economic, social, mathematical, medical and political savvy! I deem you worthy of a subscription plan, even though I am on a humble part-time housewife/rn salary.
And churn out so much amazing content! I like to wonder too--especially the Utah connection intrigues me as I have family there. He was visiting the same time as I was. Maybe I saw him somewhere maskless and didn’t know it! Ha ha just being silly.
The thing that keeps your very rational suggestions from being implemented is emotionalism. Medical care is life or death. Suggest that some should go without because they can't pay and people will screech that you're putting profits over lives. Never mind that such a policy would, over the long run, result in more effective, more affordable treatments becoming available to more people.
I'd be interested to see the same price chart for veterinary care, which so far as I know isn't subjected to the same insane, market distorting insurance system.
The classic problem of the seen and the unseen. We see the person who can't afford the care today, but don't see all the people who would have been saved if the system had been cash-run from the start.
In decades past, there were also charities and religious groups who treated the poor and indigent for free or next to nothing. But those have been supplanted and corrupted in a sense by the for-profit health care model.
In a former life, I tried to get State Level medical pricing transparency passed. The money fought hard and won. Trump somehow managed to get Federal pricing transparency passed, and the industry is outright ignoring the law mostly (10% compliance at best).
The only industry that refuses to post prices on their menu of services is also one of the most out of control. The exceptions are the ones, electives as you listed, where price awareness is built into the advertising.
You want to fix it, they're now ignoring the law because the money is too good, and whatever penalty they pay is less than their profit. It's no longer fixable because they are above the law's reach, and the regulators are captured.
Welcome to the end of civilization. Mind the gap, Express train, few stops left, no exit.
Great post! You briefly touched on the way the existing guild artificially restricts supply, and that's a HUGE deal. (In the 80s the 'experts' were saying there would be a doctor glut and government must step in to protect doctors' salaries)
Certificate of Need laws also need to go. Imagine Burger King needing to get McDonald's permission before opening a new restaurant!
And finally, all the layers between the doctor and patient need to go, as they drive up price and don't actually contribute to healthcare. Going to the doctor should be like going to a fast food place: You walk in, see the price for everything right on the wall, get what you need, and pay for it yourself.
Edit: Relevant link
https://time.com/4649914/why-the-doctor-takes-only-cash/
In arriving at their price list, Smith and Lantier did an end run around the whole system. They asked their fellow doctors how much compensation was expected per procedure, factored in necessary expenses like surgical equipment and medical implants, then tacked on a 10% to 15% profit margin. Since their surgery center does not employ the army of administrators that is often required to haggle with insurers and follow up on Medicare reimbursements, their overhead is smaller. The whole operation is 41 people. “Finding an average price doesn’t require complicated math,” Smith says. “It’s arithmetic.” Since posting the price list eight years ago, they’ve adjusted it twice, both times to lower rates.
"And finally, all the layers between the doctor and patient need to go, as they drive up price and don't actually contribute to healthcare"
I initially read that as "all the lawyers between the doctor and patient need to go", which makes sense, too! :-D
I used to think that too Beach Lover . . . but the last two years have shown me that an awful lot of doctors are lazy, stupid and totally suck at medicine; and thus we need at least a few lawyers around to hold them to account.
Those aren't the ones I'm concerned about.
ahhahah! Also true!
🎯🎯🎯
Problem with Dr logic is these last two generations the treatment of patients is now just drug dispensing. Knowledge used to be in aligning symptoms, finding the cause(s) and educating the patient on how together they could cure. Lawyers only protect the $$$, not protecting patients.
