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Something has got to change.

Our health-care system is broken, and I have the proof. But before I go into that, let me give you a little background.

I am a conservative who has moderate leanings. Or I’m a moderate with conservative leanings. Either way you look at it, I’m no raving far-right type, but I’m no liberal either.

I work for a large multi-national company with excellent PPO medical insurance. I have a fully-funded Healthcare Spending Account (HSA) that my company generously seeds with money every year. I consider myself and my family fortunate.

Here is where it gets interesting. And problematic.

My wife was hospitalized twice earlier this year with long stays both times. Without giving away too many details, there is a chronic pre-existing condition that we continuously struggle with. Thank you, Obamacare.

We are now dealing with the fallout of these events. In previous years, we had Kaiser and never realized the blessing that it was to us. Health Maintenance Organizations (HMOs) are generally integrated insurance/provider health-care solutions that enable patients to focus on healing and recovery.

PPOs, on the other hand, are self-managed and fraught with pitfalls. Now we face mountains of bills that need to be reviewed, cataloged, entered into a spreadsheet, and resolved.

My wife spends between one and three hours daily trying to understand and reconcile the many bills that we have received. I estimate that a full 75 percent to 80 percent of these bills have errors that need correction. Interestingly, the errors almost always benefit the provider in some way.

We found one physician who visited my wife nine times in the hospital. These visits were probably less than five minutes each. Imagine our surprise when we discovered this doctor was out-of-network and charged us $550 per visit!

Upon challenging the billing, the office manager grudgingly lowered the bill 50 percent, inferring that he was “doing us a favor.” Needless to say, we are not done dealing with this fellow.

What is becoming so clear to us is that our system is so fraught with incompetence and fraud that there may be no reasonable way to save it. Most medical providers do not bill on the basis of the service/item provided but by how much insurance will pay.

This is completely wrong. Think about it. Suppose you went into a grocery store and bought a watermelon. At the register, the clerk looks at your Louis Vuitton purse and says, “Oh, you can afford to pay $27 for this melon.” Would we stand for that? Nope.

So why do we allow the price of medical services and goods to be set by the ability to pay? This is not capitalism. It is a warped system where costs are allowed to spiral with no limits.

All attempts to create a “free market” in health care have failed here in the United States. Understand this: in the U.S., we pay far more in public monies for health care without a true public health-care system than European countries pay for full socialist health-care systems.

Let that sink in. Simply put, we pay more and get less. It’s just that simple.

And, unfortunately, I think it’s the insurance system that is to blame. If we remove pure insurance companies and have a more managed approach, like a Kaiser or any other HMO, we can more effectively control costs and manage care.

Insurance companies are not evil but they have to make money. So they will pass all costs along to you or your employer in the form of higher premiums. Insurance people don’t care about rising costs – they aren’t the ones who ultimately pay. They take their cut and are out of it.

It may be time for us to start considering a single-payer system to control costs and manage care. Let’s not kid ourselves – health care was not, is not, and never will be a free-enterprise system.

A few people (like insurance companies) have made a mountain of money. For the rest of us, we suffer with expensive and cost-ineffective care.

This is where uber-conservatives begin to howl about “socialized medicine” and how people are harmed by delayed elective surgery. These same folks are usually in good health and don’t think much about those who are poor, sick or injured.

But here is the great irony. Everyone, at some point, will need detailed health care at least once in his or her life. Very expensive health care. Unless they are hit by a bus or otherwise die suddenly.

These costs are inevitable and growing. We need to change how we think about our health-care systems now. Maybe it’s time to look at a single national pool of risk where everyone pays and everyone benefits.

Costs can be mandated. However, if extra services are desired, supplemental health-care coverage could be offered at a price. This will result in driving much of the confusion and fraud out of the system.

Would this be perfect? Nope, not by a longshot. But we have to consider doing something different because our current system is an abject failure.

Steve Lunetta is a resident of Santa Clarita. Angry emails can be sent to slunetta63@yahoo.com.

 

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Steve Lunetta
Raging, far-centrist conservative moderate with a slightly tongue-in-cheek humorist approach.
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  • Brian Baker

    Pure nonsense.

    First the title (which I understand may well have been assigned by the editorial staff): “Health care free market an abject failure”.

    We don’t currently have a “free market” in health care, so how can it have “failed” at all?

    Then, in all the anecdotal “evidence” in the column, one glaring element simply leaps out at me: you had an HMO, which you described as a “blessing”, and YOU made the decision to switch to a PPO, from which all your described problems arise.

    If your organization is like the ones I worked for, as an employee I had a choice between either a PPO or an HMO. Didn’t you? Even if you didn’t, you certainly weren’t forced by your employer to participate in their PPO program. So it seems to me that your problems with your health insurance provider are actually due to your own lack of due diligence, and your own decision to participate in a PPO that doesn’t meet your perceived needs.

    Your lack of due diligence is also illustrated by your example of allowing visits by a doctor without asking first what your own charges would be for his services. Why would anyone do that? That’s a question I ALWAYS ask when a medical service or procedure is being contemplated.

    The next problem here is that the insurance companies aren’t “making a mountain of money”. In fact, under the current structure, many are facing serious financial problems, and are withdrawing from many markets. Further in many jurisdictions, this state being one of them, insurance profits are limited by law.

    Then the ultimate sin: proposing “single-payer”, which means government-run health care. You want to see how well that will work out? Take a look at the VA system for your answer.

    How about we actually try some REAL free-market health care for a change? For years I’ve promoted three steps to reforming the system:

    1. Eliminate the artificial barriers to interstate competition for health care and insurance products. Let competition begin.

    2. Streamline the FDA approval process, which will significantly lower the cost of bringing new meds and procedures to market.

    3. Reform the medical tort system, which will lessen the costs involved in, and perceived need for, practicing “defensive medicine”.

    Let’s do those three things, see how well they work, and only then see what else might be done to improve things.

    Lastly, we as a society have to get away from the idea that there’s some magic bullet that will indemnify us from the vicissitudes of life. Some people are healthy until the day they drop dead; some are chronically ill for decades. That’s just the way things are. It’s no different from anything else. Some people have investments that make them rich; some people go bankrupt.
    Life isn’t “fair”.

