Policy

Health Care Ate America

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Joanna Andreasson

In 1960, six years before the start of Medicare and Medicaid, America spent about $27 billion on health care. That figure represented just under 5 percent of an economy that was about $543 billion in total. By 2016, combined public and private spending on health care had reached more than $3.3 trillion, or nearly 18 percent of the total economy, with almost half the bill paid by government. Now, thanks to factors such as increased drug prices and an aging population, official projections have health care spending increasing indefinitely.

In the five decades after the passage of America's two largest health care entitlements, that sector has become a maw, eating everything in its path. Health spending has reshaped the nation's job market, its household finances, and its public budgeting. Between January 2007 and November 2017, nearly a third of all jobs created in the United States were health care jobs. On average, American households spend 22 percent of their income on health care, up from 10 percent in the '70s. Large employers spend an average of more than $14,000 per employee on health insurance and the like each year. Medicaid, which is jointly administered and financed by state and federal governments, is one of the largest line items in every state budget. Health care entitlements are the biggest drivers of the long-term federal debt and a fixture of America's most consequential public policy debates.

Medicare and Medicaid were themselves outgrowths of the failed single-payer campaigns of the 1940s and 1950s. Nearly every decade since they came into being has been marked by battles over health care policy and politics. In the 1970s, Sen. Ted Kennedy proposed a single-payer plan that was scuttled after the newly created Congressional Budget Office estimated it would cost far more than Kennedy's staff had said. In the 1980s, Ronald Reagan presided over a series of changes to Medicare's payment system in an effort to tamp down on costs. In the 1990s, one of Bill Clinton's first major initiatives was a failed attempt to pass a disruptive universal coverage law. A decade later, George W. Bush would oversee the passage of Medicare's prescription drug benefit, his administration's most visible and priciest domestic policy achievement.

Barack Obama's presidency was defined in large part by the effort to pass and implement the Affordable Care Act, the health care law that would become known as Obamacare. Even with Democratic majorities in both the House and the Senate, drafting and voting on the legislation consumed the first year of his presidency. Once passed, it was beset by legal and practical challenges.

Over the course of Obama's two terms, Republicans swept the House and voted on dozens of symbolic repeal bills, promising to replace the law at the first opportunity. For almost a decade, eliminating Obamacare was the GOP's biggest domestic policy priority.

The opportunity arrived after the 2016 election, which resulted in Republicans controlling both chambers of Congress as well as the White House. But just as the effort to pass Obamacare dragged on longer than anticipated, so did the GOP's repeal push. In the end, it failed by a slim margin, with holdout lawmakers worried that no suitable replacement had been drawn up. President Donald Trump and congressional Republicans settled for tweaking the law at the margins—stopping payment of insurer subsidies that were never authorized by Congress, zeroing out the individual mandate penalty, slashing funds set aside to promote new online marketplaces, and pushing to add work requirements to the law's Medicaid expansion.

Democrats, meanwhile, spent the better part of 2018 campaigning on health care issues—from the preservation of Obamacare's pre-existing conditions regulation to the further expansion of Medicaid. Nearly all of the party's rising stars have endorsed a single-payer option, and Republicans have begun to respond, somewhat nonsensically, by defending traditional Medicare—a program that socializes the financing of health care—from what they have called the threat of socialism. Even Obama, who as president rejected a single-payer option, said in a September 2018 speech that Medicare for all was a "good, new" idea.

It is neither, but its return to the forefront of America's public policy debates is perhaps inevitable given the increasingly expensive and expansive role of health care in American life. Since the federal government's first major forays into health care financing in the 1960s, that sector has consumed the economy, the workforce, and both household and government budgets. It's no surprise that it has overtaken American politics as well.

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  1. As long as Healthcare and Big Pharma lobbyist are allowed to put money into the pockets of politicians (reelection funds) nothing will change. Every member of Congress has one major concern, getting reelected.

    1. It’s not big pharma demanding every treatment or potential cure be covered no matter the cost. That’s the consumers.

      1. Totally agree, JesseAz. While overpriced prescriptions and health provider fees (not to mention ambulance chasing lawyers) are significant contributors to out of control health care costs, consumer demand for these services is the biggest driver. IMO, most of this excess demand is driven by people feeling like someone else is picking up most of the costs, be it the government or insurance companies. I believe the only real solution is for everyone to have high-deductible insurance coverage, with insurance only covering for costs exceeding several thousand dollars. People will have to pay out of their own pocket for routine prescriptions and office visits. I think this is the only realistic way to put market pricing pressures on out-of-control health care costs. You already see market pressures exerting themselves in non-covered procedures, such as LASIK eye surgery, where prices have dropped dramatically over the last 10 -15 years.

    2. As long as coercive monopolistic government exists, there will be politicians looking for bribes.

      Blaming lobbyists for doing what powerful politicians want is like blaming businesses for selling what the public wants.

    3. This is such a tired idiotic cliche

    4. Tort reform would help too.

  2. George W. Bush would oversee the passage of Medicare’s prescription drug benefit, his administration’s most visible and priciest domestic policy achievement.

    Republicans, in their wisdom, decided the pills Americans take were part of “insurance”. Someone tell me the lie about how the GOP is for “small government” again.

    Both parties suck but one of them lies over and over again.

    1. “If you like your coverage, you can keep it.”

      1. I am (like most people) on private employer insurance so I kept my set of docs – not that I care very much.

        1. Millions of others did not. It is called the “Caddilac tax”, it fucked everyone who had good private insurance and forced them to have shitty insurance. It was the way that Obama fucked everyone who had something in order to pay off his supporters. You don’t realize that because you are a worthless piece of garbage who likely never had good insurance anyway. You are the piece of shit bum that Obama screwed everyone to benefit.

          1. Uh, the “Caddilac [sic] tax” is simply a cap on how much can be deducted for health coverage. Try again.

        2. I like most no idiots realized their employers coverage changed to meet the mandates of ACA which included narrowing of networks

          Are you a fucking dumbass or something?

          1. Narrowing of networks is a COST-SAVING mechanism – not an ACA mandate. That is simply a continuation of what employers have been trying to do for 30+ years – increase premiums/copays/deductibles (esp for the lo-income and part-time), require some form of gatekeeper or case mgmt, encourage HMO’s, cherry-pick recruiting among the young/healthy and find ways to derecruit older/sicker, and yes find ways to narrow networks so volume ‘discounts’ can be negotiated between the insurance co (who is not really insurance for larger companies but is merely a third-party adminstrator) and the providers.

            The main ACA mandate for employers was that they could no longer charge more than 9.5% of an employees income for their share of the premium – so it is slowly moving from a flat$-fee or a regressive charge to a % of income charge. But that has nothing to do with networks.

            1. Not quite. You are correct that the ACA does not legally require narrow networks. But the upward pressure on rates caused by the ACA’s rating rules (guaranteed issue and community rating) led to the expansion of narrow networks to a much larger extent than was previously experienced.

          2. From your grammar, you seem to be the idiot here …

        3. Lucky you. I got forced into a high deductible plan that costs the same as the plan that paid for stuff, with a very small set of in-network providers. After putting money into the HSA to pay for stuff, I’m paying one and a half times what I paid before, and I very rarely go to the doctor because doing so uses a couple month’s worth of HSA contributions.