"more cash pay with price transparency"
This is a huge part of the problem in the US--if you ask a hospital or other provider about the cost of a certain procedure, the answer is--What type of insurance do you have? Why should that matter? Why do different people get to pay different prices? Why does it matter where your provider is located? It's all so ridiculously opaque--and if other industries practiced this way, people would go to prison. Yet everyone accepts this nonsense. It bothers me when politicians talk about healthcare costs but they're always referring to insurance costs. Health insurance is the financing mechanism for healthcare. The whole system is a jacked up mess which makes insurance premiums high. This area is like so many others, where lots of politicians gain favor or push agendas by pretending to do something--usually making the problem worse--like the affordable care act. I'm certainly no expert but this illustrates perfectly the havoc that can be achieved through government meddling and regulation versus letting the market do what it does on its own.
Relevant video: Giving birth costs a lot. Hospitals won't tell you how much.
https://www.youtube.com/watch?v=Tct38KwROdw
That’s one of many reasons why I popped my second one out in my living room
I gave birth (emergency C-section) to my second child in a private hospital in Nicaragua in 2008. Not a planned pregnancy and didn’t have US health insurance as we were living in Nica at that time. I paid for labor and delivery on my AMEX card which was less than $3K.
Vaginal delivery under $7k here https://www.forbes.com/sites/johngoodman/2016/01/14/one-hospital-tells-you-what-you-will-have-to-pay-before-the-surgery/?sh=144874a927d8
Yeah but then they bill your baby for their room even if you keep the baby with you and don’t let her out of your sight
The Surgery Center of Oklahoma is doing some great things in this area. I recommend this interview: https://www.econtalk.org/keith-smith-on-free-market-health-care/
I came here to say that! Here is the Surgery Center's website. https://surgerycenterok.com/
I agree with your assessment and solution to the problem, but conventional medicine will never allow it.
A brief perspective on alternative medicine vs conventional medicine economics:
If mediocre, robot, Merck Manual-cookbook, new-Rx-for-every-ailment docs had to compete with what we in natural/alternative medicine offer for cash pay, robo-docs would have empty offices. The main reason for our competitive advantage on a cash-basis level playing field is that cash-paying patients are more motivated to get well, rather than to be subsidized on a health-purgatory treadmill, as many of those with cadillac insurance plans are. Also, we in alternative medicine are trained to look for root cause of pathologies and eliminate that, which deprives robo-doc of yet another permanent customer, but gives us new referrals from happy former patients.
Couldn't agree more. Modern medicine will probably just collapse from lack of customers at some point. Perhaps then it could become more of what it should be: a healing art.
When my husband was diagnosed with glioblastoma, he did the surgery in the US and we pursued immunotherapy in Mexico instead. He did not survive past 1 year, but he had an excellent year, despite the fact that the tumor was very aggressive and in one of the worst places possible (right temporal lobe affecting speech and right sided movement, the latter at the end). He was fully functional that year and worked on his computer until the last month. The day before his second surgery, about 11 months after he should have been diagnosed, he cut down 7 trees in the backyard.
Simply could not control the edema after 2nd surgery and he died in under 3 weeks.
The immunotherapy (6 days a week of nutritional IVs, low dose insulin potentiated chemo, laetrile, GMCSF, Coley's toxins, etc.) for about 1/2 year cost us HALF what standard of care (radiation and Temodar) would have costed in the US. And I got the US insurance company to pay for it too (probably wouldn't work today). This was after Obamacare was enacted in 2014.
I would never undergo the dehumanizing experience of "standard of care" cancer treatment in the US for any reason. We had a pretty good longevity MD who operated on a cash basis back in Colorado that would do the low dose chemo.
The thing that pisses me off most about robo-docs is the whole "one symptom per visit" thing. And they want to prescribe for each symptom.
I had to go to dozens of visits over two and a half years to finally get my primary hyperparathyroidism diagnosis and get surgery to remove two huge adenomas. Why!?! I lost another 8% bone density during those two + years.
And then they try to fragment the human body, and they get so specialized that if you've got two symptoms, in different parts of the body, then at least one is "not my department." So then you have to consult with a different specialist.
Long ago someone described this as 'silo learning' w each element isolated and functionally equivalent to the blind describing the elephant.
Medicine is hardly the only area we see this it cuts a vast swath through education too. What's fascinating is that compartmentalizing information is the basic model "intelligence" orgs are built on.
