All the health care we can afford

     DQ here.  I was reading an article on the buy-out of Chrysler the other day when one line caught my eye.  The group taking the company private is paying $1.4 billion and agreeing to invest $6.1 billion in the company.  Sounds like a bargain for a company the size of Chrysler.  But there is a catch.  The group also agreed to pay $18 billion in retiree health care.  That number dwarfed every other number in the deal.  It makes me wonder, whether publicly or privately financed, how much health care can we afford?  We have this fantasy that if the government just puts in the right program everyone in America will have complete health care at someone else’s expense.   But how realistic is this?  The health care industry continues to create ever more impressive miracles to keep us alive and healthy.  100 years ago, I would have died from a  ruptured appendix.   In 1995, my surgery was routine (okay, leaving aside that I was misdiagnosed and darn near died from the wait!).  However, miracles are expensive and the cost of health care continues to rise far faster than our ability to pay for it.   

I also wonder to what extent the government can get involved in providing health care coverage without killing the goose that lays those golden miracles.  So, what ideas to the Bookwormroom readers have to improve our health care system?  How important is this issue to you in the upcoming presidential race?  Which candidates have plans you can support?  Oppose?   


19 Responses

  1. Health care should be portable in that I own the policy and it should not matter where I am employed, such as auto insurance.

    Limit malpractice awards. Doctors are human and we all make errors. In this vein, people should have the ability to know a doctors background and the state licensing boards should have more options toward disbarring harmful doctors.

    Expand the available schooling to aspirant doctors. Limited slots for schooling hold down the supply thus raising the price for existing care.

    Allow hospitals to be built. The state of Illinois refused to allow a hospital to be built in a neighboring community, thus limiting competition. The rational was that the area is already served amply by existing services.

    There is no one answer to our health care problems. The problems have increased over the years and the solutions will have to be implemented incrementally.

    However, it is my belief that government stands in the way of meaningful reforms, just as they do with social security.

  2. Hospitals should be awarded malpractice money so that people benefit, not individuals. Or lawyers.

  3. Limit the healthcare and benefits system of the politicians to his own state’s hospitals and his own bills. With some exclusions such as the President.

  4. Aren’t there a lot more expensive procedures becoming available all of the time? For example, CAT scans are nearly a thousand dollars. I have to believe that a perverse expectation that the medical community “will do all it can” often means that there’s money dumped into procedures with little real benefit. Daniel Callahan (a bioethicist) asked whether the extension of just a few years on a life span is worth the cost when the same dollars could be invested on education or development and so on.

  5. Another fact to be noted is that high costs are also due to the massive amount of free care given to illegals. All through the southwest hospitals are forced to close because there is no reimbursement for these costs. All people with insurance are paying for those without.

    Would health care be less expensive if the taxpayers, through government, just paid for insurance for the uninsured? This would force insurance companies to compete for these contracts, theoretically lowering cost.

  6. I imagine that tort reform would be a good place to start to save medicine in America. The cost of malpractice insurance alone must drive up the price of medical care, because not just physicians must have it, but also Hospitals, laboratories, therapists, and all the associated services, too. This cost could be reduced tremendously.
    But I am opposed to having my physician become an employee of the federal or state government, he’s unhappy enough as it is. If we want to see to it that everyone gets reasonable care, and that children get every available care, an insurance subsidy might be workable. The danger is that wherever the government comes to help, the affected industry begins to dream of untold wealth, and suddenly prices climb over the roof. See what happened to medicine after the Great Society programs. Now my family is full of retired leftists who think it’s fine that they receive, gratus, far better medical care than do the nation’s low-income children, despite that all of them can afford to pay for it.
    This recent call for medical care legislation could all come to nothing–or worse. The moment the government starts to help, look to your freedoms and your children’s financial future. It won’t be well for them to have access to care if they lose their right to choose that care, or end by having their medical care rationed by bureaucrats.
    That’s another awful possibility: the Democrats cherish an everlasting resentment of those who have done very well for themselves, and it will be the Democrats’ inclination to not stop at seeing the lower economic strata get reasonable care, they will want to see to it that those who can afford extraordinary care either pay a big penalty, or have to beg a bureaucrat’s permission in order to get it.