          1. That is another approach to keep average rate increases down.

          2. And how much would pay under BernieCare?

            1. And how much would *you* pay under BernieCare?

            2. Just as much, if not more, because nothing is addressed in “Berniecare” about the actual *COST* of the service, just who’s paying the bill.

        4. Sarah Palin’s Buttplug|11.19.18 @ 8:55AM|#
          “I am (like most people) on private employer insurance so I kept my set of docs”

          So his lie is OK since it doedn’t bother you, you piece of shit?

        5. Nice strawman you infer by not mentioning how you haven;t noticed changes in premiums or deductibles or co-pays or choice of who treats you.

          Or maybe you really are so dumb and oblivious that you didn’t notice any of those things that other people did.

        6. But if you had an individual policy pre-2014, chances are the plan got canceled. If you had really rich benefits, chances are that you couldn’t find the equivalent after 2014 (when insurers who offered those plans in the IND ACA market took a beating). In response to the high average rate increases and the push-back by regulators due to those high rate increases, chances are that your broad PPO network ACA plan (i.e., one that included almost all doctors and all provider organizations) was transformed into a narrow network POS plan in 2015 or 2016.

          The ACA definitely impacted many millions of peoples’ choice of provider, or at least their ability to afford that provider. So yes, Obama lied.

          John is wrong below. Cadillac tax has been push back a couple of times and has yet to impact plans.

          1. My individual plan from Assurant was middle of the road, but still far superiorerior to the ACA ‘Platinum’ plan that was made available in it’s stead. At over twice the price too.

            Everyone who voted for these people who did this should be put to death for it.

            1. Wow, maybe you need to get a cancer diagnosis to see the error of your thinking.

              1. I’ve been with the same employer for decades, and over that span many people here have gotten cancer. The reality is that pre-government meddling (which began at the state level in MN), everything was covered 100% – no co-pays and no out of pocket. The cost of the policy was covered 100% by my employer. Cancer patients didn’t have to worry about insurance or health care costs, which was a blessing.

                When Minnesota started state provided health care for some people and got regulation heavy on the rest, we got our first co-pays and some small out of pocket, but it was still affordable.

                When the ACA went into affect, we essentially got bronze plans and my employer started having to charge us a significant amount for our policies, though they still picked up the majority of the costs. I now have a $13,000+ annual out of pocket cost for my son and I, a small network to choose from and serious hoops to jump through to get access to any of them, and it costs me about $4,000 annually for my crappy policy. It costs my employer more.

                The ACA is the worst thing that has ever been done to me personally. Nothing else even comes close.

                I fully agree with the sentiment ‘Everyone who voted for these people who did this should be put to death for it’.

              2. Wow, maybe you need to get a cancer diagnosis to see the error of your thinking.

                Maybe you need a swift punch to the mouth to correct yours, shitlib.

    2. “Both parties suck, and I regularly criticize one of them for it”.

      1. Only one of them pretends to be for small government.

        1. The other one pretends that they’re going to pay for everything that they want to do by soaking only the rich. Everyone else is going to get all this great stuff for free.

          1. Yes, that is true. As I remind progs if we taxed the 1% everything they made (which would soon become impractical) it would not come close to eliminating the current deficit.

            That is why I am a real independent.

            Not a fucking default conservative claiming to be a libertarian (like most posters here) who will always suck on the Big Gov GOP teat.

            Gridlock is our only hope to stop Big Gov.

            1. That is why I am a real independent.

              This is why you are a lying piece of shit troll who works for media matters and is sent here to lie and screw up the board. Everyone knows who you are and doesn’t believe a word of what you are saying. Media matters really scraped the bottom of the barrel when they hired your sorry ass.

              You are just a fucking subhuman.

            2. You’re a fool, not an independent.

              1. Let me reiterate why you’re a fool. One party actually wants to give you choices, the other wants to decide for you. You only criticize the party trying to give you choices.

                1. One party actually wants to give you choices, the other wants to decide for you.

                  Um…. Which is which? I can’t tell these days.

                  1. The one wants to allow cheaper plans to be offered alongside ACA plans. The other calls this “eliminating Pre-X coverage”

            3. Sarah Palin’s Buttplug|11.19.18 @ 9:14AM|#
              “That is why I am a real independent.”

              Latest running total of turd posts which are not lies:
              0

        2. That one quit pretending when it passed a law to interfere in a single marriage, in full knowledge that the law was unconstitutional.

    3. Except Bush did not lie about that. It was part of his “compassionate” conservatism where compassion is defined as being generous with taxpayer money.

      1. Show me a compassionate conservative and I’ll show you a big government progressive who opposes abortion.

        1. Yes. I found that construction appalling in its implications on several levels. Unfortunately, Bush ran against McCain and Gore, who were more appalling on all levels.

          I thought it was a bad idea, but it was not a lie.

        2. Anti-abortion leftists who believe generous welfare state is the only thing that can prevent abortions do, in fact, exist. While I am not a leftist (even though I am in favor of some welfare for those who objectively cannot provide for themselves) and I don?t like abortions (even though I believe they should remain legal – for the first trimester), I agree with them in part. Abortions mostly happen out of economic reasons.

      2. Medicare D is the one and only entitlement that has cost what they estimated (instead of 10x more)

      3. No, not just taxpayer money, but taxes from future taxpayers. See the difference?

    4. ObamaCare was not about good health insurance or good health care.

      Remember, it was a tax. It was about getting the bloated “good” government more “good” taxes.

      1. No, it was about power and micromanagement. It was a tax or a fine, depending on which argument was deployed against it

    5. “free” healthcare for all. “rich” will pay for it. “Free” college. Democrats lie non stop.

      1. +1000

      2. Democrats do not always lie.

        Sometimes they are genuinely stupid and ignorant.

    6. Democrats want to fold a prescription drug benefit into the existing Medicare system. Under their plan, seniors would pay a premium of $25 a month and face an annual $100 deducible. There would be a $2,000 out-of-pocket limit for beneficiaries, and Medicare would pay 80 percent of drug costs.

      The Democratic plan would cost an estimated $700 billion to $900 billion, more expensive than the $400 billion Bush has vowed to commit to overhauling Medicare.

      “Our plan maintains the choices that matter most to the elderly and the disabled — which doctor to go to and what pharmacy to use,” Pelosi said.

    7. Exact. Worse yet, Medicare Part D SPECIFICALLY DISALLOWED the government from negotiating to receive a bulk discount for its purchase of millions/billions of medicines. “We’re going to pool our orders to ensure that we pay FULL PRICE for a large lot, rather than being able to individually negotiate lower prices.” You would think that I’m a bitter Democrat making up the following, but it is 100% true: About two weeks after Medicare Part D was passed, the congressman who wrote it was hired as Pharma’s lobbyist.

      1. The other two specific cronyist loopholes were:

        prohibiting the import of pharmas from overseas. At the time, healthier seniors near the borders were heading across to purchase at Can/Mex pharmacies. So the provision eliminated those individual actions as well as prohibiting Medicare from doing the same thing for even that portion of the existing purchases.

        discouraged Medicare from making any effort to encourage generics. At the same time (different lobbying though), they made sure the FDA increased its regulation/costs imposed on generic mfrs for the purpose essentially of driving them out of the US market. So generics are no longer real competition for many drugs.