An operation involving many people, each with a small puzzle piece prevents catastrophic compromise of a full plan. A select few with the whole array source input offers the highest level of certainty controlling the outcome.
It's wonderful for a SEAL Team pre-dawn rescue but antithetical to learning, informed consent and self governing.
Robo-doc 😂 👌🏻
That's exactly what doctors have had to become, too. Robots and technicians.
Not only is there a revenue-side problem, there are problems on the cost side.
An acquaintance of mine was prescribed a knee-brace, which was covered by insurance. Well and good, she got her knee brace from an inventory held by the surgeon. She asked if she could have a spare, but was told the insurance wouldn’t cover it. So, she went to Amazon and got the exact same model supplied by the surgeon, and paid around $35. Out of curiosity, she looked to see what the surgeon charged the insurance company. $650. She wrote the insurance company and said (paraphrased of course) “you’re getting done”. The predicable response (paraphrased of course): “Meh”.
Why control cost, which requires staff and computers and all that crap, when its a simple matter to crank up revenue by raising prices?
The illness-prolongation industry is in desperate need of reform in this country. Sadly, probably the only way to fix it is to let it collapse of its own ponderous inefficiency. The gravy train has too many passengers who will fight tooth and fork to keep it keeping on.
I had a boss who helped negotiate with insurers for a large academic medical center. "List" prices were high because the folk negotiating for the insurance companies needed to take big discounts back to their bosses. (The negotiator's bonuses depended on how big a discount they could get.) The bottom line cost at that time was less important to the insurer than a 71% discount. The hospital would raise the "list" price so that the percentage they got was always increasing in absolute dollars. 30% of $1000 is less than 29% of $1100.
Veterinary medicine is a good proxy for what could be done for human medicine. It is more of a free market and people discuss costs with their veterinarian. And costs are a fraction of the price for humans even though the standard of care is actually comparable.
Veterinary care is preposterously expensive. There are pet insurances out there too.
I'd be fascinated to see a comparison of the price evolution between veterinary and human medicine.
Agreed! Was checking out at the vet the other day. One guy had a $1200 bill and another $800. I have pet insurance and it’s fabulous. $30 a month, but only covers $7,000 per year. I think it strikes the right balance as far as pets go. Not sure it translates to people, but there’s something to it.
Which pet insurance? Mine is ridiculous.
Nationwide
I have been advised that more vets are going corporate, not for the benefit of the animals or owner/companion.
Depends on the vet. My experience with UC Davis trained vets is not so good. Midwestern U's seem to produce more compassionate vets. My anecdotal evidence from 40 years of vets in various locations.
Yes, VCA (I think that's the name of it.). They took a nice vets office, that was already fairly expensive, bought it out and ruined it. Had vets rotating in and out, so if you got a good one, you might never get to see them again. The non-rotating, good vets left. Office staff that had been there for 20 years, left. AND because it's a Kalifornia corp. we got Kalifornia prices, in a depressed area in the Eastern Mid-west. They've bought several offices in the area. It's hell finding a good vet here.
Large animal veterinary medicine model is the way to go... small animal veterinarian prices are crazy!!! I can get my goat surgically castrated at my own farm, for less than $200... includes all meds, even a follow up pain shot (which the Dr just hands me a syringe full of the meds to give the next day). I have heard of people paying $1000 to get a dog fixed. I needed a vet here last year to pull my triplet kids... she was here an hour, gave the momma goat 3 meds, and bill was $172.50. Not sure how Large animal vets make it, but they seem to do ok... they don't have near the overhead, nor the malpractice insurance to pay. That's another thing to be addressed in medicine today... malpractice insurance. I believe that is out of control!
That’s why I had Christian Healthcare Ministries as “insurance.”
It is - like MediShare - close to as catastrophic health insurance as you can get.
The misallocation of resources due to over consumption is appalling.
