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Over at Reader's Digest, Kerry Howley investigates the gap between the health care coverage people think they have, and the coverage they actually have.

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  1. But we have the #1 health care system in the world, hear me? The world!

  2. The article correctly points out that the procedure cost hundreds of thousands of dollars. The article, however, laments that coverage for this procedure is not available for free to everyone. Claiming health care as a right does not make it free. While my personal opinion of health insurance companies is that they are scum, forcing insurance companies to provide $100 dollars worth of coverage for less than $100 dollars of premiums leads to no health insurance.

    If providers of health care don’t get paid, they will stop providing health care. New technology isn’t always affordable by the masses. Just because a procedure is possible does not create the money to pay for it whenever it is considered needed.

    For decades, America has treated lives as priceless and health care as something where money is no object. Forcing employers to pay for unlimited health care is making foreign employers more competitive. One day the boomers are going to wake up and wonder where their doctor or nurse is and discover none are to be had at any cost.

  3. This is an antitrust problem. It should be solved by antitrust law. Healthcare suppliers have too much market power, which is the primary reason that the prices are so much higher in the helthcare sector than in sectors of the economy characterized by competition.

  4. Dave,

    I still don’t follow the anti-trust angle. Who do you want to break up? Why do you believe that smaller units will be any more competative than the situation we have now? The pricing issue is a function of the disconnect between consumers and suppliers, not due to a concentration of suppliers.

    I know, I know…I’m sure I missed a more detailed explanation on another thread, but hey, it’s Friday, why not type it again? 😉

  5. “Insurance” companies.

  6. dflynn:

    “The article, however, laments that coverage for this procedure is not available for free to everyone. Claiming health care as a right does not make it free.”

    Did you read the same article as I did? If you read this page, a list of possible solutions, nowhere does Kerry say anything about “free healthcare” or “healthcare as a right”. Either you show me specific examples from that article where she claims healthcare as a right, or rescind your statement.

    “New technology isn’t always affordable by the masses. Just because a procedure is possible does not create the money to pay for it whenever it is considered needed.”

    True; however, at the same time, if, due to specific circumstances (such as cornering a market due to the mortality of life-and-death medical treatment), a provider has what can be fairly objectively called “too much” market power, then, they can easily inflate the price of a procedure far beyond operating costs and reasonable profit…and there’s little that consumers can do about it. I mean, let’s be honest here, most procedures out there, technologically advanced or not, could be done at a lower price, and the provider would still make enough money to make it worth his/her while to perform it.

    If I invented a lifesaving procedure that cost $30 to perform, but since I had the sole “rights” to that procedure, I charged $7000 for it, would that still be cool with you, dflynn? Exhorbitant market power in an industry that is so crucial, like healthcare, can be dangerous—and I’m staunchly pro-free-market.

  7. MP: unfortunately, in a truly free market, healthcare is ugly. Poor folks die while rich folks get cured. It sucks. That’s why a free market in healthcare can never be sold to the masses.

  8. MP: unfortunately, in a truly free market, healthcare is ugly. Poor folks die while rich folks get cured. It sucks. That’s why a free market in healthcare can never be sold to the masses.

    V O U C H E R S ! ! !

  9. Share your medical bill stories!

    Laparoscopic right colectomy, Nov 2005
    – Colonoscopy, $1,500
    – Surgeon, $3,500
    – Anesthesiologist, $2,500
    – Pathology, $600
    – The Kicker: Hospital bill for seven days in bed, $29,500!

    Routine Checkup, Sep 2004
    – MD looks in eyes, ears, uses stethoscope, taps knee, $160
    – Blood tests, $250
    – Ten minutes on a fricking treadmill stress tester, $450!

  10. BTW, Dflynn and evan still have an important point about there being limits on what healthcare society can provide, even with competition on the supply side and vouchers.

    However, we shouldn’t let the tail of experimental drugs and devices wag the dog of the kind of healthcare most people need and get.


  11. I still don’t follow the anti-trust angle. Who do you want to break up? Why do you believe that smaller units will be any more competative than the situation we have now? The pricing issue is a function of the disconnect between consumers and suppliers, not due to a concentration of suppliers.

    I would venture this is the medical cartel. Regulating the number of medical professionals in order to drive up prices. The fact that they act as gatekeepers to self-medication, further exacerbates the problem by preventing you from even helping yourself.