    But no one ever said it would be.

    • charles maurice de tallyrand

      1. Eliminate the artificial barriers to interstate competition for health care and insurance products. Let competition begin.

      Already don’t exist. Try again. Insurance companies can enter any market they choose. On top of that Obamacare already allows states to enter into compacts with other states as well and allow insurance providers to give coverage across state borders. Three states I believe did so and I’m pretty sure they had no company willing to take them up on the offer. There are reasons why insurance providers don’t enter into certain markets and that pertains more to the economic barriers that exist. Health care services are provided locally (remember that article about concrete you completely misunderstood). It’s not easy for a company to move into a new market for many varied reasons. As such they actually expect to lose money at first when they do — look it up, do some actual research for once.

      2. Streamline the FDA approval process, which will significantly lower the cost of bringing new meds and procedures to market.

      Uhm ok sure, won’t solve the problem though.

      3. Reform the medical tort system, which will lessen the costs involved in, and perceived need for, practicing “defensive medicine”

      States that have done so haven’t seen a significant drop in rates. And on top of that is it really a very American thing to do to give certain industries protection

      But you already know all of this. You did however mention something that is quite true

    • Phil Ellis

      Brian, Steve’s comment was: “All attempts to create a ‘free market’ in health care have failed here in the United States.” He didn’t say that a free market health care system had failed, just that we haven’t been able to create one. You have pointed out one of those barriers – interstate restrictions.

      • Brian Baker

        Phil, I understand that and acknowledged that the headline may well have been created by The Signal’s editorial staff.

        That having been said, there haven’t been any “attempts” to create a free-market system. In fact, quite the opposite. All we’ve had for the last 50 years or so is ever more government interference in, and control of, the health care system.

        Anyone, regardless of where they claim to stand on the political spectrum, who thinks that government is the answer to the problem has guzzled the Kool-Aid, big time.

        • charles maurice de tallyrand

          Here’s another reason why there can’t be a “Free Market” Brian. Doctors, pharmacies, medical equipment all are regulated by the state.

        • Steve Lunetta

          Title was changed by Signal. They are the professionals, not me.

          • Brian Baker

            Which I acknowledged was probably the case.

        • Phil Ellis

          I agree – that supports Steve’s comment that all attempts to create a free market in health care have all failed

    • Steve Lunetta

      BB- my employer eliminated the HMO option. Only PPO was available. This is the common trend today.
      When people are sick, Brian, the first question in their mind is not “is this specialist in my network? Or, what are you charging per visit?” Monday morning quarterbacking is easy. Try asking those questions when you are passed out on a table in the ER.
      What you seem to miss here is that our system provides LESS coverage for MORE money. It is cost ineffective. There are much better models that we should look at. Single payer systems seem to be the best alternative now.

      • Brian Baker

        And yet, Steve, you still had the option to retain your HMO. No one forced you to participate in your employer’s plan… as I pointed out in my comment. That was YOUR decision.

        And no, I didn’t “miss” that MORE money gets LESS coverage. EVERYONE knows that. That’s the problem with socialized medicine; there ain’t no free lunch, and in order to even ATTEMPT to pay for it, services are going to be cut, and “rationed” through financial leverage by raising costs to consumers. Your “solution” of letting the government take even more control of a system they’ve already ruined is like seeing a fire and trying to put it out with a can of gasoline.

        As I said, your “best alternative” of single-payer is easy to analyze. We’ll have the pleasure of the VA system for everyone. What a joy.

        • Steve Lunetta

          Don’t even know how to respond to this, Brian. If you infer that I could opt out of my employer’s paid program to pay thousands more per month on an exchange or, better yet, resign my job and pay even more through Cobra, yes, I suppose those are options. But, not options that 99.9995% of the public would consider…..
          I would strongly encourage you to look at the European models for health care. They pay a fraction of what we do, everyone is covered, and people are generally satisfied. Are there exceptions and “horror stories”? Yep. But, generally, these are systems that were better designed than our more “accidental” health care system with which we struggle today.

          • Brian Baker

            That’s exactly what I’m saying, Steve. You could have opted out and paid for your own insurance, which you yourself said was better. You chose to not do that, I’m sure to save on the cost of premiums, but now you want the taxpayer to pay for your decision through nationalized medicine. Why should we do that? It was YOUR decision to make, and you made it. That’s like going to a restaurant and ordering the lobster, but insisting you only want to pay the price of the hamburger that’s also on the menu.

            Comparisons to Europe are utterly irrelevant. The only way that worn out cliché would be valid is if Europe were culturally, socially, and economically identical to this country except for their health care system, and nothing could be further from the fact. They don’t have our Constitution, standard of living, FDA hurdles, medical tort problems, or expenditures on a diplomatic and military mission to protect their way of life (something we provide for the entire Free World). In essence, WE subsidize THEM.

          • charles maurice de tallyrand

            See Steve really when you think about it, it’s your fault. Your wife chose Lobster.

          • Steve Lunetta

            We checked into opting out of our company plan, Brian. The costs were astronomical. Seriously. It was not even an option.
            Will this result in some folks paying bills for others? Yes. For example, I am never sick and rarely go to the doctor. I will subsidize the cost of someone else’s healthcare. But, if the pool is big enough, the cost to me will be very small. Your interstate barrier killing idea is in a similar vein. Make bigger pools to decrease risk.
            So, you won’t even consider an alternative model that may offer us benefits over our current system? We are not as different from the Europeans as you may think….

          • Brian Baker

            No, Steve, I won’t consider it. I’m willing to let free market solutions that conform to our Constitution do their work, where you’re willing to implement methods that fundamentally conflict with those very principles, and further have a historic record of NEVER working over the long term. Socialism is a failure. As Maggie Thatcher noted, the big problem with socialism is that it invariably runs out of other people’s money.

            And yes, pard, we’re HUGELY different from Europe. I’ve been there many times (as well as most other places around the world, too), and we’re really not alike at all… as I detailed elsewhere here.