I know people on Medicare who go for any kind of surgery they’ve ever wanted (non-cosmetic) and are not only sucking dry the Medicare trust fund but are driving up the cost of insurance.
When a middle man gets involved there are usually problems. A system needs to be set up to incentivize people to be healthy. If you knew by not taking medications, treatments etc at the end of the year you could keep that money for a vacation or to purchase something would that be an incentive to stay healthy? And when you did need a treatment you called around looking for the best deal. So that you could Kept what is left of your yearly health care cost.
LASIK surgery along with plastic surgery doesn’t involve a middleman and their cost are opposite of traditional medicine.
We see a naturopathic doctor and pay out of pocket for true health care. But it’s not covered by insurance. Therefore most people can not afford it. It’s not health care it’s disease care. The whole system is corrupt and needs to be destroyed and rebuilt.
We also supplement with vitamins since we feel paying on the front end to prevent problems is cheaper in the long run by not paying on the backend. Again, they aren’t covered by insurance.
The “elites” want us to be sick, fat and unhealthy therefore they have created a financial/medical system to achieve their desire.
So sad that America and the world has gotten to this place. But people are waking up!!!
Great comment Lucy, but are you as struck by the irony of your opening pitch as I am? Wouldn't you think good health would be enough of an incentive by itself? The thought that you need to incentivize people with visions of a vacation or new flat screen says a lot about our collective intelligence.
Don't misunderstand . . . I'm not criticizing your point because I think it's wrong. I'm criticizing our culture because I think your point is right on the money.
I couldn’t of said it better!!! My husband is self employed. We spend way to much for health insurance. And then even more for true health care. It’s a racket!!
I like your term "disease" care. So true! Was told years ago by a rheumatologist that if I was not taking medications (for my issue) and not needing surgery they had no need to see me... no info on how to best manage issues naturally... they don't care. Take a drug and hope it doesn't cause too major of a side effect. No thanks. He admitted they are not taught much along the line of natural methods, and drugs is the main focus of medicine. I don't go to the Dr very often... I try to focus on what I can do to stay healthy, take supplements I know my body needs... and went 5 years without going to a mainstream Dr... till I got covid pretty bad. Even then I avoided mainstream, ended up seeing our cousin who is a physician for the Amish community... pay cash up front, and only had to visit once, and did follow up with texts. We do not have insurance, but have Medi-Share, a Christian sharing plan... so even with needing to go to ER to get a quick CT scan, and all the blood work, heart tests they did, and meds I still paid less than $3000 for everything... they gave 40% discount for cash pay. That works for me, and that is how it should be done... many Americans would not know what to do with a $3000 bill, but we saved WAY over that in less than a year by carrying a higher deductible.
Back in the 1970s there was a joke in the USSR: Even after the worldwide revolution succeeds (i.e. that "socialism in every country" staple of Marxist ideology) we'll have to keep one capitalist country up and running ... just so we know what things cost!.
Fast forward 50 years and we find that we have no capitalist countries in any real sense and we're screwed.
Same goes for "renewable/green energy" - I heard an industry guy the other day saying (close quote): "the whole industry is driven by government mandates and subsidies... nobody knows what anything actually costs" ... we may soon find out!
We have almost all capitalist countries: crony capitalism, casino capitalism and monopoly capitalism. What we definitely don't have is a Free Market Economy. The Psychopath Parasites who run the Western world just despise free markets, except for labor.
My heart is invested in sustainable, organic, healthful ideas but the PR never matches the plans. In America lobbyists set policy and BigAg Monsanto-Gates-Bayer et al have subsidized, patent protected gmo crops as the foundation to "green energy" policy.
There's no cost benefit analysis where converting food crops to renewable energy, which is what Ethanol market is accounts for reduced food supply. Nor does crop contamination factor the impact on human health when food crops have been genetically modified to suit industrial applications not life forms. Beyond those costs are the subsidy scams that are nothing more than corporate welfare and BigAg is a heavyweight like Pharma.