    As long as such a system exists, I really have no compunctions about government imposed socialized medicine that regulates their wages in order to ensure everyone gets treatment. If they have any objections, they can start by supporting the deregulation of prescription medicine, free midwifery and other intermediary healthcare providers from their centralized, top-down control. Otherwise, I say screw em – they created the oligopoly/cartel and skewed the market.

  12. Maybe we could bus people to Canada for free treatment over there?

  13. kwais:

    I hope that bus has a potty—cuz they’ll be waiting for basic treatment for a few weeks at the very least.

  14. I would venture this is the medical cartel.

    Cartel is simply the wrong word to use. There is no price coordination between suppliers. There are certainly AMA and licensing roadbloacks that help to restrict supply, but I would not classify this as a cartel.

  15. gutta percha,

    You have my sympathy. When my older son was born I had Prucare, which informed me that I didn’t owe anything over the birth. Unfortuneately, the insurance company didn’t make that quite as clear to the hospital. Andy had a minor complication — low blood sugar — so we had to stay an extra day, costing $2,500 more. The hospital actually sent me a 30-day letter (meaning we’re going to file suit for the money in a month if you don’t pay up.) I finally got it straightened out only because I go to the same church as the hospital system’s general counsel. To this day I don’t know what all that extra money paid for, since Andy only had one additional test.

    Lest you think medical savings accounts help, I got one. The administrator company has a computer program which rejects every charge that varies from my copay amount. Now, I got the damn thing so that I would not have to use the health plan anymore, but hey, I’m just the depositor. If I get to actually use my savings, the terrorists win.

    Thanks for letting me vent. I can now get to work.

  16. In 1995, while uninsured, I spent a night at a hospital (for observation), and would up with a $5,000 bill.

    In 2004-5, I was hospitalized several times, and spent about a month in the hospital. I was insured, and probably paid a little more than that in total, while my insurance picked up about $60,000 or so.

    One thing you don’t often hear about medical insurance is that the insured are billed about 1/5 the cost that uninsured patients are billed for. Had I not had any insurance, I probably would have been billed $300,000 or so. (There was an article about this in Liberty magazine last year.)

    A couple of the hospitalization were almost certainly iatrogenic – “treatment” caused. Were I a different sort, I might have taken (at least one of) the doctors to court. However, as much as those events taught me to have a healthy distrust of doctors, it still couldn’t make me trust them less than ambulance chasing shyters. Nor do I believe there would have been a positive change because of a lawsuit.

  17. HSA’s and reimportation. Won’t fix everything, but will get us a lot closer than anything else.

  18. SmokingPenguin makes the important point about cost differential between insured and uninsured treatment costs. Bills I cited above were for uninsured. (I can’t get insurance because I answer all the questions on the applications honestly; like every other 51 year old American, I have pre-existing conditions. I _would_ buy insurance, if anybody would sell it to me.)

    Hospital refused to give me the “prompt-pay” discount that all the professionals were glad to give me. The hospital room rate posted on the lobby wall was “$750/day.” So how my uncomplicated stay (and no meals for six days) ended up costing $4,000/day, I don’t know. I told the surgeon that, next time, let’s do it at the Four Seasons or the Wyndham, instead of at the hospital; it would be cheaper, and more luxurious. Seriously, next time, I’m going to go to India or Thailand for this kind of thing.

  19. Were I a different sort, I might have taken (at least one of) the doctors to court. However, as much as those events taught me to have a healthy distrust of doctors, it still couldn’t make me trust them less than ambulance chasing shyters.

    Why didn’t you bring the suit yourself as a pro se litigant then? This isn’t like medicine where you need a prescription. Also, the court tends to let a lot of the petty rules and procedures slide for a pro se. Judge gives you more leeway, too.

    you’re not allergic to a bit of hard work, are you? The payoff is 33% more recovery money (the lawyer’s typical (state-regulated) cut).

  20. should read:

    judge tends to give you more leeway in interpreting and researching the substantive legal things, too.

  21. oh, and by state regulated, I mean that the state sets a maximum (not a minimum) on what the lawyer can charge.

  22. Lawyer not Shyster – I’m skeptical of the tort system’s ability to make positive changes. Also, the first time it happened (I was given Zithromax which messed up my liver), the doctor couldn’t have known it would happen. The second time it happened (I was given a different antibiotic, but one which also clears through the liver), the doctor could claim that it was another medicine (a chemo drug that can also affect the liver) that made me sick.