            As I said there, WE are subsidizing THEIR socialized health care. That’s just an economic fact.

          • Brian Richards

            What is never talked about by the universal coverage crowd is how healthcare is rationed in the countries that have it. Not only is it rationed, but certain procedures will be denied based on life span predictions. These are not anecdotal stories either.

          • Brian Baker

            That’s a great point, Brian, and in fact we’re seeing the same thing happening here under Obamacare.

            What’s the net effect of spiraling premiums, deductibles, and out-of-pocket expenses?

            De facto “rationing”.

          • Jim de Bree

            Not in the Netherlands. I had an uncle in his 80s who had open heart surgery. But then the Dutch don’t have single payer system.

            While I agree that rationing is a real problem–particularly in the UK, we go to the other extreme. We keep people alive on live support when there is no hope of recovery. This is a huge expense. My wife is nurse who used to work in an ICU. Patients were routinely kept on life support for weeks because the family simply could not say goodbye. Their insurance paid for it, so they could postpone a difficult decision at the policy holders’ expense.

            A former partner of mine sits on a hospital board in Florida. He said that keeping people on life support for extended periods is quite common and based on the hospital’s experience is the single biggest driver of healthcare costs they provide.

          • Jim de Bree

            Brian–comparisons to the Netherland or Switzerland are relevant. I know you disagree, but there are European countries who do not have single payer systems that function very well.

            Based on our previous conversations, you believe that those countries are not comparable. I strongly disagree. Trying what they have will be a better result that what we will have five to ten years from now. We will just have to disagree on this point.

            I am sorry but I don’t understand your point involving the nexus between the fact that we support their defense and the cost of their healthcare. They are spending half the portion of their GDP on healthcare than we do. If Country X spends 10% of GDP without paying for their defense and we spend 16% of GDP on healthcare and also pay for their defense, why is paying for their defense relevant? I could see if they were spending more than we were and they were diverting expenditures from defense to healthcare, but their level of healthcare spending is lower than ours.

          • Brian Baker

            “… why is paying for their defense relevant?”

            You’ve got to be kidding me. You’re an accountant. If they had to pay for their own national defense — which they don’t, since we do that for them for free to them — as well as pay for their socialized medicine, their economies would completely collapse.

            Further, I notice you completely omitted what I wrote about standard of living. I’ve been to those countries, and I wouldn’t trade theirs for ours under any circumstances.

          • charles maurice de tallyrand

            This is how you know you’re talking with an irrational man Jim. Mere ignorance cannot account for a statement such as this below.

            “You’ve got to be kidding me. You’re an accountant. If they had to pay for their own national defense — which they don’t, since we do that for them for free to them — as well as pay for their socialized medicine, their economies would completely collapse.”

      • Brian Richards

        “Brian, the first question in their mind is not “is this specialist in my network? Or, what are you charging per visit”
        Why is that Steve? You’re a consumer of someone’s labor and effort and I know you’re smart enough to know that costs could be massive where you wife’s condition is concerned. We’ve all been there to one degree or another, but it’s still your responsibility to see to it that you don’t get hosed by our moronic system.

        • Jim de Bree

          Speaking from thirty years of experience dealing with a daughter who has cystic fibrosis and spending $50,000 annual for medical expenses since 1986, it is impossible not to get hosed by “our moronic system.”

          Those who chastise Steve obviously have not had to deal with the financial aspects of a chronic serious medical condition. All of those espousing free market, etc. would sing a much different tune if they had to deal with a real life situation.

          Furthermore, from your comments, you are not familiar with a huge problem in our system that catches medical consumers unaware. They are admitted to a hospital that is an-in network provider. The hospital has a physician on staff who assigned to the patient’s case who is not in network. The network status of the doctor is not disclosed to the patient. when you are sick in the hospital you aren’t going to ask the doctor if he is in your network. Furthermore, even if you asked, the doctor wouldn’t know. They say call my office. I have been there.

          Again, if you had to deal with a chronic illness, rather than dealing from an academic perspective, you would be aware that there are few consumer rights in this area.

          After 30 years of dealing with these problems, I am one of the most diligent consumers of medical care. I still get screwed right and left. I have had to engage counsel to deal with some of these matters. I am healthy and can do this for my daughter. Unfortunately, many are too sick to do so.

          You need to lighten up on Steve.

          • Brian Richards

            I have not had to deal with a chronic condition Jim, but I have dealt with a myriad of health concerns for myself, my wife, and my children. It’s just a matter of financial degrees we’re talking about, not about the relevance of the point I was trying to make. It was not my intent to chastise him.

          • Brian Baker

            No, I don’t need to “lighten up” on anyone, Jim. You’re simply repeating the same things he already said, and making an absolutely unsubstantiated assumption that you guys are the only ones who’ve had to deal with expensive medical issues. What do you base that idea on, anyway? Frankly, it’s preposterous.

            “Again, if you had to deal with a chronic illness, rather than dealing from an academic perspective, you would be aware that there are few consumer rights in this area.”

            I deal with it all the time, seeing as how I personally have two permanent disabling conditions, and have had for many years. I’ve been having to deal with the medical establishment for a couple of decades now, so I think I’m just as “qualified” as anyone in this virtual “room” to state an opinion based on MY OWN personal experience with it. And I happen to practice what I preach.

          • Jim de Bree

            Brian, I am sorry to hear about your medical conditions, but aren’t you on Medicare? If so, doesn’t that insulate you from the Obamacare issues?

          • Brian Baker

            Thanks. The issues predate Medicare by many, many years. I’ve only been on Medicare for three years.

            So no, I wasn’t immune to the joys of Obozocare.

          • Brian Baker

            Incidentally, Jim, Obozocare’s impacted Medicare, too, though most people don’t pay much attention to that.

            My monthly premiums have increased by somewhere around 30%. My out-of-pocket annual max has increased. Drug copays have increased. So even we aren’t immune.

        • Jim de Bree

          Brian, I spent last night going over about $50,000 of medical bills that we cannot get my daughter’s insurance company to pay. The bills resulted from at recent hospitalization. The state of California has ordered the insurance company to pay the bills, but the insurance company is dragging their feet and the providers are going after my daughter.