        And it wasn’t just Tauzin who revealed himself as a pharma whore immediately after the legislation. The head of Medicare did the same (who specifically threatened the employee who came up with a more accurate cost estimate) – as did 14 congressional staffers. There is a reason that that industry pays $1 billion each year to lobby. It has an enormous ROI.

      2. My old Congressman, Billy Tauzin!

  3. People can’t work when they’re sick.

    1. And when they don’t work, they get sick.

  4. One thing often overlooked in discussions of “exploding” health care costs, particularly when framed over half a century, is what “health care” was available. In 1960, most cancers were death sentences. New (effective) chemo drugs are expensive–but actually provide cures in many cases. Cure Hepatitis C? Fuggetaboutit. In 1960, few treatments for acute heart attack or stroke or effective therapies for recovery from same even existed. When joints wore out, folks simply got into their wheelchairs and then rather more quickly died, rather than having the joints replaced and resuming activities of daily living. And the list could go on far longer than posting rules here permit.

    Bottom line–health care is more expensive in large measure because there’re more services and medications that are available to make a difference. It isn’t a conspiracy.

    1. Also, in 1960 you didn’t put in an insurance claim when junior went to the doc for the sniffles or his shots or ace bandage when he sprained his ankle. It is no wonder insurance spends about 20% of expenses administering all sorts of minor claims that never were (nor should be) submitted.

      1. Clearly you dont know about mid 20th Century medical care.

        There were surgeries! and casts set! and hospital stays! with nurses!

        Doctor house calls! Limbs removed! Blood given!

        1. Sorry. wrong spot.

      2. Uh, going for an office visit is the least expensive part of the Medical Industrial Complex; bellyaching about how that is a major driver of bloated health-care costs is ridiculous.

    2. This is a fantastic point that I agree is constantly overlooked.

      However, it also isn’t the entire story. Procedures that aren’t covered (such as lasik or breast augmentation) get cheaper and cheaper eventually, while somehow MRIs get more expensive.

      Furthermore, the invention of multimillion dollar cures shouldn’t morally tie us to using scarce resources to extend every life just because we can.

      To give a hypothetical that won’t ever exist: if I were terminally ill and a $3M procedure could extend my life a few years, but you also gave me the option to give my family $1M cash and just die, I’d actually have to think about it. (and I hope I’d pick the latter)

      Our current system, and every one currently proposed to replace it never allows people to prioritize any form of spending over health care spending. It’s no wonder we all choose to spend as much as possible. If you don’t, the value just disappears.

      1. To give a hypothetical that won’t ever exist: if I were terminally ill and a $3M procedure could extend my life a few years, but you also gave me the option to give my family $1M cash and just die, I’d actually have to think about it. (and I hope I’d pick the latter)

        I would too, but hopefully they’d give you the option of going out nice and quickly, instead of wasting away from some horrible cancer.

      2. > Furthermore, the invention of multimillion dollar cures shouldn’t morally tie us to using scarce resources to extend every life just because we can.

        Wow, that sounds like one of Caribou Barbie’s death panels!

      3. “Procedures that aren’t covered (such as lasik or breast augmentation) get cheaper and cheaper eventually, while somehow MRIs get more expensive.”

        MRIs that you order yourself are also getting less expensive.

        Health care is cheap.
        Government enabled rent seeking is expensive.

    3. I was thinking the same thing.

      It’s like comparing today’s cars to those of the 1960s. Sure the cars then were tons cheaper, and you could do most of your own maintenance, but they had all the technology of a modern lawnmower.

      Today’s cars cost a lot more because they’re better. They get better fuel economy, they are safer, and they last longer.

      Same with health care. It costs more because it gives better results.

      1. I respectfully disagree.
        If the task is transportation from point a to point b, today’s cars are no better then the sixties.
        They get better fuel economy, but even allowing for inflation, they do not get enough better to make up the difference in the price of the vehicle. I can buy a whole lot of fuel for my 20 mgp dinosaur with the money I am not paying for a new 30 mpg car. And if necessary, I can reduce my driving and reduce my fuel cost; the pesky banks want their monthly payment on a new car no matter how little you drive.
        Lasting longer is mostly a function of proper maintenance. Witness my still running dinosaur without a single engine repair. (198,000 on one, 135,000 on the other)
        Insurance on an older car is much less.
        Safer is a matter of physics; a brand new little car, with wonderful technology and great fuel economy will still crumple when hit by, or hitting, something bigger.

        1. My point was that things cost more because you get more. Yeah, the analogy wasn’t perfect, but the point remains.

          1. While that might seem correct, why does the price of a scalpel used on you in the hospital cost magnitudes higher than inflation would have raised the price? A scalpel does not seemed to have changed much in 50+ years.

            Same logic for bed pans, sheets, etc.

            A big increase in cost is paying customers subsidizing non-paying customers. High reimbursement insurance patients paying for low reimbursement insurance patients (Medicare/medicaid patients).

            Massive amounts of overhead to remain within regulations also add huge costs to medical care.

            On your point though, technology has created better medical care but its pricey sometimes.

            1. The third party payer system has jacked prices for sure. But there is no denying that health care is leaps and bounds better than it was fifty years ago. And better things tend to cost more.

              1. Unfortunately this misses the real problem with our current system. Which is that most people are healthy. They don’t need or use the medical system much. Their risks of potentially needing that system in an emergency haven’t changed at all over the last 60 years. But they are the ones who are expected to pay for it all – and the only ones who CAN pay for most of it.

                But since the sick drive all the spending – with no restraint on themselves at all – it is the healthy who get choked on the bill and are made to suffer.

                The reality is that the only thing that can ever change anything here is a restraint on the spending/utilization decisions by the sick. And that almost certainly has to externally imposed because the mere act of ‘being sick’ does not produce some magical knowledge about medicine or some dramatically changed ethic about life/death or some fountain of money that can pay for things then.

                1. Are these the death panels that congressional Republicans keep wanting?

                  But, yes, a HUGE problem with health care costs is that the patient doesn’t get to choose what he wants done and doesn’t get a list of prices for it. The doctor orders the works every time, it seems.

                  Kinda like… You bring your car to a mechanic for minor work, he changes all of the fluids, changes all of the tires, does a tune up, and full detailing of the interior. He/she never asked if you wanted or thought you needed any of those things and never told you the price, it was just done.

                  The equivalent of this being done for every car on the road every time one goes to the mechanic is similar to what is being done in the health care system. Sure, every car on the road is finely tuned and fuel efficient, but its costing us untold billions of dollars for marginal benefit.

                  1. My father is 88 years old. He worked as a pharmacist. He has no life threatening illness but has difficulty walking and lives in a very nice home for elderly folks. He has become, in my opinion, a victim of the medical industry. Every time he has a medical issue however minor, he is forced to endure every conceivable test known and prescribed some new drug which inevitably creates another issue leading to more tests and more drugs. Before he retired he set aside a suicide kit that disappeared at some point. He often tells me he wants to decide when he’s ready to leave this life but no longer has the choice. It’s wonderful that we have better medical care than we had in the past but, as with all things, some of us pay a price. And it’s not just money

                    1. Your dad’s experience is kinda similar to my folks. What changed everything for my folks was getting a geriatrician. In their city, those are almost unknown except for patients who are in dementia and can no longer make their own decisions. But the skills of that geriatrician – about aging, about increased recovery times and complications from multiple things – has made it possible for my folks to actually think about how they want to live their life rather than how they want to deal with this or that medical thing.