  23. …effect the liver…

    Guttapercha beat me to the medical tourism topic. I had a post that links to some medical tourism sites. It appears that India is becoming the hotbed (sickbed?) for that. Since I’ve never posted a hyperlink before, it is currently being vetted by the server squirrels to ensure I didn’t link to some website with hot hot hot naked Indian nurses or something.

  24. What metalgrid said. The medical industry is a gigantic gov’t-mandated scam:

  25. For some reason the server removed this line, which was above the Q.E.D.:
    “Ten minutes on a fricking treadmill stress tester, $450!”
    (Always preview!)

  26. For some reason the server removed this line, which was above the Q.E.D.:
    “Ten minutes on a fricking treadmill stress tester, $450!”
    (Always preview!)

  27. Also, the first time it happened (I was given Zithromax which messed up my liver), the doctor couldn’t have known it would happen. The second time it happened (I was given a different antibiotic, but one which also clears through the liver), the doctor could claim that it was another medicine (a chemo drug that can also affect the liver) that made me sick.

    1. Maybe your malpractice claim wasn’t that strong after all.

    2. However, if it was strong notwithstanding these complicated facts, then you could have, as a pro se litigant, hired an expert witness (a doctor not a lawyer) to explain all this to the judge and jury. Your problem is complicated facts and expensive expert witnesses to wade thry that — not ambulance chasing shysters.

    3. I am kind of picking on you here, mostly because I perceive an unfair anti-lawyer bias at HnR and in society at large. Lawyers work in something like a free market. You can hire one or not. If you hire one you can fire her later. The state puts a maximum, but not a minimum on what you can pay her. Contrast all of this with the way the medical profession is structured cutting into every last paycheck (sick or not) and all those lawyer jokes you have heard for 20 years wear kinda thin.

    4. it seems like my generation has been raised to despise lawyers, but cherish doctors. Time for a society-wide reality check.

  28. I invite anybody with pro-lawyer sympathies to be the object of a custody battle. Go ahead, try it. See how much fun it is to have two scum sucking pieces of trash fight over you, while a court-appointed scum sucking piece of trash ignores everything that you tell him, even though the court allegedly appointed him to represent your interests.

    Go ahead, try it. See how much fun it is!

    (So that you can continue to live a relative happy life, I strongly urge you to bring a heavily armed guard with you when you visit the lawyers. This is so that the guard can restrain you from doing anything that might get you in trouble. Believe me, you’ll be tempted. So very tempted…)

  29. it seems like my generation has been raised to despise lawyers, but cherish doctors. Time for a society-wide reality check.

    I hate ’em both. Sorry, Dave.

    OK…actually, that’s not true. I do trust doctors less than lawyers. But I trust tort lawyers less than doctors. The only interaction I’ve ever had with lawyers has been in real estate, and so far I’m 2 for 3 (one was totally incompetent, but those odds are the same in any profession).

  30. T:

    that is like blaming oncologists 4 cancer.

  31. I’ll repeat myself:

    while a court-appointed scum sucking piece of trash ignores everything that you tell him, even though the court allegedly appointed him to represent your interests

  32. “that is like blaming oncologists 4 cancer.”

    Except that, like, you know, it totally isn’t.

  33. I can hang with that. I am 0 for one with lawyers. I gave one a thousand dollars and never heard from him again. Couldn’t get in touch. Gave up.

    that hurt. The money represented 2 months worth of medical insurance premiums!

  34. ON EDIT:

    MP:

    I can hang with that. I am 0 for one with lawyers. I gave one a thousand dollars and never heard from him again. Couldn’t get in touch. Gave up.

    that hurt. The money represented 2 months worth of medical insurance premiums!

    On second thought, I am 1 for 2:

    More recently I paid for a family member’s legal consultation. (Family member was called as grand jury witness.) That one was $600 for tons and tons of work, from what I could glean 2d hand. I actually wanted to pay the lawyer more.

    Not that these anecdotes mean much, but you stack my $1600 of legal fees against my med insurance premiums and the ‘tude adjustment makes itself.

  35. ON EDIT:

    MP:

    I can hang with that. I am 0 for one with lawyers. I gave one a thousand dollars and never heard from him again. Couldn’t get in touch. Gave up.

    that hurt. The money represented 2 months worth of medical insurance premiums!

