My wife and I used a long drive across the state yesterday to read Steven Brill's journalistic magnum opus, "Bitter Pill: Why Medical Bills Are Killing Us." (Erin read aloud while I kept my eyes on the road.) We gagged at the stories of hospitals consistently charging out-of-pocket patients two to three times the cost Medicare reimburses for medical devices and fifteen times the Medicare rates for aspirin, swabs, and other mundane medical items.
Wonkblog's Sarah Kliff sums up Brill's essay in one sentence: "The American health-care system does not use rate-setting." I offer an even shorter summary: "Medicare for everyone" (see also Moyers, McGovern, and others).
Among the barriers to challenging medical vulturism we found in Brill's essay is the vital role high-charging hospitals play in the local economy. The massive profits hospitals turn on pacemakers and pills translate into lots of jobs and charitable donations. Without hospital money, Madison would be short 118 jobs, about 2% of the Lake County workforce. Without hospital money, various charities would lose an important source of revenue. Without hospital money, we'd struggle to build giant sports arenas.
But even if you accept the economic utility of what hospitals spend their money on, the way they get that money is still wrong. If we accept the status quo model of health care, we accept subsidizing jobs and social services and the Sanford Pentagon by taxing the sick. We get those social goods by exploiting the sick as a means to an end (Kantians, unite!).
Instead of submitting to a system that extracts wealth from those least able to bear such burdens, we should seek a more rational and just system that imposes equal burdens on all citizens. Instead of acquiescing to hospitals' exploitative and discriminatory pricing (low prices for the strong, high prices for the weak) for the sake of their purported economic largesse, we should nationalize health care to make it more efficient and use the economic savings to promote the general welfare.
Keyword is "General Welfare" which I think has been written down somewhere.......
Future of healthcare will likely be Big Data:
http://www.forbes.com/sites/netapp/2013/04/17/healthcare-big-data/
As sick as casinos for tax rev.? Those with no money can get health care Cory. Casino gambling ruins the lives of those with and without money.
I think this is my first post on your blog! This is an interesting read, hospitals are price gouging ad while they serve an obvious critical need to every community, we need to get their fees under control. Yes being a Republican I know that sounds anti-Republican. Non-Profit doesn't mean no profit, but does the Affordable Care act really address this issue? I am asking that as an open ended question as I am the type who is open to all schools of thought when it comes to making our country "better."
Thanks for the honest question, Joshua! I'll happily offer an honest response: No, the ACA dropped the ball on cost control. The pharmaceutical lobby, the medical device lobby, and the GOP (with help from Dems like SHS) made sure of that.
Brill's essay includes this salient example of ACA's failure on cost: the law boosts comparative effectiveness research, which can identify the relative effectiveness of various treatments. We could use this research to exclude from Medicare and Medicaid expensive treatments that don't perform any better than cheaper treatments. (The British National Health Service does something like this.) But when Betsy McCaughey, Sarah Palin, and the GOP conflated this policy and discussion of end-of-life care with "death panels," Congress inserted a provision into ACA to prohibit using comparative effectiveness research to set policy or price limits. Grrr!
Medicare imposes cost controls. It fails to impose cost controls on the prescription drug benefit, which has thus been blowing holes in the budget since 2004.
Hospitals are leveraging their other community contributions to protect their profit margins. Hospitals should get back to their primary mission of healing and leave it to us to find more direct, moral ways to fund community needs than taxing the sick.
Les, the comparison to gambling struck both of us as we read and sailed along I-90. Gambling is a tax on the stupid; hospital price-gouging is a tax on the sick; arguably both may be a tax on the desperate.
Quantifying immorality is a challenging question! Les, you're saying gambling is worse than hospital profiteering, right? The moral failing in casinos and hospitals is the same: both take advantage of people who cannot function as fully informed, rational actors.
But I can tackle the lack of information among gamblers with a five-minute lesson in probability and arithmetic. Curing the lack of information in hospitals involves asking people suffering from life-threatening injury and disease to pause for a few hour to read their hospital bill, Medicare data, comparative effectiveness research, and Brill's article.
Besides, we will be hard-pressed to find an example of a person forced into a casino by crippling pain or the threat of death.
You will also be hard pressed to find a person under crippling pain or threat of death turned back at the hospital door Cory.
Patients can't be turned away by law but can be sued into pauperhood by the church that owns the hospital.
but you have anxiety meds to help you cope, right les?
Larry's on point with the first response to Les. Furthermore, at the casino, I at least know exactly how much I'm betting. The hospital offers me no price list at the point of sale.
And actually, Les, Brill's article opens with the example of a man facing terminal cancer whom the hospital would not admit or treat until his wife wrote a $48,000 check up front.
What you are doing Les is advocating for irresponsibility and healthcare system freeloaders. Why should anyone purchase health insurance? Let the system treat them for free, the costs can be shifted to the health insurance companies and eventually those suckers who are stupid enough to purchase their product.
The best way to cover everyone and hold costs down? Medicare for all, spread the cost of healthcare across the entire population and empower the payer, Medicare (aka taxpayers), negotiate the charge for each service and which services will be covered.
How does any of this change the cost of our drugs or what the hospital charges? That's what I would like to get to the bottom of.
Les-
Hospitals are only required to treat people in immediate danger and only to the point where they are temporarily stable. They aren't required to treat anyone with chronic conditions like diabetes or high blood pressure until there is a catastrophic event that immediately endangers the life of the patient. For only a few dollars a month in pills these catastrophic and insanely expensive events could be trivially prevented.
Japan's health care system is a great example of a system that embraces universal care which prevents catastrophic events through inexpensive prevention that can only be accomplished through consistent doctor/patient interaction.