Archer Daniels Midland: A Case Study in Corporate Welfare
September 26, 1995 • Policy Analysis No. 241 By James Bovard
At least 43 percent of ADM’s annual profits are from products heavily subsidized or protected by the American government. Moreover, every $1 of profits earned by ADM’s corn sweetener operation costs consumers $10, and every $1 of profits earned by its ethanol operation costs taxpayers $30.
https://web.archive.org/web/20210506232642/https://www.cato.org/policy-analysis/archer-daniels-midland-case-study-corporate-welfare
Agrofuels are the most idiotic, stupid moronic way to produce energy. Wasting precious topsoil, fertilizer, and fossil fuel to replace less fossil fuel. A scam so bad that the people promoting it deserve a long prison sentence. Pure Evil.
Biden Cynically Uses Ukraine to Cover Food Sabotage, by F. William Engdahl:
http://www.williamengdahl.com/englishNEO26Apr2022.php :
"...At the same time, the Biden gang has announced a fake remedy for record high gasoline pump prices. Washington announced the EPA will allow a 50% increase in corn-based biodiesel and ethanol fuel mix for the summer. On April 12 the Secretary of Agriculture announced a “bold” initiative by the US Administration to increase the use of domestically-grown corn-ethanol biofuels. Secretary Tom Vilsack claimed the measure would “reduce energy prices and tackle rising consumer prices caused by Putin’s Price Hike (sic) by tapping into a strong and bright future for the biofuel industry, in cars and trucks and the rail, marine, and aviation sectors and supporting use of E15 fuel this summer...."
"...Only the capitalized “Putin Price Hike” is not a result of Russian actions, but of Washington Green Energy decisions to phase out oil and gas. The energy price inflation is also about to go vastly higher in coming months owing to US and EU economic sanctions on export of Russian oil and likely gas. However the central point is that every acre of US farmland dedicated to growing corn for biofuels removes that food production from the food chain, to burn it as fuel. Since passage of the 2007 US Renewable Fuel Standards Act, which mandated annually rising targets for production of corn for ethanol fuel blends, biofuels have captured a huge part of total corn acreage, more than 40% [95% of feed grain] in 2015. That shift, mandated by law, to burning corn as fuel had added a major price inflation for food well before the covid inflation crisis began. The USA is by far world’s largest corn producer and exporter. Now to mandate a significant increase in corn ethanol for fuel at a time of astronomical fertilizer prices, and fertilizer rail shipping are being blocked reportedly by White House orders, will send corn prices through the roof. Washington knows this very well. It is deliberate..."
And covering precious agricultural land up with idiotic solar farms that produce no useful energy is just one more example of the green energy scam, deliberately trying to destroy the middle class and create a poverty stricken world. A feudal society.
Fab reference.. love & adore William Engdahl as longtime voice of truth sanity!
I added the part about Biden announcing a 50% increase in agrofuels & E10 to E15 gasoline ostensibly to alleviate the high cost of gasoline. (by causing a much higher increase in food prices).
This analysis gives a good estimate of what wind & solar really costs in Europe. There is a linear price relationship between wind/solar grid penetration and price of electricity by Ken Gregory, P.Eng, graph Euro/kwh by country 2019: Conclusion: European Wind Plus Solar Cost 6 Times Other Electrical Sources
friendsofscience.org/index.php?id=2550
I finally had to look up a word! : impecunious. Nice. Ty,gato. Repeated thanks, because you have broken this down and described it in ways I failed to when trying to explain to my 25 year-old son why the medical system. In this country can bankrupt people. Insurance.
You're halfway there on this one, but I think you're too much of a free market guy to see the other half of the problem.
Free markets only work out well when both buyer and seller are free to walk away from a bad deal. This is in large part why prices for cosmetic surgery have bucked the trend. If boob jobs cost too much, people won't get them, and that exerts downward pressure on prices.
For the life-saving/life-prolonging aspect of medicine, that isn't true. Diabetics will willingly pay their entire income and even go into crushing debt to buy insulin at any cost.