    On second thought, I am 1 for 2:

    More recently I paid for a family member’s legal consultation. (Family member was called as grand jury witness.) That one was $600 for tons and tons of work, from what I could glean 2d hand. I actually wanted to pay the lawyer more.

    Not that these anecdotes mean much, but you stack my $1600 of legal fees against my med insurance premiums and the ‘tude adjustment makes itself.

    Side note to T.: Do you know how serious family disputes got settled b4 lawyers came along? Better yet, I’ll show you. I’ll play the dad and you play the kid. Meet me out back at the woodshed unless you would rather have me drag you by the ear.

  36. I am a non-smoker getting aggressive chemo treatment for inoperable lung cancer. Costs since Jan 1 through March 17th, $60,000, all outpatient, I am responsible for a little under $3,000, so far. If I was uninsured, the real cost for me would be anywhere between $80,000 and $95,000. One drug alone, Avastin, made by Genentech, costs $5,280 per injection, every 2 weeks. $10,500 if you are uninsured. (Taxpayers picked up 44% of the tab on the clinical research of this drug in 2004 according to NPR’s Marketplace.)

    My biggest fight right now is getting preapproval from my insurance to do a much needed PET scan to evaluate my progress. They refuse to pay on account that it is a diagnostic tool as opposed to a prognosis/progress tool. There are several well researched scientific papers supporting the use of PET scans a prognosis tool than simply evaluating tumor shrinkage or growth (google PET scan). And since my lung tumor(s) are mostly nodules, the CT scan barely picks them up. I am 34, relatively healthy and make a good candidate to survive this even though the suvival statistics for me is less than 15%. While my employer has gone the distance for us and supplied a top notch, high quality insurer (RegenceBlueShield of WA state), I am still at the mercy of what they are willing to approve and pay for even though the contract does say this procedure is covered.

    I used to be a common knee-jerk commenter here but my health has left me with just reading with a chemo scrambled brain that could only come with mostly incoherrent ramblings for comments! I save those mainly for NRO and Daily Kos! They seem more intelligent there!

  37. I am a non-smoker getting aggressive chemo treatment for inoperable lung cancer. Costs since Jan 1 through March 17th, $60,000, all outpatient, I am responsible for a little under $3,000, so far. If I was uninsured, the real cost for me would be anywhere between $80,000 and $95,000. One drug alone, Avastin, made by Genentech, costs $5,280 per injection, every 2 weeks. $10,500 if you are uninsured. (Taxpayers picked up 44% of the tab on the clinical research of this drug in 2004 according to NPR’s Marketplace.)

    My biggest fight right now is getting preapproval from my insurance to do a much needed PET scan to evaluate my progress. They refuse to pay on account that it is a diagnostic tool as opposed to a prognosis/progress tool. There are several well researched scientific papers supporting the use of PET scans a prognosis tool than simply evaluating tumor shrinkage or growth (google PET scan). And since my lung tumor(s) are mostly nodules, the CT scan barely picks them up. I am 34, relatively healthy and make a good candidate to survive this even though the suvival statistics for me is less than 15%. While my employer has gone the distance for us and supplied a top notch, high quality insurer (RegenceBlueShield of WA state), I am still at the mercy of what they are willing to approve and pay for even though the contract does say this procedure is covered.

    I used to be a common knee-jerk commenter here but my health has left me with just reading with a chemo scrambled brain that could only come with mostly incoherrent ramblings for comments! I save those mainly for NRO and Daily Kos! They seem more intelligent there!

  38. In Canada out-of pocket medical expenses

    -Colonoscopy, $0
    – Surgeon, $$0
    – Anesthesiologist, $0
    – Pathology, $0
    – Hospital bill for seven days in bed, $0

    Taxes – High

    According to a World Health Organization report published in 2003, life expectancy at birth in Canada is 79.8 years, versus 77.3 in the U.S. (Japan’s is 81.9.)

    “There isn’t a single measure in which the U.S. excels in the health arena,” says Dr. Stephen Bezruchka, a senior lecturer in the School of Public Health at the University of Washington in Seattle. “We spend half of the world’s healthcare bill and we are less healthy than all the other rich countries.”

  39. Two companies that came up in the 60 Minutes piece on “medical tourism:” Bumrungrad in Thailand, and Apollo Group in India. These were said to charge about 85% less than American health-care, and got kudos for high quality as well. I asked my gastroenterologist about medical tourism when he recommended surgery. He never heard of it.

    JSM, good luck to you!