          One of the bills is from an out of network pulmonologist who visited my daughter in the hospital. My daughter required the daily care of a pulmonologist who monitored her situation. Her regular pulmonologist took a day off and she was seen by this other pulmonologist who was the only doctor on call who has hospital rights. There was no in-network alternative.

          I showed your comment posted above about it being the patient’s responsibility to see that they don’t get hosed by our system. My daughter laughed and commented that is a naïve view of today’s world because you simply do not have control over who sees you when you have a multidisciplinary team providing medical services.

          By the way, another place where you can really get hosed is lab work. Many times while in the hospital, if you need special tests, the work has to be sent to an outside lab. You don’t even know it until you get the bill from the lab. If a lab is in network, usually the bill is for a few dollars. If it is out of network, it is typically several hundred dollars.

      • Brian Baker

        Also, Steve, as to this: “When people are sick, Brian, the first question in their mind is not ‘is this specialist in my network? Or, what are you charging per visit?'”

        Actually, when I’ve needed medical care, that IS the first question I ask. The only time I don’t is if it’s an emergency situation, and in such cases — ER visits, etc. — all the plans of which I’m aware cover those visits and necessary medical care pretty fully. And that, Steve, is exactly “when you are passed out on a table in the ER”.

    • Brian Richards

      Well said Brian!

      • Brian Baker

        Thanks, Brian.

      • charles maurice de tallyrand

        Unfortunately none of his proposals would work, but conservatives prefer political slogans to actual viable governance. That much is clear.

    • Jim de Bree

      Brian,

      You stated that you think eliminating artificial barriers to interstate competition will work. I agree, but the ACHA does not do this in a true sense. The existing ACA effectively takes a tranche of the population that is not as healthy as the general populations and places those people in a separate risk pool. These risk pools are further segregated by state.

      The ACHA merely consolidates those risk pools for all the states that do not choose the high risk pool option. So now you have a multistate risk pool with actuarial demographics that are similar to those of the individual states. How is that going to significantly reduce the cost of medical care for the people covered by exchange policies?

      I think that there is a systemic failure of the ACA that will not be cured by the ACHA provisions.

      • Ron Bischof

        The political reality of an uncooperative Democratic minority and a Senate legislative filibuster limits what can be accomplished immediately, Jim.

        Medical services financing has been dysfunctional for decades and ACA compounded the underlying defects and added to them while exponentially increasing costs for many. Further Federalization of healthcare financing will not improve it.

        It isn’t pragmatic to expect ACHA to be more than an incremental unwinding of the dysfunctional when most of the energy expended is a political fight over who will be subsidized and by how much.

        Witness the hysteria and disingenuousness over the CBO projections.

      • Brian Baker

        I wasn’t referring to the new GOP version of Obamacare in any way whatsoever, Jim. In fact, I find their proposed bill irrelevant to the topic, to be honest, because it really doesn’t advance a free-market approach either. So I couldn’t agree with you more.

  • single payer

    “Free market” simply means whatever the market will bear…………or whatever price the provider can dream up…………
    Single payer aka Medicare for ALL…………..

    • Ron Bischof

      You demonstrate no understanding of what a free market is in your post.

      To remedy this deficit, I recommend this lecture in an Economics 101 course:

      The Principles of Free Market Economics

      “How Markets Work”

      https://online.hillsdale.edu/courses/economics-101/lecture-2

      • single payer

        You don’t have to be an economics major to understand pricing according to what you can either convince or coerce from a customer. It has little to do with the value of the service or commodity and everything to do with what you can squeeze out of somebody……………..
        Single payer will allow government to set price controls on pharmaceuticals or healthcare providers that are non-existent today. It is the only thing that will rein in the uncontrolled escalation of healthcare costs……….
        Free market = unchecked greed

        • Ron Bischof

          Ah, “greed”. You didn’t bother to take the opportunity to learn a modicum of economics, did you?

          Here’s more economic reality for you to ignore in preference to your ideology:

          https://www.youtube.com/watch?v=MQ0-cDKMS5M

          • single payer

            I think greed is so natural to you that you don’t even realize its prevalence……………..

          • Ron Bischof

            Assertions aren’t facts.

            Please advise how my understanding of economics is incorrect and yours is accurate, fictional nom de plume.

        • charles maurice de tallyrand

          Do you think if Ron actually had a degree in economics he’d condescend so much and post the link to an online econ 101 course he watched online from a right wing conservative christian university?

          • Ron Bischof
          • charles maurice de tallyrand

            Awe that’s cute, Ron can’t even properly identify the claim in my last statement.

          • Ron Bischof

            Your obtuseness continues to amuse, deceased one.

            The knowledge level displayed indicates “single payer” needs to start with the basics taught by a qualified economist that has public sector experience.

            That’s something you have in common.

          • charles maurice de tallyrand

            Lol deflecting now eh Ron? What claim did I make in that statement, what did I say exactly? This whole logical fallacy stuff is a bit over your head isn’t it?

            Also sorry little Ronnie but unlike yourself I have actually taken economics courses as a student at a real brick and mortar university — one ranked within the top ten in the United States for economics. I don’t hold a fake tea bagger degree like yourself.

          • Ron Bischof

            Your boorish adolescence and circumvention of word filters is now on full display, deceased one.

            You can’t help yourself, can you?

  • Gene Uzawa Dorio, M.D.

    Thank you Steve

    Until someone is ill requiring hospitalization, their reality of our healthcare system is ephemeral at best. If you are healthy, it doesn’t matter what kind of insurance you have. When a chronic condition or acute sickness rears it ugly head though, one not only has to meet that challenge, but also fear it won’t put you in tremendous debt, teeter you on the edge of bankruptcy, or threaten the loss of your home.

    Why should you and your wife now have to face potential financial disaster? Will it effect the efficiency in how you do your work? Can the psychologic worries be detrimental to your wife’s healing process. Could it effect the rest of your family?

    All of us will get sick.

    The present system will not allow us to compete in the global marketplace with countries that have worthy healthcare. We lag far behind in fixing this problem.