                      They have in the last year prob eliminated about half their medical utilization. They are no longer talking all the time about this and that health issue – well not so much. They have clearly taken control back from specialists and tests and are happier for it. And their geriatrician loves having two patients who can actually have a conversation.

                      Medicare should have made the decision decades ago to train more geriatricians as GP/gatekeepers for the elderly and structured their pay differently. For both better and cheaper healthcare. It’s a disgrace that that this didn’t happen then and isn’t happening now.

                2. > But since the sick drive all the spending – with no restraint on themselves at all – it is the healthy who get choked on the bill and are made to suffer.

                  OK, I’ll play Beelzebub – you have the choice of paying a high health coverage costs and not being able to take advantage of them, or be able to take advantage of them; which do you choose?

                  1. you have the choice of paying a high health coverage costs and not being able to take advantage of them, or be able to take advantage of them; which do you choose?

                    You really think you’re making a point here?

              2. Some medical care is better than it was 50 years ago.

                Some medical care is fundamentally the same as it was 50 years ago.

                An example is broken bones. We still take an image of the bone and set it just as they did 50 years ago.

                Cutting dicks off trans and making dicks out of vaginas. You’re right, medical care is better now.

                Another example is medicines. Much of the costs of medicine is not production, distribution, or marketing. Its covering R&D costs. That skews the costs of medicine higher but we have some amazing medicines in the USA because of that strategy.

                1. Medicines, like most health care, are rent seeking shakedowns.

                  You pay less in proportion that you evade the shakedown.

            2. A big increase in cost is paying customers subsidizing non-paying customers.

              This gets said a lot, but it isn’t the main problem. The main problem is that people are not price sensitive. The scalpel gets more expensive because if the hospital adds another $10 to the bill, it won’t reduce the likelihood that they get customers. The customer will still go there, and the hospital will still be paid.

              However, in healthcare services that ARE price sensitive, the owner of the business is laser (lazik?) focused on reducing their costs, because if they are not competitive with other services, people won’t buy the product.

              We see this problem everywhere that the government reduces price sensitivity. Make loans for houses super easy to get, with low interest? Housing bubble. Make college education loans easy to get? Tuition goes through the roof. Get insurance to cover every scratch and itch? Healthcare prices soar.

              1. Yea Overt, you articulated that better than I did.

              2. Patients are divorced from the cost of their healthcare. I have no insurance, and pay cash. I have done this since the ACA unconstitutionally interfered with my insurance coverage. All this insurance bullshit has made it hard to deal with most urgent care clinics on a cash basis.

                Since all of this is an ongoing threat to my health and my life, I consider it reasonable to consider a long range plan to cleanse America of it’s progressives who create this threat.

                1. Well, Mr. Buffet, let’s see how your investment pays off when you get cancer!

                  1. Well, Mr. Buffet, let’s see how your investment pays off when you get cancer!

                    Shitlibs always cite healthcare at the margins to prop up their idiotic arguments.

              3. “The main problem is that people are not price sensitive.”

                The main problem is that we are not free.

            3. A lot of that stuff is due to cost-shifting. The great government programs the left loves so much do not pay for the care received. Therefore costs are shifted (when they can be) to private sector payers. In private sector payments, a lot of hospital costs are shifted to the ER, because people can go to any ER under the ACA, and therefore a fee schedule is less impactful on ER spending.

            4. The high price of the scalpel is to make up for the non-payers that the hospital has to treat because of St. Ronald’s EMTALA.

              1. BS. Non-payers are fairly close to irrelevant to hospitals – maybe 5% of receivables.

                The high price of all the stuff hospitals can nickel-and-dime on their bills is because insurance exists and they CAN nickel-and-dime all that stuff. They don’t assume any risk whatsoever in our system and so they milk that.

                If our system worked differently – eg if hospitals sold their capacity wholesale to groups and retail to local individuals and had to reinsure themselves for outlier stuff, then they would manage their internal costs far differently and far more wisely.

        2. > today’s cars are no better then the sixties.

          I see; would you care to do an experiment for me and get into a head-on crash at 35 mph in one of those classic cars, while I do the same in a crush-zone, ABS & air-bag equipped modern car?

          1. You getting in a major wreck would instantly improve the human race.

        3. > Safer is a matter of physics; a brand new little car, with wonderful technology and great fuel economy will still crumple when hit by, or hitting, something bigger.

          You fail Mechanical Engineering 1001. Is your degree in business?

          1. As licensed professional engineer, Swampshit, I am guessing you did not fail ME1001 (a course that does not exist) either.

            The safety features of a modern car are tested by collision against a fixed wall. The vehicle is light weight and designed to collapse on itself to absorb the energy. This is a poor example of a head on collision with a larger and heavier vehicle.

            That wonderful modern vehicle hitting a wall at 50 mph, completely crunched but saving the passengers has a problem in the real world. That 1500 lb vehicle in a collision with a 4500 lb vehicle suddenly needs to absorb 2500lb at 100 mph. The 1500 lb vehicle was at it’s limit to deal with it’s own weight at 50, meaning that the passengers are dead and getting them out requires cutting them out in this case.

            The larger vehicle, tested at 50mph and 4500 lb, is not dealing with 100mph and 2500 lb and the passengers have a fighting chance. It is more than 50 mph at 4500 lb, but not WAY more.

            Like the man said, it IS in fact, Physics.

      2. Cars are more expensive, true, but the cost of the average car has grown more slowly than per capita GDP since 1960. They cost more because they’re way better, but we’re richer too. To the extent that we spend a greater percentage of GDP on buying cars today than in 1960, it’s because we buy MORE of them–there are about twice as many motor vehicles in operation, per capita, today.

        1. Yes we buy more of them, but we’re also buying more car. Power windows, intermittent wipers, cruise control, crumple zones, emissions controls (exhaust doesn’t smell like a lawnmower), heated seats and mirrors, all those things add up to a better, safer, and more expensive, car.

          Same with health care. Last time I broke a bone they put metal pins in to secure the pieces and put on a fiberglass cast. That’s miles away from setting the bones, putting on a plaster cast and hoping for the best.

          The list of treatments and procedures we have now that didn’t exist forty or fifty years ago is a mile long.

          And it costs money.

          1. I dont want back up cameras, 100+ airbags, catalytic convertor, and the million other “features” that drive up the costs of vehicles. Many of these are mandated by government.

            I want a high performance car, with the features that I want, at a decent price.

            1. I agree 100%. I hate ABS. I’d rather tap the brakes myself if I’m in a slide. Regardless though, cars are better now than they were.

              1. The car companies and dealers have more wiggle room for profit with more features. Each feature can be padded with a profit to keep car prices higher.

                The car market should give us better cars for cheaper prices. Cronyism and massive regulation has allowed required “safety features” to artificially keep car prices higher than they would normally be.

                As you said about ABS, it would save money if you did not have that feature. ABS type systems are probably pretty cheap now compared to when they first came out and were one of the main advertised features.

                With my example of airbags, 1 or 2 are enough. I dont need to pay for 10 airbags per seat position.

                let the consumer decide about most of the features.

                1. > With my example of airbags, 1 or 2 are enough. I dont need to pay for 10 airbags per seat position.

                  I see, Mr. Mechanical Engineer; did you do your research on air-bag effectiveness?

