A RADICAL CURE:HOW CAPITALISM CAN SAVE AMERICAN HEALTH CARE

New York Post ^ | 3 December 2006 | Sally Pipes

[shrinkermd]

IF you find yourself in a room with 10 people this holiday season, eight of them will think the United States health-care system is riddled with problems...

Today, 93 percent of Americans, according to Gratzer, have health insurance or can afford to purchase it. And as he points out, the other 7 percent receive plenty of care, as being uninsured is not the same as going without health care.

There is also a serious paradox at the center of U.S. health care. Although the vast majority of us tell pollsters we want a different system, popular opposition kills any prospect for major changes when people discover they will lose their current insurance coverage.

People complain about the expense, but the reality is that Americans spend very little out of pocket for health care. The reason that's it's so expensive is because it's nearly free...

[shrinkermd]

This is a book review of:

THE CURE: HOW CAPITALISM CAN SAVE AMERICAN HEALTH CARE BY DAVID GRATZER ENCOUNTER, 325 PAGES, $25.95

Conclusion to the review is:

"...Although we call it insurance, what most of us have is employer-supplied prepaid medicine. This, as Gratzer notes, is a relic of government wage and price controls during World War II, and the IRS's blessing of medical insurance as non-taxed compensation. Insurance, after all, pays for things that are unlikely to occur, but have serious financial consequences when they do. Think auto, home, liability, life, disability and long-term care insurance.

"...Consider the consequences of acquiring other necessities of life the way we do health care. Would we want our employer providing our housing, clothes, transportation and food? The results would be familiar, a frustrating and expensive mess that, nonetheless, few would want to abandon.

[expatpat]

Right on. Health "Insurance" is not insurance, it's employer pre-paid medical treatment. It would become health insurance if it covered only expensive, unlikely health issues, i.e., there were large deductibles. But even then it would not be 'insurance' for seniors, since they have a high expectation of a wide variety of expensive health problems. That's where MSAs come in.

[Syntyr]

Last year my sister had suregery to remove a growth on her wrist. She dosent have any insurance so I picked up the bill for her (Long story she needs my help and better me than the Government). When the Doctor and the Anethsiologist found out I was paying cash they both cut their fees by 2/3's because they didnt have to deal with insurance. That explains it right there.

[Andy from Beaverton]

Burning the Federal Register and all of its ridiculous mandates on the health system would dramatically lower costs.

[Gorzaloon]

Last year my sister had suregery to remove a growth on her wrist. She dosent have any insurance so I picked up the bill for her (Long story she needs my help and better me than the Government). When the Doctor and the Anethsiologist found out I was paying cash they both cut their fees by 2/3's because they didnt have to deal with insurance. That explains it right there.

But when my sister in law was out of work and had no insurance, she encountered people who would not treat her at all, when she offered to pay out of pocket.

I suspect it was because they no longer had a blank-check opportunity to loot and plunder her coverage.

Yet, I know several physicians personally who walked away from their practices because they could no longer stand dealing with HMO paperwork.

Maybe some providers are better at gaming the system than others.

[ClaireSolt]

'Maybe some providers are better at gaming the system than others." That's definately true, I think. Here, both docs and dentists are enrolling ther practice with subscribers who pay $1500/yr.

I ordered this book and read it. It is a tentative first step. However, it does not begin to address how government controls the supply of docs and thus subsidizes them to be the highest earners while runnng inefficient cottage industy with poor accountability. We need major doses of competition and sunshine.

[pieceofthepuzzle]

There are definitely physicians out there who 'game' the system, but the expenses of medicine go very far beyond physician fees. If you look at a standard bill from a hospitalization you will see that physician fees are a fraction of total costs. It's a complex mix of the costs of technology, malpractice and product insurance costs (built into just about everything you can imagine related to medicine, including drug costs), and what has become an unwieldy bureaucracy. From what I can tell from reading the summary, I think this book puts forth some good ideas.

[reformedliberal]

Where did this occur?

We have high deductible catastrophic. We are never denied treatment. If a medical bill is too large for immediate payment, we have never been denied the ability to pay it off in installments at our own discretion, without interest penalties. Our dentist offers 10% discount for cash. I am not aware if we receive any discounts for being self-pay for medical procedures/exams/tests, etc, but the charges have seemed moderate, so far.

Locally, we are blessed with a large population of top-notch medical providers and being in rural Wisconsin, we have a large percentage of Medicare recipients and a fairly large population who need Medicaid. The last time I had to use the ER, I noticed that it was near empty on a summer Sunday afternoon. It can take 2 months to get an MD or DDS appointment for minor things, but emergencies are seen ASAP.Our physicians retire at 65 or older and I have not heard of any private practices shutting down because of malpractice costs, even though they operate under a lot of ridiculous rules, like needing a full-time radiological tech on premise when they only need to take X-rays perhaps 2-3xweek.

Are we just fortunate, here? We do have illegals who work in meat packing, ag and construction, but again, lately, we see way fewer of those even in Walmart. I know that at least one large ag operation self insures with a high deductible MSA for all its employees, as do several small manufacturers.

Factory pay here is $10-$14/hr w/benefits and even Walmart pays nearly $8 for part-time asociates and time-and-a-half for holidays. Our FP guys make around $160k/year +benefits and the large hospital practice pays their malpractice. Probably a lot less then they could make in an urban area, but the quality of life seems to make it worthwhile for them. We have at least two OB/GYNs, as well.

[Dave S]

When the Doctor and the Anethsiologist found out I was paying cash they both cut their fees by 2/3's because they didnt have to deal with insurance

You were lucky. Because of contracts with HMO's and PPO's etc, many physicians and hospitals are not allowed to charge less than full price to those not covered by insurance. The HMO's and PPO's etc have negotiated deep discounts from list price. I think you will find that hospitals in particular will charge those without insurance say 50% more than what someone with insurance would pay for the same service regardless of whether they have to jump through hoops to get payment.

[wastoute]

HMOs killed most private practices in the 80s and 90s. As they become more efficient to create that wealth that went to their creators they squeezed physicians to see more and more patients and cut hospitalizations to the bone (so to speak). You may remember the "drive by delivery of the 90s? Now Most medical systems are hospitals that employee the physicians and "own" the patients. What with insurance companies cutting their fees to the basement to match what physicians accept from Medicaid and Medicare there is no profit in outpatient medicine and there is no profit in taking care of inpatients as a physician.
There IS a HUGE profit in running a hospital. So the "health system" is owned top to bottom by the hospital and almost everything else is a loss except providing the treatments, procedures, etc. in the hospital. The hospital just provides the clinics and doctors so they can "own" the patients.

[wastoute]

Yes and no. When you get your bill the statement will claim that the ins. co. paid whatever, but you can bet that they actually paid less. They just have to play along with the hsopital on this because YOU pay a deductibel or co-pay based on what the hospital CHARGED.

[ClaireSolt]

I used to pay $100/visit to a specialist. Now my Medicare HMO pays $20. So, I see a nurse practitioner instead of a doc.