    I agree with you Steve, the free market system will not work in healthcare. Glaring statistics point to that.

    Once and for all, let’s fix this system for the health of our children and grandchildren…and yes, even ourselves.

    Gene Uzawa Dorio, M.D.

    • Brian Richards

      Dr. Dorio, I was brought into this world over 50 years ago and the cost to my parents was less than $300.00, or about $3,100.00 in todays dollars. They had no insurance so please do not lecture the rest of us about how the free market wouldn’t work for healthcare. It absolutely would work and the only reason it’s failed is because of massive government intervention distorting the markets grossly. How would we know the free market wouldn’t work in healthcare since most of us have never experienced it?

      • Brian Baker

        “How would we know the free market wouldn’t work in healthcare since most of us have never experienced it?”

        That is the question, isn’t it, Brian?

        Like you, I’m old enough (at 68) to have existed under our system before all the government meddling, and it worked just fine, thanks.

        As time went on, the more the government meddled, the worse it got, until here we are today.

        • charles maurice de tallyrand

          Which begs the question, why did the government get involved in the first place? Why for instance did a republican president, Nixon, implement much of the employer based system we have today? Oh right because the invisible hand of the market was not sufficiently solving the problem.

          • Brian Richards

            And despite 5 subsequent decades of ever increasing government involvement, your solution is even more involvement. The definition of insanity comes to mind.

          • charles maurice de tallyrand

            Hey Brian, I carry a special bear amulet in my pocket and guess what in all that time no bear attacks. Must be working huh?

            The definition of insanity is not acting rationally and rejecting information which isn’t cohesive with your own preference for what you’d prefer reality to be.

          • Ron Bischof

            Incorrect, deceased one.

            Employer based medical insurance coverage began common implementation as a circumvention of WWII wage and price controls.

            Subsequently, the Federal government gave this adaptation to government regulation tax favored treatment by not categorizing medical insurance benefits as taxable wages.

            Facts matter and you frequently fail to provide them.

          • charles maurice de tallyrand

            What??? Was I giving a comprehensive history? Nixon didn’t implement a mandate for employers? What planet are you on Ron?

          • Ron Bischof

            You truncated history in a unsuccessful attempt to score a lightweight ideological point.

            I’m among the living with intact memories and competent faculties, deceased one.

            That’s how I provided the why when you did not.

          • charles maurice de tallyrand

            Well gee Ron next time I’ll include a complete history of health care of the united states.

            You religious belief in abstract free market solutions is nothing more than childish and naive.

          • Ron Bischof

            The root cause would have sufficed, as I demonstrated. It was government wage and price controls, not a market failure.

            When you first appeared under an assumed name, I formulated an opinion based on your initial posts. Subsequently, you’ve done nothing to alter it.

            The real Tallyrand captured it thusly:

            “To succeed in the world, it is much more necessary to possess the penetration to discern who is a fool, than to discover who is a clever man.”

          • charles maurice de tallyrand

            You think you’ve found one detail that negates my point however it does not. The root cause is that a free market will never exist nor has a free market provided for what as a society we deem necessary and just. It didn’t do so before WW2. It didn’t do it after WW2 when companies started offering health benefits as a means to competitively secure employees. Your naive desires do not reflect reality.

          • Ron Bischof

            “… as a society we deem necessary and just.”

            Now you’re adding qualifiers to cover your error.

            You’re not worthy of further attention, amateur. You don’t offer substantive debate.

          • charles maurice de tallyrand

            My error? Hahaha ok Ron. I think your Asperger’s is showing through again.

          • Ron Bischof

            You claim medical expertise in addition to being a deceased European statesman?

            Hey, look everyone! A performance artist making a medical diagnosis over the internet. 😀

          • charles maurice de tallyrand

            I know that if you received an enema there would hardly be any of you left.

      • Jim de Bree

        Brian–fifty years ago medical services were provided by independent small operators. Today the providers, pharmaceutical companies and insurance companies are oligopolies. Unlike 50 years ago, the management of many (if not most of the providers are Wall Street driven. If you suffer from a chronic illness you will soon come to understand this. Any move to a free market solution will have to contain extensive regulation to protect the consumer.

        One other huge issue is that today, technology and pharmacology provide a much bigger role in healthcare. Those have driven up the cost of services. When you were delivered, there was no ultrasound, there were limited neo-natal care facilities. Medicine has improved significantly over the past fifty years and the improvement has come at a cost.

        As I have said, I think that the healthcare industry is tantamount to a utility. It can be market based, but must be regulated to afford consumer protection.

        Furthermore, we are the only advanced country that fails to centralize our purchasing so that we can extract quantity discounts from providers. Why do I pay $700 for Crestor prescription when my cousin in Australia pay $5 for the identical prescription. Australia subsidizes hospitals but not drug purchases.

        • Brian Richards

          Are you saying that the current system is not regulated or insufficiently regulated? While I may not have your experience with chronic issues, I do have experience and it seems to me the more we regulate, the worse it gets. Why can I not purchase insurance and coverage based upon my needs and not what some bureaucrat in DC thinks I need?

          • Jim de Bree

            Brian–what are your needs? If you are basing your decision solely on your current needs and postpone your purchases until your needs increase, you pay more. That is what happened before World War II and sick people went broke.

            You provide regulatory guidelines to alleviate anti-trust concerns and provide consumer protection. We now have a massive array of regulations that do neither.

        • Ron Bischof

          Oligopolies… the symptom is the root causation, Jim?

          Australian pharmaceutical pricing of U.S. originated patent drugs are subsidized by USA R&D and cost recovery, are they not? Note that the USA is one of the primary patent application markets for Australian pharmaceutical patents.

          Perhaps a more fair comparison would be an Australian pharmaceutical drug patent price comparison.

          • Jim de Bree

            Ron–the US consumer is paying for pharmaceutical R&D. The economic adage that profit is maximized when marginal price equals marginal cost is what the pharmaceutical industry accomplishes. After the R&D costs are recaptured, the pharmaceutical companies can sell for less to other nations.