            2. +100

              The fucking auto “hill hold” that can’t be turned off is the most annoying thing on a manual transmission when you are on a steep hill. I’ll take a good old fashioned hand brake (which they got rid of in this car) any day. Unfortunately there are a million little nannies installed you can’t pick and choose from.

            3. Safety gear in cars is skewed towards protecting the occupant, not the car. Replacing a $30k family sedan will not cost more than $30k. A severely injured human requiring Heartflight, emergency surgery, plus possibly follow up surgery, a stay in ICU, additional convalescence in a regular hospital room, physical therapy, various medictioans, etc, well, skys the limit there.

              1. Also, Camaros are more bitchin’ than ever before.

    4. True. A large part of the problem is that people don’t want to be confronted w the choice between paying more for their health & spending more on things they really enjoy. They want to spend on health what previous gener’ns did, yet get what’s available now for it.

    5. Ditto “the exploding costs of prescription drugs”

      1960 bleeding ulcer – dangerous and life threatening, requires a dangerous and life threatening expensive surgery

      2010 bleeding ulcer – take a pill, controlled

    6. This is true, but some of this is also encouraged by third-party payment, which is turn encourage by tax rules.

      In a rational market, the rich would pay for new therapies because they could, and later those therapies would be cheaper and cover everyone. This is why a “right to healthcare” is so dangerous. It does nothing to incentivize advancement and the lowering of costs.

    7. There are certainly new procedures that for good reason do cost a lot because of their complexity or being rarely encountered, things that didn’t exist back in the 60s.

      But then there are extremely routine procedures and teststhat there is no good reason they don’t cost 1/10th to 1/50th what you’ll be charged.

      If you look at Doctors and Surgery centers that operate strictly on a cash basis, they do these routine things at considerably lower cost than when done by facilities that take insurance/government as the primary payer.

    8. Bottom line–health care is more expensive in large measure because there’re more services and medications that are available to make a difference. It isn’t a conspiracy.

      BS. Smartphones didn’t exist in 1960, color TVs didn’t exist in quantity in 1960, virtually all the technology we have didn’t exist in 1960, yet all those things were introduced at high cost and then the price dropped to something approaching commodity levels.

      Health care is probably 90% technology based, and yet it doesn’t follow the cost curve of all other unregulated technologies. Regulation and government cronyism are the differing factors.

      Get the government out and you can have MRI’s at Walmart or as a smartphone attachment.

  5. Better if the poor would just die quietly away from everyone. May I suggest under the front porch?

    1. At the abortion clinic would be better.

    2. Medicare is so great, I’m sure you’ll be the first to sign up for it when it becomes available everyone. Right?

    3. Are you suggesting prank SWATting alleging hostage situation in poor neighborhoods? Oops, that’s ON the front porch. Sorry, my bad.

  6. Not gonna argue that health care in America sucks ass, it is the 3RD leading killer of Americans, via preventable errors, after all…
    But why are “articles” at Reason so amateurish, rudimentary, biased, and so very incomplete?

    Post-war years in America were a time when way too many doctors grasped for the gold.

    The most common “entrepreneurial” excesses were fee splitting, where a specialist paid a kickback to the referring doctor, and ghost surgery, where a surgeon secretly paid a colleague to operate on an anesthetized patient. The first surgeon paid the “ghost” a small part of the total fee and pocketed the difference. Even worse was rampant surgical overuse, where common excesses included appendectomies for stomachaches and hysterectomies on young women with nothing more than back pain.

    Doctors “display a consistent preoccupation with their economic insecurity,” a 1955 report by the AMA concluded with discomfiting bluntness.

    A 1956 AMA poll found that 43 percent of patients thought their doctor charged too much.

    With professional self-control the only control, the rate of increase in doctors’ fees doubled.

    Speaking at an AMA conference, AMA president Milford O. Rouse noted that physician fees were rising faster than the cost of food and housing, and he urged members to address “efficiency, cost and methods of delivery” of health services in order to preserve freedom from further government intervention.

    THAT WAS BEFORE MEDICARE.

    1. No doubt that Bureaucratic intervention has done little to control costs, but presenting a highly-reductionist view is no solution.

      THE PRIVATE SECTOR HAS BEEN JUST AS BIG A FAILURE.

      In fact the AMA, a PRIVATE, PROFESSIONAL ASSOCIATION, fought the Medicare proposal UNTIL they included “Conservative” “Republican” big-industry concessions:
      ? They were broader than hospital care and provided for covering physicians’ services.
      ? The proposals were also based on the principle that they were not related to social security or the contributory and compulsory payroll tax basis, which was a continual point of opposition by the AMA and the Republican supporters.
      ? The AMA demanded an AMA-owned system that is used by Medicare to set up its fee schedule for various medical procedures and services..

      the American Medical Association calling the original plans “unAmerican” and socialized medicine, supported the proposals after they gained control over such.

      Thus the American Medical Association played a key role in establishing the power of doctors in the American health-care system, and thereby in the out-sized compensation that American physicians enjoy relative to their developed-world counterparts.

      The concept of a “Free Market” is a total sham.
      EVERY MARKET IS MANIPULATED….FIRST BY THOSE PRIVATE INDIVIDUALS THEMSELVES, THEN BY THOSE PRIVATE INDIVIDUALS EXTENDING THEIR INFLUENCE ONTO GOVERNMENT AS THEY GAIN MORE WEALTH & POWER.

      1. jello.beyonce|11.19.18 @ 9:54AM|#
        “THE PRIVATE SECTOR HAS BEEN JUST AS BIG A FAILURE.”

        Yes, you really are a stupid fuck.

      2. The “Writers” at Reason are either completely stupid, wholly ignorant, or just highly-propagandist.
        They merely present one-sided, strongly-biased and prejudiced views.

        THIS IS WHY “LIBERTARIANISM” IS NOT SUSTAINABLE.
        IT FAILS TO ADDRESS THE COMPLEXITIES OF THE WHOLENESS OF THE ISSUES IN DEPTH.
        IT PROVIDES OVERLY-SIMPLISTIC ASSESSMENTS TO CONVOLUTED PROBLEMS.

        IT FAILS TO EXAMINE HISTORICAL CONTEXTS, SEEKING TO IMPLEMENT COMPLETELY INEFFECTIVE “SOLUTIONS” THAT HAVE ALREADY PROVEN COMPLETE FAILURES IN THE PAST.

        IN FACT, IN ORDER TO TRY TO MAKE “LIBERTARIAN” “FREE MARKET” IDEALS A REALITY, IT WOULD REQUIRE STRICT MARKET CONTROLS AND ENFORCEMENTS.
        ONE WOULD HAVE TO REQUIRE THAT NO ONE BE ALLOWED TO PRIVATELY MANIPULATE MARKETS IN ORDER TO TRY TO ESTABLISH TRUE “FREE MARKETS”.

        FREEDOM FROM GOVERNMENT IMPOSED MARKET MANIPULATIONS WOULD ALSO NEED TO MEAN FREEDOM FROM INDIVIDUALLY IMPOSED MARKET MANIPULATIONS.

        YOU CAN’T HAVE IT BOTH WAYS.
        YET WITHOUT GOVERNMENT MANIPULATIONS, YOU GET INDIVIDUAL MANIPULATIONS.

        THUS “LIBERTARIANISM” IS WHOLLY CONTRADICTORY.