  7. I think one of the big problems with health insurance is that it doesn’t function like other types of insurance. People expect their health insurance to pay for their routine care. Other forms of insurance just pay out when something goes wrong (house burns down, car accident) but they don’t pay for upkeep. If home/car insurance functioned the way health insurance does, it would pay for things like painting your house, mowing the lawn, oil changes, and balancing your tires. It costs plenty to replace a burned-down house or a car that’s been totalled, yet those forms of insurance are cheaper than health insurance because the occasions for claiming benefits are rare. And many people who pay premiums never collect (if they’re lucky). Given a choice, they don’t WANT to collect, because who wants a disaster to contend with? Yet purchasers of health insurance expect to collect with every sneeze. (That’s an exaggeration, but you get the point.)

    Also, sellers of insurance for homes/cars will pretty much insure anyone who can pay the premiums, unlike health insurance which rejects many people for pre-existing conditions (a state of health hard to come by as a person continues to age). I wonder what health insurance would cost if it were only used when a person became ill. I don’t know if we’ll ever find out, but I think the way we’ve come to view health insurance in contrast to other forms of insurance is a factor in why it’s so messed up.

  8. I oppose universal health care (aka rationed health care). However, I think that a lot of insurance problems could be mitigated if:
    a) There was a national program to subsidize (not fund completely) catastrophic insurance only.
    b) Individuals could deduct their cost of insurance (same as corporations).
    c) All insurance (including Medicare and Medicaid) carried higher deductibles to discourage frivolous expenditures.
    d) Federally mandated limits on malpractice liability.

    Just a thought.

  9. Good, insights, folks. Judyrose, you have a great point and it fits in nicely with Danny’s suggestion about catastrophic insurance. The problem will come from the folks who have decided that health care, including routine care, is a “right” and, of course, we all have the “right” to have somebody else (read, “the government” aka “the taxpayers”) pay for our “rights” in the liberal view of things.

  10. We had a doctor when we were growing up in the 50s and he billed us and we paid him w/a personal check. It was a personal relationship and we knew what it cost for whatever he did. When no money changes hands for services provided, there is a disconnect. I commented to my 79-year old mom that it seemed like she was going to the doctor a lot lately and she said, don’t worry, it’s free. I could have cheerfully strangled my own mother. I’m interested in a candidate who will back health savings accounts (which would encourage shopping around for medical procedures and promote judicial use of medical care) and who would have the guts to say that health care is not a right, least of all for those who break our laws to get here and stay here.

  11. I’ve always liked the idea I came up with in 2004. Which is to find a way to electronically or physically trace where people’s money actually goes. Whether it goes to a bank adn stays there or goes into this or that program. It would make transparency easier and be something a bureacracy would be justified for.

  12. Y – In #11 it sounds like you think it would be a good idea to trace how and where private citizens spend their money – is this what you mean?

  13. Yes Y, Marguerite asks a very good question about what exactly you are suggesting.

    In regards to this whole issue, I think the underlying frustration for most hard working Americans is that their monthly health insurance premiums are so expensive, and yet they still end up paying for doctors vists, etc, (often large sums of money out of pocket) in addition to these monthly premiums leaving them wondering “What exactly am I paying for every month?”. And of course, the countless personal testimonials of people who pay these premiums for years, and then their claim is denied (or only a very small amount is covered) when they are diagnosed with something major, like cancer, which may put them millions, if not hundreds of thousands of dollars in debt.

    Health insurance companies are a joke, and everyone knows it.

    I am not sold on universal public healthcare as THE answer. But I do know that we have universal public fire departments and nobody is screaming bloody murder about that. It actually seems to be working pretty well.

    Anyone want to comment on this? Why is having universal public fire departments OK, but not universal healthcare?

    Is it the fact that there are a lot less fires than illnesses? Are illnesses not just fires breaking out in our bodies? What is more important, our bodies or our property?
    What do we value more? What would Jesus do?

  14. Y – In #11 it sounds like you think it would be a good idea to trace how and where private citizens spend their money – is this what you mean?

    Comment by Marguerite | August 5, 2007

    The government would acquire little benefit from such tracings. I’m talking about every tax dollar being used having its own UPS tracking code so that people can see either physically or electronically (meaning either the dollar has a tracking method or the electronics funds have a special chunk-tag) at the touch of a button where their money is actually being spent.

    This removes such guessing such as “my money is going to abortion” or “I support the troops with tax dollars so I want a skull as a trophy” rhetoric.

    You will know exactly what your money was used for by the government. And like accountant books, people may circumvent it, but the very act of cooking the books prove that there’s something wrong going on. This creates a system to fight corruption, rather than fight corruption individually such as calling out this pork or that pork. Top down eradication rather than bottom up targeting.

