Military History | How To Make War | Wars Around the World Rules of Use How to Behave on an Internet Forum
United States Discussion Board
   Return to Topic Page
Subject: John C. Goodman - A Prescription for American Health Care
CJH    4/25/2009 1:20:32 PM
Imprimis - A Prescription for American Health Care "Let me offer a few examples of how the free market is already working on the fringes of health care. Cosmetic surgery is a market that acts like a real market—by which I mean that it is not covered by insurance, consumers can compare prices and services, and doctors can act as entrepreneurs. As a result, over the last 15 years, the real price of cosmetic surgery has gone down while that of almost every other kind of surgery has been rising faster than the Consumer Price Index—and even though the number of people getting cosmetic surgery has increased by five- or six-fold. In Dallas there is an entrepreneurial health care provider with two million customers who pay a small fee each month for the ability to talk to a doctor on the telephone. Patients must have an electronic medical record, so that whichever doctor answers the phone can view the patient’s electronic medical record and talk to the patient. This company is growing in large part because it provides a service that the traditional health care system can’t provide. Likewise, walk-in clinics are becoming more numerous around the country. At most of these clinics a registered nurse sits in front of a computer terminal, the patient describes his symptoms, and the nurse types in the information and follows a computerized protocol. The patient’s record is electronic, the nurse can prescribe electronically, and the patient sees the price in advance. We’re also seeing the rise of concierge doctors—doctors who don’t want to deal with third-party insurers. When this idea started out in California, doctors were charging 10-15 thousand dollars per year. But the free market has worked and the price has come down radically. In Dallas, concierge doctors charge only $40 per employee per month. In return, the patient receives access to the doctor by phone and e-mail, and the doctor keeps electronic medical records, competes for business based on lowering time costs as well as money costs, and is willing to help with patient education. Finally, consider the international market for what has become known as medical tourism. Hospitals in India, Singapore and Thailand are competing worldwide for patients. Of course, no one is going to get on a plane without some assurances of low cost and high quality—which means that, in order to attract patients, these hospitals have to publicize their error rates, their mortality rates for certain kinds of surgery, their infection rates, and so on. Their doctors are all board-certified in the United States, and they compete for patients in the same way producers and suppliers compete for clients in any other market. Most of their patients come from Europe, but the long-term threat to the American hospital system can’t be denied. Leaving the country means leaving bureaucratic red tape behind and dealing instead with entrepreneurs who provide high-quality, low-cost medicine."
 
Quote    Reply

Show Only Poster Name and Title     Newest to Oldest
Pages: 1 2
CJH       5/2/2009 5:35:34 PM

Reforming health care in the US is easy.  Get the gorram lawyers and business admins out of it.

 

Too many of our hospitals (including my local one) are run by CEOs.  They don't give a damn about health care.  All they care about is the bottom line.  Case in point: I had to have some minor surgery done over the holidays.  I went to one hospital, got charged $2000 for them just to find out what was wrong, then they wanted to charge me another $7000 to fix the problem.  I said, well, okay...can I pay you off over the next four years?  They said, "No, we want it in 18 months or we're sending you to a collections agency." 

 

I replied, "Okay, I can't pay you in 18 months.  No way."

 

The reply: "Then I guess you're not getting the surgery done."

 

My reply: "Given that there is a small chance I might, you know, die without this surgery getting done, am I to understand you're denying me care because of my ability to pay...which is against the law?"

 

Their panicked reply: "Well, no, of course not, but if you don't pay us $9000 in 18 months, we're going to send you to a collections agency."  Which of course would ruin my credit rating and life in short order.

 

What I ended up doing was going to a different hospital, got the surgery done, and for a considerably less price.  I found out later that the first hospital bills itself as a "boutique" hospital.  I later asked the first hospital's admin people when we had become Soviet Russia, where the Politburo gets the nice hospitals and everyone else just makes do.

 

The problem is, when you don't really care if your patients live or die as long as you get paid, this is what's going to happen.  Doctors care about their patients; those who don't find themselves out of the practice very quickly as word spreads.  In my experience, the price I have paid for doctors has been reasonable--$750, $2200--and they have been very reasonable about payment plans.  The hospitals, however, tack on an extra $2000 or $5000 for the use of facilities.  I don't mind paying for the facilities, but you're not going to tell me you need an extra $5000 to pay for nurses and supplies, especially when the doctor provides his own and the anaesthesialogist is also billed separately. 