        JESUS, TRY READING THE PLETHORA OF HISTORICAL PHILOSOPHICAL TEXTS ON THE ISSUE.

        ADAM SMITH HIMSELF RECOGNIZED THE PROBLEMS.

        1. WHY CANT YOU FUCKING RETARDS GET THE WISDOM OF JELLO BEOYNCE’S ALLCAPS?1!11!1!1!1!1!!!!111!

        2. Oh shit. It really is the Hihnswarm spambot for goat sodomy and shitposting again. Hopefully the server it’s running on will crash again soon.

          1. “Oh shit. It really is the Hihnswarm spambot for goat sodomy and shitposting again”

            Bingo

          2. The North Koreans are attacking Reason just before the new NK nuke test.

        3. Cool story, bro.

          Shorter: “FREEDOM IS SLAVERY!!!”

        4. Well I don’t know, but Bouncy Jello here sounds like a fuckin’ progtard traitor. Best we lower our healthcare costs by harvesting all his organs.

      3. The free market is the market absent government interference. What are you blabbering about?

    2. jello.beyonce|11.19.18 @ 9:21AM|#
      “Not gonna argue that health care in America sucks ass, it is the 3RD leading killer of Americans, via preventable errors, after all…”

      You really are a stupid fuck aren’t you?
      Even if that is true (and I doubt it is), all it shows is US medical care is so good, it has solved all other problems, leaving the minor ones requiring attention.

      1. The CDC says that the third leading cause of death in America is Chronic Lower Respiratory Disease. I’m an engineer, not a medical type, but I’m pretty sure that “Chronic Lower Respiratory Disease” isn’t fancy science talk for “medical malpractice”.

        Medical malpractice doesn’t crack the top ten.

    3. “Not gonna argue that health care in America sucks ass, it is the 3RD leading killer of Americans, via preventable errors, after all…”

      And the danger of healthcare explains exactly why people want gobs of it for free…

      1. Some people are willing to walk a thousand miles for it.

        1. Oh, I would walk 500 miles and I would walk 500 more, just to be the man that walked a 1000 miles to avoid Honduran healthcare.

          Oh wait, that doesn’t scan or rhyme.

          Remy help me out here

    4. Because you’d be laughably provably wrong

      You suck as a propagandist as well

    5. But after the explosion of tax-favored group healthcare coverage from employers. Those plans protect beneficiaries from the cost of healthcare at the point of service and dilutes the impact of raising premiums in later years (employee contributions started very small or were non-existent in the early days of group health insurance).

    6. “With professional self-control the only control, the rate of increase in doctors’ fees doubled.”

      The professionals were given the power to control the consumer’s access to medical care, so naturally they shake them down for rent seeking profits.

      If we were free, they’d have to earn our business.

  7. We need to decide whether the healthy or the sick are the main priority. Because it can’t be both.

    1. The problem is the pronoun you used. Not because helping people isn’t good, but because our convoluted system is set up to protect people from the cost of care at the point of service. This distorts the market for healthcare for everyone.

      1. It is a we problem because:

        Govt currently covers a part of the population directly (over-65’s, its own employees, veterans) and those can’t simply be carved out from the rest of the population since they use the same supplier/provider market as everyone else.

        NO market-based system can EVER have a solution for those who are either too poor for a pricing system to actually function for them or too sick for prices to change behavior. You can avoid thinking about those two groups of wretched refuse – but ‘no solution’ does actually mean they are treated in specific ways (eg let them die on the street, let them be rationed by pro bono care, etc) by whatever system does arise. And so those folks – and those folks who think they might risk becoming those folks – WILL tend to seek a better system.

        The issue really is as simple as — for those two groups, who is the healthcare system primarily designed for and thus who on the other side will it disadvantage. Those who pay (the healthy) who expect someone to control that spending/utilization – or those who utilize providers who in turn will expect to be paid for that.

    2. The problem is the pronoun you used. Not because helping people isn’t good, but because our convoluted system is set up to protect people from the cost of care at the point of service. This distorts the market for healthcare for everyone.

    3. Just stop treating progtards. That will save billions.

    4. We need to decide whether we wish to be free.

  8. Cash for all minor medical stuff and catastrophic health insurance for major medical stuff.

    Its the only workable solution to this mess. Get government out of medical care and medical insurance.

    1. It is not that simple. High deductalbe plans sound great until you get something cronic. They they are pretty much worthless.

      1. That is why young people would need to start their catastrophic plans early and pay their entire lives.

        The plans would cover more because there would be more lifetime payments from people and more competition for those lifetime payments. My catastrophic plans covers most things and I know what is covered and what is not. I pay cash for all the minor stuff.

        Life insurance is a very similar setup. If you get life insurance plans early in life, they are cheaper and you can pay that rate your entire life or wait until later in life and pay a higher rate. Its all about what the customers wants to do and plans for.

      2. Due to the Cadillac tax fee in ACA, nearly all emoyer plans have been driven to hsa based catastrophic plans. But even there they can be affordable woth planning by funding your hsa before you need it.

      3. Is there a reason we couldn’t buy some kind of maintenance plan for chronic illnesses?

        1. There is not.

          You could add “riders” to your catastrophic insurance plan for cancer if cancer runs in your family. Or add something for some chronic condition you have at the time of application.

          Its why signing up for these long term catastrophic plans at early ages is so important. You lock in your rate while you are young and healthy. If you paid on time, the insurance companies would not be able to simply dump you if you got sick.

      4. It is not that simple. High deductalbe plans sound great until you get something cronic. They they are pretty much worthless.

        Your statement is not correct.

        HSAs with a High Deductible Plan are the godsend, if you start them early enough. For 8 years, I have been building a nest egg between contributions from my employer, and me depositing the maximum individual contribution. I have enough money in there that I could continue to meet the high deductible[1] for the foreseeable future.

        I have coworkers who spent the last 8 years in the company PPO, and we paid roughly the same amount every year. The difference is that they were paying a premium, while I was depositing the difference in my HSA. That, plus the yearly deposit from my employer has created a significant amount of money, despite paying for the odd hospital/doctor visit out of pocket.

        The big problem is that I cannot keep these plans if I leave my company. If I could, then if I had a chronic issue and could keep working, I’d be able to cover my bills through retirement. If I couldn’t keep working, my long term disability plan would pay enough that I could do the same with some belt tightening.
        [1] This is true even looking at the original HDPs that I was enrolled in. ACA has significantly reduced the deductibles on these today, and increased premiums somewhat, making the math even more favorable.

        1. You cannot transfer your cash in your HSA to another HSA if you leave the company?

          If you can’t I would pay cash for medical stuff and pull money out of the HSA to reimburse yourself. This way you are drawing down you HSA amount and putting that money into other investments/bank accounts.

        2. Let’s correct this:

          > HSAs with a High Deductible Plan are the godsend, if you LUCK OUT AND BE HEALTHY.

          1. So you’re saying the vast majority of Americans are going to max out their HSAs?

            You truly are a stupid person.

    2. True, but how to you put the genie back in the bottle? The federal gov’t going bankrupt is the best way to get a rational system, but that isn’t going to be fun.

  9. “Republicans have begun to respond, somewhat nonsensically, by defending traditional Medicare?a program that socializes the financing of health care?from what they have called the threat of socialism.”