My wife was recently in a hospital. I think there were two computers per patient. Nurses and aides spent as much time entering data into computers as they did providing patient service. So far, we probably have no reason for complaints. One thing we did not see was bunches of nurses standing around gossiping about their weekend, etc.
I don't think there is any real solution to medicine and patients unless we have single-payer, universal coverage possibly with supplemental coverage from private insurance much like medicare and medicaid.
I'm not sure where you've found me advocating for anything here Nick. We already have the freeloaders and irresponsible and the ACA is turning all including employers into freeloaders and cheats..I have a cousin who could save 1,020,000 by paying the penalty on his 120 employees. Not a hard decision in my book.
.
What I have kept insisting is, Cory or anyone else saying the poor don't get treatment, is bogus. I agree they will bankrupt me if I get sick without insurance and probably even with it. So be it, that is my choice if it happens. I don't like it but when I made enough to lose, I chose to operate in that system.
.
My initial rsponse to Cory's post is gambling is a tax on the sick and least able as well. Sorry if you think you're not sick and gamble to the degree it takes to keep the casinos in biz.
Les, back up to my earlier response. Brill's article opens with a clear example of a guy with cancer who was not going to get treatment if his wife didn't pay for the treatment in full up front. We're not even talking about the poor. We're talking about middle class folks who get sick, get treatment, then discover their insurance peters out at a low year/lifetime cap and leaves them with bill collectors constantly calling, their credit rating trashed, and their life savings wiped out. That's a sick system.
Les, I also think you're now stretching the gambling example. Yes, the gambling industry preys on addictive behavior (thus their fervent opposition to smoking bans). But even without going hard-core libertarian, I can argue confidently that the regular folks facing six-figure medical bills don't walk into the hospital as willingly as folks walking into casinos.
Regular folks. Is that you and I Cory? Darn right, I'd rather be healthy and hope to win a Mil than put 6 figures in a Docs pocket for something the statistics say he can't cure. I don't even like to give them 10 thousand when they can fix me. That said, it'd take more room and time than we've got here to hash out the social costs that touch the gambling industry, though I hope your not soft on that industry due to you're profession being tied to a slice of the pie.
.
I understand and agree the system is broken and it needs fixing, but, all those on both sides of the aisle have had many opps to fix the issues and continue to feed the sharks rather than repairing the cracks in the dam. The ACA is broken due to both parties and I do not blame either party more or less.
.
You are also complaining of someone not getting treatment for a terminal disease. Isn't that an oxymoron? Or a blessing? Depending on who you believe, our med system kills between 250-750 thousand people annually from mistakes and incompetence. It's not just bad in the billing dept.
.
I can tell you most assuredly from family history, desperate treatment for terminal cancer far outweighs the crime you and Shari Kosel are fighting for protection from.
.
Tony, Medicaid or $5?/month payments has been the norm for less able in our world for years. Maybe in the last five it could have changed in some places or everywhere.
Oh no, Les: I'm not soft on the gambling industry at all. I think subsidizing my check with gambling is immoral. Eliminating gambling from South Dakota's revenue scheme and creating a universal single-payer health care system would both be moral policy reforms. But gambling at least gives people a choice to participate and a fair chance to calculate the odds. The current health care system hammers citizens when they are least capable of calculating the costs.
terminal—let me rephrase. The guy in Brill's article had been diagnosed with a disease that would kill him if not treated. The hospital would not treat him unless he paid up front.
"""""Gleevec, a drug used to treat leukemia, costs $70,000 a year in the US but only $2,500 in India. This costly gap exists thanks to US patents that prevent competitors from making and selling lower cost versions."""""
.
How do we reward research and not price the common good out of the market? How do we keep the doors open serving those who abuse their bodies beyond comprehension. One of several of my customers has been on an alcohol disability for 15 years. Another died after repeatedly abusing alcohol after his successful liver transplant. Ins or no it still cost all of us for the any treatments he received.
.
Life is not about fair. You want fair go to the county fair. Life is about equity or an equitable choice. None truly mind the compassion that should exist and does in most cases given opportunity for it to exist. Abuse at all levels is the problem we face, both inside and outside our medical care system in the US.
.
To your point of the dying man not treated. My customer with no ins who has or had the cancer at the same time as my brother who Jana claimed prob had his pants sued off for the treatment costs, wasn't sued and will prob make those 100/month payments for life. They did hit the end of the road at the "church owned hospital" and an experimental treatment became an option at Mayo. He could only become part of the study with a 5-10? thousand, upfront payment many of us raised for him. Fair? I believe he ran more money down the drain in bars than I made in this lifetime. Do we continue to treat all equal or is there somewhere, a reward for effort?
Brill does a couple of short Q&A things on Andrew Sullivan's blog
http://vimeo.com/64637725
http://vimeo.com/64726955
Asking that the hospital charge every citizen the same price for the same service is not an unreasonable amount of fairness. But if we can't have that, then we all ought to get in one big pool that can demand the same price from hospitals. Bigger pool, better leverage, better rates from hospitals, less GDP wasted on inflated medical bills, more GDP available to prime other economic sectors.
If life is about equity and equitable choice, then every hospital should have a price list available in the examination room on every item they intend to sell me. Every doctor and nurse should be able to inform every patient of the cost of every procedure and every pill so every patient can make an informed choice.
Oh, but wait: half of those patients are out of their heads with pain or worry for themselves or for their families. They can't make patient, deliberate, rational choices even if the hospitals will share price information, can they?
Forget fair: I'm just asking for workable. Free market principles aren't workable in health care. Government single-payer is a reasonable, workable response to a situation that the free market doesn't handle well.