 

The other thing driving up costs is malpractice insurance.  Lawyers have found a gold mine in lawsuits, and many of these lawsuits are trivial at best.  Doctors have to raise their fees to cover their insurance.  A lot of them are simply getting out of the practice, because the risks are too high.  I joked with my surgeon that if he made me sterile (an impossibility with the surgery being done), I was going to sue.  He almost refused to do the surgery at that point, because he didn't realize I was joking.

 

Are we going to get this kind of reform? Nope.  Lawyers aren't giving up their gold mine; CEOs aren't going to throw away a $200,000 a year cushy job just because a few patients keel over here and there.  So naturally, they're all for nationalized health care.  They won't lose their perks.

 


Too many "officials" is what's wrong with education too.
I had the onset of a potentially life threatening condition and was driven to the ER at the local county hospital which is also a teaching hospital and the biggest hospital in the region. They took my temperature, checked my blood oxygen and after an hour sent me home.
 
A day and a half later, being weak and nauseous, I drove myself to a local private walk-in clinic. The doctor there ran the appropriate diagnostics and found the problem in 5 minutes.
 
In the ER on a weekend there are a lot of gun shot wounds and stabbing wounds being treated at the big hospital from what I had seen.
 
Quote    Reply

Photon       5/2/2009 7:29:14 PM
This thread reminds me of a lecture video that I saw many years ago, courtesy of UCSD.  The lecturer was a proponent of the 'single payer' system.
 
1.  A rough comparison on cardiac bypass operation:  in Canada, equivalent to a Honda, while in the US, equivalent to a BMW with added options.  The operation part is the same in both countries.  Why this significant cost difference?
 
2.  The biggest problem with the US health care system is that, compared to other advanced industrialized countries, there is a huge additional administrative cost.  Certainly legal issues play a big part.  But the way the US health care system is organized is makes it even worse.  First of all, we have local, state and federal governments.  They have different legislations which results in different eligibility requirements and so on.  Very convoluted.  (My mom had to go through this bureaucratic jungle a while ago, and she finally got out of this mess only after she suffered from stroke -- she then could qualify for the state program because she is now disabled!)
 
3.   There are political difficulties especially within the US towards health care.  In most 'single-payer' system, to an extent, you have to ration health care.  For example, someone in his 50's needing a cardiac bypass operation is likely to get one.  On the other hand, someone in his 90's is not likely to get one.  This sort of cost-benefit thinking is openly discussed in Europe, but not in the US.
 
4.  US politicians, in addition to the difficulties associated with openly talking about cost-benefit analysis, must also put up with powerful special interest groups.  By all means, pain in the ass to say the least.  A Californian governor (I think he was either Pete Wilson or Gray Davis) remarked something like ... 'These powerful special interest groups are like huge elephants, and the state government is a bystander who just got swamped by piles of elephant droppings!'
 
5.  As things stand now, the US health care system is a land of extremes:  On one hand, it has the best high-end service in the world, but not very good at providing nation-wide health care.  We have tens of millions of uninsured.  Not because they do not want to become insured, but because they cannot afford it.
 
Quote    Reply

EvilFishy       5/3/2009 2:59:06 AM

---Photon---As things stand now, the US health care system is a land of extremes: On one hand, it has the best high-end service in the world, but not very good at providing nation-wide health care.---

This is a contradiction. With one hand you say the system provides the BEST service in the world and with the other hand you say it does not provided service very well.

The truth is you can get service to stabilize your health anywhere in the USA with out having a dime in your pocket.

Illegal-s do it every day. I once had the displeasure of watching a woman (most likely an illegal immigrant) reply ---I do not know--- when asked where she lived by hospital staff. 

I had to use the emergency room myself last year and it was not UNTIL AFTER I was treated that the hospital even asked how I was going to pay for my care. 

---Photon---We have tens of millions of uninsured. Not because they do not want to become insured, but because they cannot afford it.---

How many people are in the United States illegally?   I have seen estimates as high as 20 million. Let us cut that number in half to be conservative and say it is around 8 million instead.

8 million blood sucking leaches who literally get FREE HEALTH CARE (free for them, paid for by people like ME who actually service the bill).

Now, of the rest who are uninsured, how many of those LEGAL Americans are uninsured by CHOICE?

How many of the rest, who are uninsured because they cannot afford it, do NOT qualify for a state or federal program of one sort or another (I know for a fact hospitals can and do negotiate payment plans; thankfully I actually work for a living so I could pay my bills)?