            Furthermore, the other nations do not expend the amounts we do on the drug approval process, because they FDA equivalents general do not approve a drug until after it receives approval in the US. Therefore, the pharmaceutical company spends less in those countries getting new drugs approved.

            Pharmaceuticals are a global industry with a global market and there is a distortion in the market inasmuch as US consumers pay significantly more for drugs that elsewhere.

            My niece is a middle market executive involved in the drug approval process for a bio-medical drug maker. She tells me that even drugs developed elsewhere, typically the UK or EU, still cost significantly more in the US. The US is where all of the profit is made.

          • Jim de Bree

            Ron, I am not sure about your point on oligopolies. All industries consolidate over time and the healthcare industry is no exception.

            Also, there is no other industry where the US customer bears all of the R&D costs of a globally marketed product. Does American Airlines pay more for Dreamliner than Air France?

            We are the only country that does not centralize purchasing to obtain optimal pricing. That, in and of itself, ensures that we will pay a higher price for services.

          • Ron Bischof

            In normal markets that aren’t frozen by regulation, monopolies and oligopolies are ephemeral. Remember when IBM dominated computing hardware and Microsoft software platforms? Or GM sold most of the autos in the USA?

            My point is that healthcare oligopolies are partially a response to government regulation, Jim.

            As you noted, there are enormous R&D and regulatory costs incurred to gain FDA approval. Regulating procurement will not ameliorate the approval process that even Europe manages more efficiently.

            While I agree that the Medicare negotiation prohibition should be jettisoned, I’m skeptical that procurement legislation that is imposed rather than developed by private industry will reduce drug pricing. Instead, it will produce unintended consequences and calls for more regulation to fix the fix.

            The Pentagon has procurement and bidding regulations. I have professional experience in how bids are structured to circumvent the regulation and how rent seeking firms game the process to keep pricing and profits. As expected, taxpayers pick up the tab.

            Only the competitive market process is capable of solving the economic knowledge problem. You cannot regulate markets into efficiency.

    • Brian Baker

      “I agree with you Steve, the free market system will not work in healthcare.”

      Right. Let’s expand the VA system into “universal” government-supplied health care.

      No thanks.

      • Gene Uzawa Dorio, M.D.

        Hi Brian

        I do hate the idea of government running our healthcare. But as most of my patients are on Medicare, even with its problems, that system seems to work.

        I’ve cared for veterans at four VA hospitals around the country, each for at least 6 months. We should be ashamed. You are correct, it cannot be expanded.

        We should though look at models around the world and extract the best ideas and contour them into a better system for the American public and veterans alike. Tort reform is a start, but first we must make sure for whatever law is adapted, Congresspeople have to live under those same laws. If not, and they want to continue receiving free healthcare, they can only do that at a VA hospital or clinic.

        Gene Uzawa Dorio, M.D.

        • Brian Baker

          Hi, Gene.

          First of all, I absolutely couldn’t agree more that our elected reps should have to suffer — or enjoy — the exact same system they foist upon us peons, the general public. It’s beyond shameful that they exempt themselves. But then, most of them seem to be beyond the capability of embarrassment.

          As to Medicare, it may seem to “work” at the front line level, in the trenches where you are, but it’s doing so from a fiscally unsound basis; it’s going bankrupt. So even if AT THE MOMENT it seems to be “working”, it’s an unsustainable model

          As I said, I think there are those three first steps I outlined. We can use them as a basis, a starting point. Once they’re in place, if further work needs to be done, we can re-evaluate and move forward from there.

          Brian

        • Steve Lunetta

          My son worked as a contractor for the VA. The waste and mismanagement were terrible. However, the entrenched incompetent management culture is more to blame at the VA than it simply being a government enterprise.

          • Brian Baker

            (((((((((((((( sigh ))))))))))))))))))))

            “Waste and mismanagement” in a government program. What a shocker.

            I guess somehow “single-payer” will be magically immune from such a rare phenomenon.

          • Steve Lunetta

            I’ve seen the same thing in private industry as well. I am no defender of big government. That is the whole point of the column. We need to try something different. But to say “stick with the same system because we KNOW it doesn’t work” makes no sense. Let’s be open minded to something that could benefit us in the long term.

          • Ron Bischof

            I think you’ll agree that private industry has market remedies that address incompetence and waste that aren’t available in government monopolies, Steve.

            I don’t see anyone arguing that the status quo is acceptable. That’s why Obamacare legislation is being rolled back and methods to implement market competition and state experimentation back into medical services financing are being explored.

          • Brian Baker

            That doesn’t even make any sense, Steve. What happens in private industry when a company is inefficient? It goes out of business. What happens in the government when a bureaucracy is inefficient? We waste even more taxpayer money on it.

            Pard, YOU’RE the one wanting to stick with the same broken system, which is government-run healthcare, and in fact you want to DOUBLE DOWN. What do you think “single-payer” is if it’s not government-run healthcare?

            Good grief!

          • Steve Lunetta

            A single payer system is different. You know it and I know it. Brian, we are simply going to need to agree to disagree. I think the political winds are now blowing a different direction. Healthcare will be different in the future and I think the only question is what shape it will take. My guess is a single payer system.

          • Brian Baker

            “Single payer is different”? How? Who is that “single payer”? It’s the government.

            It’s fancy terminology trying to dance around and avoid using the more accurate term of “socialized medicine”.

            Now you’re down to denying actual facts?

            Huh…

          • Jim de Bree

            In efficient companies do not necessarily go out of business. They may become less profitable, but there are many inefficient companies out there. Most insurance companies are inefficient.

            My experience is that as a company grows in size, it becomes more inefficient. Additional layers of management are added and bureaucracies become entrenched on politics become more important. I saw it all the time during my career.

            The problem is that the public sector has a supercharged political dynamic that entrenches bureaucracy and panders to special interests.

          • Brian Baker

            If a company consistently loses money, it goes out of business.

            If a government program loses money, the government wastes more tax dollars on it.

            C’mon, Jim, you can do better than that.

          • Brian Richards

            We tried something different 7 years ago. How’s it working out? Is your solution to the failure of Obamacare to double down?