  40. Daniel-

    That may very well be accurate, in which case libertarians would do well to acknowledge it. It’s not like we have a binary choice between the current craptacular system and socialized medicine.

  41. “Did you read the same article as I did? If you read this page, a list of possible solutions, nowhere does Kerry say anything about “free healthcare” or “healthcare as a right”. Either you show me specific examples from that article where she claims healthcare as a right, or rescind your statement. ”

    The gist of the story is that the poor patient is lying on the table waiting for a very expensive procedure and the insurance company decided it wouldn’t pay the bill. The implication is that the insurance company was obligated to pay. How can insurance policies cover new therapies that did not exist at the time the policy was sold? The rational solution would have been to get pre certification before putting the poor patient on the table.

    “If I invented a lifesaving procedure that cost $30 to perform, but since I had the sole “rights” to that procedure, I charged $7000 for it, would that still be cool with you, dflynn? Exhorbitant market power in an industry that is so crucial, like healthcare, can be dangerous—and I’m staunchly pro-free-market. ”

    It would be cool with me. Since it is your product and property, I would agree you could set whatever price you wanted. Isn’t that a basic tenet of libertarianism? At whatever price you charged, I would have more options than I had before you invented the procedure. Your choice of $7000 as price might be very foolish from an economic perspective, however, but it would be your call. I think my position is free market and yours is not. You seem to consider health care as a right that overrides free market considerations and requires government to set a “fair” price.

  42. The scenario that Kerry describes in the beginning of the article– that of a doctor just about to start a costly operation, then getting a last-minute call from the HMO hedging on coverage– is very common.

    I worked for five years in the Surgery Dept. of a major university hospital, and dealt closely with the ‘patient care coordinators’, people who acted as a liason between the doctors, patients, and insurance companies. (BTW, being a PCC is one of the most stressful jobs I’ve ever seen, and I’ve seen some doozies.)

    The PCC’s believed this scenario was a deliberate ruse by the insurers. They’d get the pre-authorization for the patient’s procedure and schedule the operation weeks in advance. Then at the last minute the insurance company would call with ‘additional questions’, in the hope that the doctors would be too involved with other things to immediately respond. (Which could often be true. Many times they might be physically gone, say, traveling from a conference or something.) Anyway, the insurer could then refuse payment claiming that their authorization procedures hadn’t been met. Purely a game.

  43. There is no price coordination between suppliers.

    No, but there are price minimums mandated by the government — everyone else starts there and moves UP!

  44. In Canada out-of pocket medical expenses

    -Colonoscopy, $0
    – Surgeon, $$0
    – Anesthesiologist, $0
    – Pathology, $0
    – Hospital bill for seven days in bed, $0

    Taxes – High

    But you are talking about a simple procedure like Colonoscopy. You could have cancer, and find yourself getting a morphine drip and a bed to die in, where as you would get real treatment in the U.S… The guy who needed the heart pump in the story mentioned above, WOULD NOT HAVE GOTTEN THE HEART PUMP in Canada. The treatment is rationed, that would be too expensive, and he would die on a waiting list.

    I don’t understand what is so hard for people to understand – a health system cannot deliver more health care than there is supply of health care – that is a fundamental law of reality (conservation of matter and energy). Health Care costs are expensive, because the demand is greater than the supply. Even if government “covers” all expenses, there is not enough health care to go around to everyone. People die from lack of health care. People do not get the expensive treatments that you get in the U.S. … It doesn’t happen. The magic of the Maple Leaf cannot overcome the laws of economics. And having a profitless system doesn’t do a whole lot for capital investment to make sure there is a greater supply of healthcare.

    You might not have to pay $150 for your checkup, but you are not going to get the $1,000,000 dollar cancer treatment that would in the U.S. either – you are going to die.


    According to a World Health Organization report published in 2003, life expectancy at birth in Canada is 79.8 years, versus 77.3 in the U.S. (Japan’s is 81.9.)

    Yeah, and if you correct for the higher murder rate and auto accident rate, U.S. life expectancy is longer. What you have to look at, in order to compare medical systems, is lifespan after disease. So compare the lifespan of lucemia patients, or heart patients, or whatever.

    “We spend half of the world’s healthcare bill and we are less healthy than all the other rich countries.”

    Americans ARE less healthy, but that is because we drive in SUVs instead of walk, and eat fast food in huge amounts, etc. Lifestyle issues have nothing to do with healthcare.

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