    I remember wishing the Tea Party movement was more libertarian than it was. Even back then, they wanted spending cuts, but the reason they wanted to cut spending was to save Social Security and Medicare. It’s not hard to see that some of the people who got behind the Tea Party movement circa 2010 and got behind Trump circa 2016 were some of the same kinds of people.

    P.S. There’s nothing “nonsensical” about politicians chasing the opinions of their constituents, especially if their constituents are sick to death of what they’re calling “elitism”.

    1. “Keep your damn government hands off my Medicare!”

  10. It’s the pursuit of immortality the fountain of youth, that is bankrupting us. Take Medicare. We spend so much in the last year if a person’s life that the system is not sustainable. The average recipient takes out 3x what the average person puts into the system. We need a more rational end of life discussion. How much do we pay to extend the life for 1 year or less?

    1. I agree we need a rational end of life discussion. Or simply a discussion about aging. And more specifically we need a ton more doctors (geriatricians) who actually understand that and can be trained to talk with patients about it. There are 7500 geriatricians in the US – and going down. There are 44 million people over 65 – which will rise to 79 million by 2030. That’s one of those doctors for every 6000 potential patients now – with an inevitable rise to over 10,000 patients/doctor soon – so no surprise the discussion ain’t happening.

      It is not directly an argument about money and once it becomes about money, then it will become irrational.

      1. A medical and health insurance free market factors in end-of-life discussions.

        If you are 80 and cannot pay for a new hip after a fall, you are probably going to die or be bed ridden.

        As it is now, an 80 year old will likely get that new hip whether they are risk factored to die in a year anyway.

        Medicare, yea!

        1. No it doesn’t. Insurance is merely a discussion about how to finance medical care. The end-of-life or aging discussion is about the utilization of medical care itself.

          The biggest delusion among ‘free market’ advocates (esp those who are R’s) is that a pricing system on top of a ‘patient drives all utilization decisions with no one to even advise them what that actually means’ framework will actually control costs or utilization. That we can avoid talking about actual medical care delivery if we just come up with the perfect insurance system. It’s BS based on abject ignorance.

          1. If you cannot afford to pay for a new hip, then the decision is made for you. As I said, it factors into end-of-life discussions.

            Under free market medical, you know what things will cost you. You know how which location and how much a baby being will cost you. Like other free market products and services, you might turn down certain medical procedures or equipment because of cost or some other market factor.

            When big insurance companies pay to the extent that they do, most people dont work out ahead of time what the most economical hospital is with the best care for ____ situation.

            Ask someone you know where they would go right now if they had a heart attack and how much would typical heart attack care cost? They would not know. That is a major fucking problem.

            If my car has a problem, I know exactly where I would take it and I could call and get a quote in less than 5 minutes or I would know approximately how much it would cost.

            1. Its also as designed with socialized medicine types. Uncle Sammy will take care of you.

              The perfect insurance system is already known.

              Pay cash for minor medical stuff and have catastrophic insurance for major medical stuff. Relatively few American have major stuff happen every year, so there is a massive pool of money for those that do.

              1. That is not a ‘perfect’ system at all. It is a fucking delusion based on abject ignorance. ‘Insurance’ is not expensive because of ‘routine-type care’. So you are not going to reduce the amount of spending much by ‘eliminating’ that spending from the cost of insurance. It is expensive because of overutilization of ‘heroic’ care.

                Your ‘solution’ is nothing more than the EXISTING system of high-deductibles and out-of-pockets – with ‘insurance premiums’ that could choke a horse, eat up one’s entire paycheck at the lower income levels, and that 90% of people don’t need and thus don’t ‘value’ anywhere near what it costs. It is the equivalent of shouting USAUSAUSA whenever any one wants to talk about reforming our current medical system.

                1. If by ‘heroic care’ you mean care that paying customers would probably not choose or super expensive care for old people who could die at any moment… I would agree. That is not the only reason for high medical costs.

                  The solution is catastrophic insurance premiums that cost about $50 per month and cover catastrophic care. These plans dont pay for minor stuff like birth control pills.

                  Breaking a leg would cost under $1000 for a clinic visit.

                  People can cut their wasteful spending on expensive cell phone plans and save $1000 for medical emergencies.

                  What I advocate for was done before WWII drove some medical insurance to corporations as a benefit and before Medicare and medicaid shuddered the private medical insurance market.

                  1. The solution is catastrophic insurance premiums that cost about $50 per month and cover catastrophic care.

                    What fucking planet do you live on? The average cost for employer plans which pretty much by definition only cover the healthiest segments of peeps (18-65’s who are healthy enough to work full-time) is $6900 for employee-only and $19,600 for family coverage. They pretty much don’t cover ‘routine care’ because that is all paid for via the out-of-pocket requirements or the deductible.

                    So where are you gonna find the remaining $6000 per person or $19,000 per family?????? Is this some magical money tree?

                    What I advocate for was done before WWII drove some medical insurance to corporations

                    Yeesh. So before modern medicine even EXISTED, it didn’t cost much. That fits into the category of Well duh!! There are a ton of problems with the employer-based system – but pretending that we can just return to that as if nothing else has happened in the interim is just silly.

            2. Under free market medical, you know what things will cost you.

              Another fucking delusion. OK – you have heart pain. One cardiologist advertises cheap bypass surgery. Another advertises more expensive bypasses. A third doctor isn’t even a cardiologist but is a GP – so what if you don’t even need a bypass? Or maybe the guy who does expensive bypasses has more patients who survive? Or what if you know you don’t know shit about medicine (which excludes most engineers/etc because they all think they know everything about everything) so you need someone more knowledgeable to be the intermediary.

              This notion that what we need is price lists like some fucking Chinese cafeteria or auto mechanic is simply stupid beyond belief. Insurance companies – and most larger employers – have all this info. They – unlike you – actually know how to interpret it too. And every single time they actually make this info known to the ‘patient’, the patients entitlement mentality kicks in. Cuz ‘insurance is supposed to pay for whatever I say I need’.

              1. Life is rough. Its full of informed decisions THAT YOU MAKE. Medical is the same thing.

                All those excuses for why you dont like it, you work out before hand via contract or set pricing models with medical facilities. Same principles as working out a vacation with air travel, hotel, and food. You plan ahead and plan for unexpected expenses.

                Clearly, the current insurance companies and corporations that sell widgets have this whole medical care and medical insurance thing under control. CLEARLY.

                I’m rich for various reasons and one of those reasons is informed decisions where I spend my money. I dont pay for ObamaCare medical plans because they are a waste of money.

                I pay cash for my annual physical. I pay $50 per month for catastrophic health insurance.

                I pay far less than most uninformed consumers each year. I do that. Not government.

                1. “”I pay cash for my annual physical.”‘

                  Who pays for the labs done in that physical? That’s the expensive part of the physical.

                  The last physical I had, I was sent a lab bill for Six Grand. My insurance paid all but $500 bucks.

                  1. I pay cash for my labs and they are included. My bill for physicals never goes above $300. Some places charge you once for all services included. Some places send a bill for each service provider.

                    OBGYN might be more expensive than $300 total but I dont know how much.

                    $6000 for a physical !?! Jesus Christ, that sounds like something more than an annual physical.

                    BTW: You paid $500 PLUS all you medical premiums, totaling $____ .

                    See, people always forget how much medical things actually cost.

                    1. “”$6000 for a physical “‘

                      Just for the labs for the physical, plus one other lab.