This number we are left with: Uninsured people in USA - Illegals - those who can afford insurance but do not purchase - those who cannot afford insurance but qualify for government assistance = X.

Are you telling me that X numbers in the tens of millions (in a nation of 300 million)?

The health care system in America does need help (tort reform for starters) and lost of it. But the FIRST question we need ask ourselves is probably the most important:

Do you want to turn over what you consider the BEST health care service in the world to a government that cannot run a WHORE HOUSE, a TRAIN, or a FOOD COURT properly without delving into the depths of corruption and insolvency?

 
Quote    Reply

CJH       5/3/2009 2:38:42 PM

This thread reminds me of a lecture video that I saw many years ago, courtesy of UCSD.  The lecturer was a proponent of the 'single payer' system.

 

1.  A rough comparison on cardiac bypass operation:  in Canada, equivalent to a Honda, while in the US, equivalent to a BMW with added options.  The operation part is the same in both countries.  Why this significant cost difference?


 

2.  The biggest problem with the US health care system is that, compared to other advanced industrialized countries, there is a huge additional administrative cost.  Certainly legal issues play a big part.  But the way the US health care system is organized is makes it even worse.  First of all, we have local, state and federal governments.  They have different legislations which results in different eligibility requirements and so on.  Very convoluted.  (My mom had to go through this bureaucratic jungle a while ago, and she finally got out of this mess only after she suffered from stroke -- she then could qualify for the state program because she is now disabled!)


 

3.   There are political difficulties especially within the US towards health care.  In most 'single-payer' system, to an extent, you have to ration health care.  For example, someone in his 50's needing a cardiac bypass operation is likely to get one.  On the other hand, someone in his 90's is not likely to get one.  This sort of cost-benefit thinking is openly discussed in Europe, but not in the US.


 

4.  US politicians, in addition to the difficulties associated with openly talking about cost-benefit analysis, must also put up with powerful special interest groups.  By all means, pain in the ass to say the least.  A Californian governor (I think he was either Pete Wilson or Gray Davis) remarked something like ... 'These powerful special interest groups are like huge elephants, and the state government is a bystander who just got swamped by piles of elephant droppings!'


 

5.  As things stand now, the US health care system is a land of extremes:  On one hand, it has the best high-end service in the world, but not very good at providing nation-wide health care.  We have tens of millions of uninsured.  Not because they do not want to become insured, but because they cannot afford it.



4.  US politicians, in addition to the difficulties associated with openly talking about cost-benefit analysis, must also put up with powerful special interest groups.  By all means, pain in the ass to say the least.  A Californian governor (I think he was either Pete Wilson or Gray Davis) remarked something like ... 'These powerful special interest groups are like huge elephants, and the state government is a bystander who just got swamped by piles of elephant droppings!'
 
The special interest groups are there because the government has so much power to interfere in healthcare. If the government did not interfere, there would not be the presence of lobbyists and such groups. Our constitution specifically mentions this function.
 
About California, a very vocal interest group consists of healthcare industry worker unions. These and public service employee unions are most certainly the big pains for the governor.
5.  As things stand now, the US health care system is a land of extremes:  On one hand, it has the best high-end service in the world, but not very good at providing nation-wide health care.  We have tens of millions of uninsured.  Not because they do not want to become insured, but because they cannot afford it.
There is no constitutionally specified right to healthcare in this country. It is implied that people may be able to obtion care without going to such an extreme.
 
Also, there is not necessarily any correlation between the ease of healthcare access and the rate of insurance coverage. People are not flatly refused healthcare. They may have to dispose of a financial obligation but they will not be denied treatment.
 
This statement would make more sense if it went this way - "5.  As things stand n
 
Quote    Reply

Photon       5/3/2009 7:28:48 PM
Blaming the tens of millions of uninsured on illegal immigrants is soooooo ingenious!
 
If the issue over illegal immigration is such a big deal, there is a straightforward way to deal with it:  Turn the US into a third-world country.  That will take care of such a problem in the most efficient manner, since migrant workers go wherever there is a demand for them.  Once we become almost as poor as them, they will not come to the US, even if we beg them to do so.  Unfortunately, this would require the Americans to cut down on their standard of living and contract their GDP.  But that is America's problem, not immigrants.
 
Quote    Reply

EvilFishy       5/3/2009 7:56:48 PM

---Photon--- Blaming the tens of millions of uninsured on illegal immigrants is soooooo ingenious! ---

When the shoe fits.

---Photon--- If the issue over illegal immigration is such a big deal, there is a straightforward way to deal with it: Turn the US into a third-world country.---

Many parts of the USA are already third world thanks to the large influx of illegal immigrants.