  15. Hi BigAl,

    Thanks for writing. I haven’t really thought about it, but let me suggest a couple of differences to get us started. Fire departments are locally controlled and I’ll nearly always trust something controlled by locally elected representatives over a national bureaucracy. It’s hard to imagine how health care could be controlled locally. Second, firefighting is a special skill, but it can’t compare to health care in complexity. We used to have (and still have in some places) volunteer fire departments, but there aren’t many volunteer hospitals around. Third, fire insurance IS private. It’s the actually fire fighting that is controlled by the local government. As for Jesus, God helps those who help themselves. I suspect he’d want the churches to run hospitals before he’d want the government to. I don’t remember Jesus calling for government programs to take care of us all. But, as a non-believer, I’m a poor one to speak for Jesus.

  16. Jesus lived in a time where government could barely protect people from barbarian raids. Don’t think Jesus was thinking about how to spend wealth from 300 million people.

  17. The following is an answer by Milton Friedman to this question asked by Larry Arnn, the president of Hillsdale College: “Is there an area here in the United States in which we have not been as aggressive as we should in promoting property rights and free markets?”

    His answer, from 2006, was “Yes,in the field of medical care. We have a socialist-communist system of distributing medical care. Instead of letting people hire their own physicians and pay them, no one pays his or her own medical bills. Instead, there’s a third party payment system. It is a communist system with a communist result. Despite this,we’ve had numerous miracles in medical science. From the discovery of penicillin, to new surgical techniques, to MRIs and CAT scans, the last 30 or 40 years have been a period of miraculous change in medical science. On the other hand, we’ve seen costs skyrocket. Nobody is happy: physicians don’t like it, patients don’t like it. Why? Because none of them are responsible for themselves. You no longer have a situation in which a patient chooses a physician, receives a service, gets charged, and pays for it. There is no direct relation between the patient and the physician. The physician is an employee of an insurance company or an employee of the government. Today, a third party pays the bills. As a result, no one who visits the doctor asks what the charge is going to be – somebody else is going to take care of that. The end result is third party payment and, worst of all, third party treatment.”

    He did to on to say that ” health savings accounts are a hopeful sign in the medical area.”

    “Reprinted by permission from Imprimis, the national speech digest of Hillsdale College,”

  18. DQ – we’re replaying a previous discussion in your #9 – I have long wondered from whence comes this “right.” Mostly in life you get what you pay for, and if you can’t pay to feed, shelter, or clothe yourself, what makes you think you get doctor visits?

    And as I also once before pointed out – where does it stop? Is food not health-related? Obviously so: so must the government buy you food? How about a car? Clearly in today’s spread-out society you can’t walk everywhere: for me it’s a 25.2 mile round trip to the grocery store; so manifestly Uncle Sugar has to buy everyone a car. Certainly being exposed to the weather is a palpable health risk – so have yourself a house, folks.

    And if someone has a nicer car than you do, that poses the risk of depression and mental-health issues, so let’s just have the government buy everyone a Ferrari, and be done with it.

    I’m with you on keeping the government as far away from it as possible: government controlled monopolies give you Trabants, and the American educational system. Anything the giovernment gets into is instantly screwed up.

  19. Our medical system is overwhelmingly regulated and monopolistic. Pharmaceutical companies control the drugs, insurance companies control the flow of money, and the AMA controls the service providers.

    Nine out of every ten years of my life, my health care needs could be met by someone with two months of training and a lab analysis of blood work. I don’t need a doctor! I need someone who can take my blood pressure and scan the bloodwork results. Heck, I can read 98% of the bloodwork results myself and identify the anomalies. I think someone with six months of training could catch 95% of any high risk abnormalities and tell me, “You’ve got something unusual here – you’d better see a licensed professional about this.” They would also need to maintain records. Period.

    If such a limited form of yearly, maintenance health care were provided such that they could NOT be sued, and were open to competition, and if lab blood analysis were open to competition, costs would PLUNGE. The doctors would deal with the serious cases. Some people would not realize they had entered a risky situation; some of these yearly-maintainers wouldn’t realize it either. Them’s the risks. But for the vast majority of us, we don’t need this monstrous system we’ve got now.

    It’s not in the pharmaceuticals interests to give us cheap maintenance health care. It’s not in the insurance companies’ benefit. It’s certainly not to the lawyers benefits, since a requirement of this advisory maintenance health care would be that THEY ARE NOT LIABLE, period. And the AMA and the doctors would never stand for it.

    But I repeat: Nearly all of my health care needs could be handled by someone with two months of training. Or less.

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