Yes, this is a situation where we need an intervention. Essential healthcare should be treated as a public utility. If a city wanted to jack up the price of drinking water by 300% its citizens would never go for it, and the city has a mandate to provide water at an affordable rate so that never happens.
The biggest problem with government intervention/Medicare for All/etc. is, of course, that the government is in the pockets of the medical and pharmaceutical companies who would be happy to negotiate a pork-barrel bonanza for themselves behind closed doors using public funds. So that is not the answer either, however much the left might want it.
The free market is not the answer here. The best I can come up with is establishing local clinics and hospitals that are organized as public utilities rather than for-profit entities, and eventually generating the political will to crack down on exploitative for-profit healthcare.
Agree that a totally free market is not a good answer for a society structured as the US is structured. Essential healthcare, long term care, hospitalization, etc. should be a community service in any society that truly believes 'we're all in this together.'
Also, self-insuring is an option only for those with the financial wherewithal to self-insure. Try it with a middle-class family with a mortgage and three kids. Or an unemployed single mother.
Of course, a country might pick the path Canada seems to be choosing today. Which logically may end up as encouraging assisted suicide to those who are struggling economically. (See https://www.spectator.co.uk/article/why-is-canada-euthanising-the-poor-)
I do not think it is any coincidence that just about the time that people started saying Social Security was in trouble that there was also a big push to legalize assisted suicide just as I do not think it is any coincidence that most abortion clinics are located in or near low-income neighborhoods. When I hear a woman say, "I had an abortion but I did not feel I had any choice," then I wonder what role does choice play in the matter and WHOSE choice? Hers, or society's? Is this something that low-income women, especially Black women, really want? Or is it what the rest of us want for them?
Well allowing assisted suicide is a good thing. Debatable that some provinces are actually encouraging it. It becomes a mute point in any case the way they are deliberately killing people by preventing therapeutics for Covid and administrating intubation and remdesivir in hospitals to the sick. Add to that killing 10's of thousands with toxic vaccines.
Whether 'allowing' assisted suicide is a good or not good thing is debatable. Many countries allow it under specific conditions. But to actively encourage people to kill themselves because they're healthy but poor is another bill of goods entirely. You could also encourage upper class people to 'cull' the underclasses by killing them. Just as some countries kill or imprison dissidents. These are cans of worms that most people probably don't want to see opened.
You are using the Straw Man & Slippery Slope fallacies. I don't know anyone saying we should actively encourage the poor to commit suicide. Although I think in many cases staff in hospitals all over the World will nudge the impoverished infirm to overmedicate, mainly morphine, to precipitate their early demise. That's a long way from allowing the rich to kill the poor as right now the uber-rich are murdering the underclasses with their vaccines, remdesivir and intubation. Amazing how many good Catholics are participating in that slaughter. A good paycheck is amazingly effective at causing most people to look the other way.
Wow that’s a cynical take on people who tend to the sick and vulnerable. As a nurse I witness the idiocy and barbarity of the system every single shift. Yeah there are often discussions about the absurdity of frail 90 year olds being full codes, which is human idiocy on par with systemic idiocy, but actively speeding up a human being’s death? Dude you live in a dark place. How much time have you spent at the bedside of suffering people? Have you ever been in an hour long code trying to resuscitate someone? The system is barbaric. Most of the people doing the actual caring aren’t, though some are pretty damaged. I hope you remain open to reevaluation. Be well.
Spot on. My dad is a retired dermatologist. Back in the 70’s, he would remove moles and say which he thought needed biopsies, go over the costs, and the patient would decide how much they wanted to spend. Once employer-sponsored insurance became the norm, every mole was biopsied every time. One because the patient didn’t have to make a cost decision. And two to protect the doctor in case he was wrong. The second point is important as well-better to be safe and order that additional test in case you missed something. The threat of malpractice suits needs to be addressed, as we all know, lawyers have driven up the cost of everything. Let’s get rid of them too while we’re at it.