If you want to convert the rest of the USA into third world status, keep the spicket open.

---Photon--- That will take care of such a problem in the most efficient manner, since migrant workers go wherever there is a demand for them.---

Migrant worker? A person from Bolivia in the United States illegally is not a migrant worker. That person is an ILLEGAL IMMIGRANT who is breaking the law and leaching off of all other Americans.

The ones who come here legally are welcome. All others: no vacancies.

---Photon--- Once we become almost as poor as them, they will not come to the US, even if we beg them to do so. ---

Our current immigration policy is seeing this happen right now.

Our current health care situation has many problems and illegal immigration is a BIG CHUNK of that problem.

 
Quote    Reply

debugger    false choice   5/3/2009 8:18:10 PM

The choice between socialist health care and what we have now is a false choice.
We already have a version of socialism in our health care.  We are being offered the choice of supply with huge cost (today) or very little supply with little visible cost.
 
Perhaps a few Socratic questions might help?
 
When was the last time you saw a hospital advertise for customers based on cost?
When was the last time you saw a coupon for a medical care discount?
Can you go to the Drug Store and buy an antibiotic without a doctor/government certified prescription?
 
How hard it it to diagnose a simple ear infection?
How much time will it take the doctor to diagnoses it?  How much will you be charged to get that diagnosis?
What does that work out to for an hour?
A good programmer needs much more education than it takes to do an ear infection diagnosis.  How much does
a good programmer charge for an hour?
 
The length of time it takes to make a ear infection diagnosis is a problem of the market.
The length of time it takes to get a medical degree and become a licensed doctor is a problem of socialism. 
 
Just as Jiffy Lube might say you need to see a transmission company, a medical practitioner in a free market
could refer a patient to a more trained practitioner.
 
 
 
Quote    Reply

CJH       5/7/2009 6:55:32 PM




The choice between socialist health care and what we have now is a false choice.

We already have a version of socialism in our health care.  We are being offered the choice of supply with huge cost (today) or very little supply with little visible cost.


 

Perhaps a few Socratic questions might help?

 

When was the last time you saw a hospital advertise for customers based on cost?

When was the last time you saw a coupon for a medical care discount?

Can you go to the Drug Store and buy an antibiotic without a doctor/government certified prescription?


 

How hard it it to diagnose a simple ear infection?

How much time will it take the doctor to diagnoses it?  How much will you be charged to get that diagnosis?


What does that work out to for an hour?


A good programmer needs much more education than it takes to do an ear infection diagnosis.  How much does

a good programmer charge for an hour?

 

The length of time it takes to make a ear infection diagnosis is a problem of the market.


The length of time it takes to get a medical degree and become a licensed doctor is a problem of socialism. 


 

Just as Jiffy Lube might say you need to see a transmission company, a medical practitioner in a free market


could refer a patient to a more trained practitioner.


 

 


I am not sure what you mean here.
I think that any time a doctor looks at a patient the doctor has to be aware of the entirety of the state of the patient. An ear ache might be a simple ear infection or it might be something else.
 
I think one reason we have a recommended arrangement consisting of patients being seen regularly by the same primary care doctor is that the doctor has a benefit of a health history.
A primary care physician referral is required (by insurance and common sense) often for a visit to a specialist. The primary care guy screens patients.
 
Quote    Reply

CJH    Friday Interview: Exposing Health Care Myths   5/9/2009 12:11:56 AM
Carolina Journal
Friday Interview: Exposing Health Care Myths
And my third myth is that socialized systems — such as the system that exists in Canada, which is where I?m from — are more efficient and cheaper than the American system. And if you look at it, United States spends 16 percent of its gross domestic product on health care. I don?t know whether that number is too much. Perhaps it?s too little. We demand a lot in our health care in this country, and people come from all over the world, from socialized systems, to use it.

Pipes: Well, you know, the polling, the recent polling data shows that 81 percent of Americans like the health care they have. So, you know, we need to focus on those people. And what people have is what they like. We need to also work on those people that aren?t enjoying the health care system and are having trouble getting care. How do we get them the type of care without throwing the baby out with the bathwater? So we need to beef up ? the health saving accounts, consumer-driven care, because, as P. J. O?Rourke says, if you think health care is expensive now, just wait until it?s free.

 
Quote    Reply
1 2



 Latest
 News
 
 Most
 Read
 
 Most
 Commented
 Hot
 Topics