          • Brian Richards

            The entrenched incompetent management culture IS the singular thing that is the heart of almost every government program. How is it that if something doesn’t work at X scale, but increasing it a factor of 100 that all of a sudden it will become a competent program?

  • gary

    Steve,

    Strong column. And I agree on so many points.

    Dude, I have an Anthem PPO, select network. Carrie and I pay about $14,000 a year for our coverage for 2 people. And with that, $2500 deductible, each. So, nothing kicks in until about $7,000 per year. This is not cheap.

    So – generally, we are very healthy. But, as you know, I just went through back surgery.

    I’ve been circling this surgery for 8 years… working through it, seeing pain docs, interviewing 5 different surgeons.

    Finally, a good fit was found for my very serious condition.

    Then, Anthem denies coverage. “Not medically necessary.” I can barely walk in the morning and risk losing control of my legs, but it’s “not necessary.”

    Doctor does battle and wins. Surgery is finally on.

    The doctor I chose is a hot shot and outside the network and doesn’t take insurance at all. I’m paying that bill of my own accord. One would think the medical insurance should be happy.

    Surgery done, success! Now comes the piles of paper you just described. MOUNTAINS.

    Most of it denials of some sort. The latests was a $6,000 bill from a neurologist and the insurance says “You’re responsible for $5,600 of the bill…”

    This is a joke! I will be doing battle between the insurance company and providers on this for months. And the surgery center bill hasn’t even arrived yet…

    You are right about the Kaiser thing. Much, much simpler. And, I hear a high level of satisfaction.

    But in any case, my insurance is luxury level and still is a joke and a headache. Imagine those with lessor policies!

    Meanwhile, I asked my Canadian friend who’s wife just recovered from a week long bout in the hospital, “How much of the bill do you pay?”

    His honest to God response: “What bill?”

    SAD for us.

    Everything about our system is inefficient. All can agree to that. We need to set new national goals:

    How do we recover efficiency? How do we remove all this paperwork and expense? How do we simplify so ordinary people can navigate? Now do we cover those of modest means?

    Obamacare OBVIOUSLY did some good in the states that embraced it like CA. Your wife was saved from non-coverage. All kinds of families benefited from the age for kids going to 26. No lifetime caps. All of this stuff was good and necessary, but we did not achieve cost controls despite the good stuff that came from the program.

    Thinking people will accept that we must provide health care to all citizens. That said, NOW, how can we pull together to actually accomplish this very basic national challenge?

    Gary

  • lois eisenberg

    “Universal health care, sometimes referred to as universal health coverage, universal coverage, or universal care, usually refers to a health care system that provides health care and financial protection to all citizens of a particular country. It is organized around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services, and improved health outcomes.”

  • lois eisenberg

    ” GOP health bill to double the number of uninsured ”

    “Million’s of state students will be hit hard by Trumpcare”

    “It’s the same old conservative line: ”
    “Cut services to the poor and disabled , and increase spending on defense”

  • Jim de Bree

    Steve, this is an excellent column that clearly illustrates the situation from the perspective of a person who is chronically ill. Our system fails these people.

    • Brian Baker

      The current system fails everyone. Turning it into a national VA system will make it even worse.

  • Ron Bischof

    The headline is a non sequitur.

    The free market is providing every medical service imaginable. It’s high quality and available with little wait.

    What is failing is the financing model, where a free market doesn’t exist. The term “insurance” is being misapplied, because insurance is a means of sharing risk for unexpected events rather than financing of expected medical services.

    Single-payor is one “solution” and we know the outcome of that policy because it exists. Because not everyone can be subsidized, no one will be. Absent price signals, demand will be unlimited. And the response will be rationing and all the innovation one would expect from a government regulated utility model.

    Predictably, a two-tier system will be created by those with the means to avoid a Veterans Administration level of rationing will have access to free market medical services, where the very best specialists and innovative therapies will operate.

    Those who support single-payor may get their wish. There’s likely as sufficient number of citizens in this state convinced government regulation and taxation is the optimal model to deliver medical services. The “rich” will be the unicorns with magical powers to grant subsides for the “99%”.

    It will be interesting how to watch the arc of state implementation I outlined and the economically ignorant drumbeat to address the failures with a call to supersize it to the Federal level.

    • Brian Baker

      Well said, Ron.

      “The term ‘insurance’ is being misapplied, because insurance is a means of sharing risk for unexpected events rather than financing of expected medical services.”

      Exactly! We use that term wrongly in discussing medicine. It’s as if we expected car “insurance” to cover routine maintenance like replacing worn tires or dead batteries.

      • lois eisenberg

        “Universal health care” ***

    • lois eisenberg

      “Universal health care” ****

  • Maria Gutzeit

    Lots of discussion! I wanted to add (since a lot of people are referring to VA as the “government” model )- that I found Medicare + Supplement model to work very well for our two now-deceased mothers. From a user standpoint – never a problem with anything. I also found it interesting that it has cost control, unlike regular insurance. Time Magazine’s article “A Bitter Pill” was very interesting and detailed that. I wish in all the drama over healthcare reform someone would discuss a) uniform and transparent billing b) uniform and transparent policy documents and c) cost control. We all can see where the current system (including the current federal “improvements” are going….no where good and sustainable. Perhaps a uniform basic affordable catastrophic plan, with no lifetime cap and no pre-existing disclaimers – could be developed and then you can buy supplements as you wish….none to deluxe.

    • Brian Baker

      Maria, as Gene Dorio and I discussed a bit further up, Medicare is working well… for now. But the underlying problem there is it’s going bankrupt, so it’s an unsustainable business model.

      Your suggestions are good, IMO. All the various “transparencies” would be a natural byproduct of an actual free-market approach, such as I’ve suggested.

      The idea of a “uniform basic affordable catastrophic plan” also sounds good…….. as long as it’s not something MANDATED by the government.

      We need to get the government completely out of managing and controlling healthcare.

      We need to accept the completely unavoidable fact that no matter what system is in place, there are some people who are going to suffer. There is no panacea, no magic bullet. No universal indemnification. That’s quite literally impossible to achieve.