I agree tort reform is needed. We all have stories of zebras found by practicing shotgun/ defensive medicine but the waste is ridiculous. The potential for harm from unnecessary testing/procedures is real as well.
Another disturbing development is the RaDonda Vaught case. The criminalization of medical errors will be counterproductive.
Agree. She did everything right after the mistake was made. Came forward, admitted what happened, spoke with family, but then the government via CMS came in and audited the hospital and decided they didn’t like how the situation was handled and charged her criminally. It will result in a lot less people being honest/whistleblowers and admitting mistakes, that’s for sure.
A few ideas to reduce medical costs -
1. Allow import of medicine
2. Allow insured to choose any doctor as long as the cost is not over 'negotiated' network prices. This is important because doctors can't be independent operators today. Otherwise they are locked out of the healthcare market.
3. Publish all prices
4. Make it illegal to charge prices that deviate by more than 15%. It is ridiculous that blood test can cost anywhere from $5 to $100 depending on your insurance status.
5. Get rid of 'free' Obamacare. That is simply a transfer of cost to the paying group.
Yup. Any time you ask what something costs, the initial response is always the same question: “What insurance do you have?” That should be irrelevant and is explicitly illegal for good reason… but those laws aren’t enforced or even acknowledged when it comes to the medical industry.
IM Doc, a contributor to NakedCapitalism, is a respected (anon) doctor who mentors and teaches new doctors. This is what he wrote a couple days ago -
"I will say it again – Obamacare has done nothing to make health care more affordable in any way. Indeed it is the exact opposite. I have never in my life had so many “insured” going without needed care. And who would have thought we would have needed so many “GoFundMe” pages for patient’s health issues after Obamacare.
It is just another example that if you wait long enough – the truth will eventually come forth.
Obamacare has been the single biggest debacle/disaster in politics in my lifetime. I see multiple patients daily suffering under the load. It is one of THE big reasons why this life long Dem will no longer vote for any Dem again until there is a major clean up."
See point #5 above.
https://www.nakedcapitalism.com/2022/05/2200pm-water-cooler-5-13-2022.html
Some of these sound like killing the golden goose. Admittedly that goose is in poor health now, but somehow I doubt offing it will improve things.
Who are you Gato Malo? You must be a clouder of big brained felines to have so much economic, social, mathematical, medical and political savvy! I deem you worthy of a subscription plan, even though I am on a humble part-time housewife/rn salary.
And churn out so much amazing content! I like to wonder too--especially the Utah connection intrigues me as I have family there. He was visiting the same time as I was. Maybe I saw him somewhere maskless and didn’t know it! Ha ha just being silly.
The thing that keeps your very rational suggestions from being implemented is emotionalism. Medical care is life or death. Suggest that some should go without because they can't pay and people will screech that you're putting profits over lives. Never mind that such a policy would, over the long run, result in more effective, more affordable treatments becoming available to more people.
I'd be interested to see the same price chart for veterinary care, which so far as I know isn't subjected to the same insane, market distorting insurance system.
The classic problem of the seen and the unseen. We see the person who can't afford the care today, but don't see all the people who would have been saved if the system had been cash-run from the start.
In decades past, there were also charities and religious groups who treated the poor and indigent for free or next to nothing. But those have been supplanted and corrupted in a sense by the for-profit health care model.
In a former life, I tried to get State Level medical pricing transparency passed. The money fought hard and won. Trump somehow managed to get Federal pricing transparency passed, and the industry is outright ignoring the law mostly (10% compliance at best).
The only industry that refuses to post prices on their menu of services is also one of the most out of control. The exceptions are the ones, electives as you listed, where price awareness is built into the advertising.
You want to fix it, they're now ignoring the law because the money is too good, and whatever penalty they pay is less than their profit. It's no longer fixable because they are above the law's reach, and the regulators are captured.
Welcome to the end of civilization. Mind the gap, Express train, few stops left, no exit.