      • Maria Gutzeit

        How do you address people who, for instance, don’t want insurance and then get a cancer diagnosis, or have a heart attack, or get in a car accident (yes, I know there is a small amount of medical coverage from the ..interestingly mandatory….car insurance.) As I understand it now, that person gets medical care that then is put in a big blender of “cost” and passed along to others who can pay. That doesn’t seem fair to me. Private “charity” doesn’t cover all those costs. Plus, what if they lose their home, go on food stamps, go bankrupt and stiff other debt holders? It seems irresponsible to choose not to even have a basic catestrophic coverage….Let’s say a 10,000 deductible. If not, who pays for that care and the financial fallout? Not the patient.

        On a related note, many places give HUGE prompt pay or cash discounts. I would assume their costs are still covered by that lower price, so why do insured people pay a higher price for the same service. That Medicare apparently figures actual cost plus a percentage for things is a good start but again….if people are getting “free” healthcare (to they point that individual never pays for it) that means someone else is paying. Hard to tell but doesn’t seem very “rugged individualisty” to stiff others with medical bills by knowingly not getting insurance coverage.

        • Brian Baker

          Maria, people make decisions every day, and sometimes they make bad decisions. There’s no inherent “right” to be indemnified from the consequences of making bad decisions.

          If people decide to not have insurance and then get hit with a big disease, well that sucks for them. They’re going to be wiped out. That’s the chance they took. They gambled and lost.

          Once their own assets are completely depleted, I’ll agree that at that point society can step in and offer the minimal care required to treat them symptomatically, or provide palliative care.

          We need to grow up in this country and learn to accept the fact that EVERYBODY dies.

          • Brian Richards

            That goes hand in hand with solving the issue of people being poor. Nobody wants to be poor, but lots of poor people wont do what’s necessary to become not poor. I’ve employed thousands of people in my time and hard work and effort is universally rewarded. If someone decides not to get insurance, that’s not my problem just as it’s not my problem that someone with marginal motivation is poor. I don’t have a problem helping the truly needy, but I have a big problem with the expansion of the definition of what constitutes truly needy.

          • Ron Bischof

            The controversy revolves around folks seeking to socialize their personal medical costs. If it involves coercion and force, it’s unjust.

            “Government is the great fiction, through which everybody endeavors to live at the expense of everybody else.”

            ― Frédéric Bastiat

        • Ron Bischof

          Auto insurance isn’t an apt comparison to argue for mandatory medical services financing participation, Maria.

          You’re only required legally to have liability to protect *others* from your driving mistakes or negligence. If you own your vehicle outright and don’t thus don’t have a contractual obligation, you don’t have to insure your self-interest (the equity in your personal vehicle).

    • Jim de Bree

      Maria, you stated: “I wish in all the drama over healthcare reform someone would discuss a) uniform and transparent billing.”
      If you talk to providers, they will uniformly tell you that billing and collecting is a disproportionately high share of their costs. Each insurance company/governmental agency has a their own payment process. Providers pad their bills hoping to game the system to get a few bucks out of the insurance companies. If we provided a uniform process that is administered by a clearinghouse run by a consortium of providers and insurance companies, that would help contain costs through efficiency and transparency.

      Brian is right about Medicare. In 2028, eleven years from now it will start going bust. Unfortunately the ACHA will reduce repeal the .9% Medicare surtax on earned income over $250,000 which will exacerbate the problem. Also, as the result of legislation enacted during the Bush Administration, Medicare, unlike the VA, is not allowed to negotiate quantity discounts on prescriptions. From what I understand, prescriptions are one of the fastest rising components of Medicare costs.

  • lois eisenberg

    Universal Healthcare, Universal Healthcare, Universal healthcare ****
    End of story, end of story, end of story ****

  • lois eisenberg

    “The Republican healthcare plan would have irreversible, devastating consequences for families across our nation.”

    “Millions would be left uninsured, women would be left without affordable reproductive care, and our seniors left without critical services.”

  • lois eisenberg

    “The AHCA will utterly devastate millions of Americans. Costs will go up, and millions will lose care altogether.”
    “This is a cruel piece of legislation.” ***

  • lois eisenberg

    “Trumpcare will make it even harder for millions of California’s kids to graduate and get jobs.”

  • lois eisenberg

    “Support for Trumpcare is rapidly COLLAPSING.”

    “And now, Democrats now have a real shot at providing universal healthcare for all Americans.”

  • Ron Bischof

    Healthcare: “Insurance” Now Just Means Redistribution

    “Americans have been fighting over health insurance reform for ages. For example, 25 years ago, in 1992, over 200 congressional health care bills were introduced.

    Unfortunately, while the rhetoric has focused on insurance, such as how many would supposedly gain or lose insurance if some change was implemented, that has not been the real issue. Income redistribution has. As Henry Aaron estimated that year, implementing a comprehensive national health insurance system would redistribute more income than any single national policy then in existence.

    What Is Insurance?

    How do we know insurance is not the real issue? Because claimed “reforms” violate so many principles of insurance.

    Insurance is about reducing risk in the face of uncertain events. But insuring things that would happen for certain, say annual checkups, offers no risk reduction — it offers no benefits to weigh against the added costs of insurance administration that must be borne — yet such coverage is frequently mandated.

    Similarly, small health care risks are cheaper to provide for from modest levels of savings, rather than bearing insurance administration costs. If one’s own resources were involved, absent government interventions, they would not be insured at all. Only when others are forced to bear much of the cost would people want insurance to cover such things.

    Administrative costs are not the only issue, either. The benefits from risk-reduction through insurance would also have to outweigh the cost of the health care. This is made especially difficult by the fact that the insurance itself induces over-consumption of health care services.”

    “The health insurance debate has been so contentious in part because it has allowed massive income redistribution to be misrepresented as about overcoming market failures in health insurance. It helped sell Obamacare dishonestly and now portrays reducing massive theft from government targets as imposing heartless harm on others. Such misrepresentation may be able to produce misinformed political support, but it cannot generate policies that advance Americans’ general welfare.”

    https://mises.org/blog/healthcare-insurance-now-just-means-redistribution