                      “”BTW: You paid $500 PLUS all you medical premiums, totaling $____ .”‘

                      Disclaimer, I haven’t actually paid the $500. Not that I won’t. I just haven’t seen a bill to send it to. The Dr. visit had a $25 co-pay.

                      I’m paying about $500 a month in premiums (single person) for insurance from my job. Also I took the more generous plan since I’m over 50.

                      The problem was my ex-provider sent the labs to a company outside of my network. My insurance accepts claims from outside providers so they paid most of it. The $6,000 was the lab companies billed amount. What people with no insurance would be charge. When I contacted my insurance company, they worked it out so I would only pay the $500.

                    2. Also I’m in the NYC area. I’m sure that makes a bit of difference.

                    3. Also I’m in the NYC area. I’m sure that makes a bit of difference.

                    4. The only way a physical should be $6k is if Tori Black is the doctor, and Riley Reid is her nurse, who has to ‘assist’ with the physical.

              2. What is a “more expensive bypass”

                The main problem is we have uninformed idiots chiming in on things they don’t begin to understand.

                Nowhere was this more evident than Idiot Obama discussing Dr’s making a killing on tonsilectomys and diabetic foot amputations

                1. What is a “more expensive bypass”

                  Heart bypass surgery costs between $70,000 and $200,000 – with an average of $117,000.

                  You tell me how someone is going to make the decision by googling some price list from ‘cardiac surgeons’? Or from some subset of people who pay google to appear on the first page of the results?

      2. I have been harping on the need for actual death panels in medicine forever. When they came out with that as an argument against the ACA they couldn’t have been more wrong (though of course, there are a plethora of good arguments available, just not the death panels).

        The amount of health care dollars wasted, resources wasted, pain and suffering caused by keeping 90+ year olds hopelessly hovering around deaths door for days to weeks in an ICU is crazy. Usually because son/daughter didn’t feel comfortable letting go, or knew a miracle was coming for their loved one, or someone promised them too much in terms of beating their illness.

        The really sad part is how much suffering it causes the patients. You know what sucks more than dying slowly of whatever illness in an ICU? Having that happen while repeatedly having people pumping their chest, breaking all their ribs every other day to keep them alive when they repeatedly code.

        We have prolonged life expectancy to an impressive extent, but unfortunately now many people are alive much longer than their good years. Keeping a person with minimal quality of life alive because we can is not a good enough reason.

        1. We certainly need death panels. Voted for Obama twice? You die. Voted for Hillary? You die. Voted for progressive initiatives? You die.

          You get the idea.

      3. The ObamaRomneyHeritageCare law was supposed to have this service provided, but the nihilist Republicans made a hissy fit about it.

    2. The ultimate problem is socialism, and it presents all sorts of symptoms.

      For instance, in countries that don’t have Medicare and Social Security, taking care of one’s parents is a high responsibility like taking care of one’s children.

      When I was living in the Yucatan, one of the two questions the locals always wanted to ask me about the United States was whether it was true that one hardly ever sees any elderly people anywhere in the U.S. because Americans send their elderly parents off to live with strangers. In Mexico, taking care of your parents at home is probably more important than taking care of your children–because you owe your parents for taking care of you when you were a child.

      It used to be that way in the United States. One of the big differences is that with the advent of Medicare and Social Security, Americans came to imagine that taking care of one’s elderly parents was the responsibility of the government rather than their children. They don’t have Social Security and Medicare in the U.S., so the elderly live with their children.

      Socialism fucks up more than markets. Socializing responsibility also fucks up our morals. That being said, how much money would we save if people in the middle class took care of their own elderly parents?

      1. An analogy would go like this:

        In the U.S., we treat our dogs like they’re part of the family. Psychologically, they are part of the family.

        In Korea, they eat dogs. From an American cultural perspective, it’s like they’re eating a family member.

        Americans who know nothing else about Korean culture know that they eat dogs because it runs so contrary to our own culture.

        From the perspective of cultures that haven’t been corrupted by socialism, sending your elderly parents off to live with strangers is like dropping your children off at an orphanage.

        1. When the U.S. dollar is no longer considered king and we bankrupt ourselves (and it will happen, it’s just a matter of “when”, not “if”), America will inevitably also go back to the old school way of taking care of our own families that you describe.

          It’s the way that human civilization worked for most of its existence, and it’s the way it will eventually work here as well. The idea that everything can be free and that everyone can live at the expense of everyone else is a fallacy destined to collapse in upon itself.

      2. No ‘socialism’ is not the ultimate problem here. Virtually every country outside the basketcase economies – including Mexico – has a retiree pension/healthcare system that is guided mostly by govt.

        The phenomenon you describe is almost unique to the US – and not as pervasive even in the US as you seem to think.

        1. Georgia is building elderly care homes like crazy.

          Boomers are predicted to be put in home and left to die alone, evidently.

          1. There’s a kind of rough justice there. Since Boomers and subsequent generations (Boomers are grand- and great grandparents now) pretty much contracted out the raising of their children it is not surprising that their children are going to contract their care out as well. 🙂

            Joking aside, it takes true dedication to care for a parent with serious aging issues.

            My mother is 95 years old with dementia but is in amazingly good physical health. Other than having to use a walker and having a pacemaker she looks like she could live forever. The oldest of her three children is 75, the youngest (me) is 71; IOW getting close to the age where most people start to need care. Taking care of our mother full time is the last thing any of us is prepared or even able to take on.

            1. My grandmother was like that, too. She never got dementia, but she didn’t stop driving herself until she was 94. She’d rather I drove, but she’d drive herself when there was no one else available. I used to have to ask her to slow down in the mall so I didn’t have to practically run to keep up with her.

              My grandfather was a minister, and when he retired, he started a visitation program for people in nursing homes especially. He wanted me to be a minister, too, so he would take me with him.

              They both refused treatment for fear they would end up in a nursing home. Having seen what they saw through that visitation program, I don’t blame them. We imagine that no one wants to die, even at that age, but aren’t hospices full of elderly people who’ve made the decision not to seek further care?

              1. The effects of dementia (whether it’s Alzheimer’s or not) have to be seen to be believed.

                When I say my mother is physically healthy I mean that she is not suffering from any life threatening diseases and has no terminal conditions. Absent the dementia, she would be a much more vital person, though nothing like how you describe your grandmother.

            2. The pros estimate $80+ per day for elder care. That’s $2400+ per thirty days.

              Georgia also has a bunch of homes with in-law suits so people can take care of their elderly family at home but give them some independence.

              To add to your point, many parents will never ask for help. Certainly not before they fall a few times.

              Its one of those subjects nobody wants to talk about but if you fail to plan for it, the experience is extra rough.

              1. My mother’s ALF (in Florida) is almost double that cost. She does get some add-ons, though. Like having medtechs bring her medications, a couple of times a day. It is also a private studio apartment.

                Around here 2400 would pay the basic rate (semi private room, meals, housekeeping once a week and minimal nursing care) for a third tier ALF.

                1. I bet! $80 is the low estimate and price just keeps going up and up.

        2. This table from 2013 is showing $28 billion being spent–only from Medicare on SNFs.

          http://www.cms.gov/Research-St….._SNF_1.pdf

          That doesn’t include what they’re getting through Medicaid and Social Security. Are you not already familiar with the term “moral hazard”?

          How much do Social Security, Medicare, and Medicaid contribute to nursing homes in the U.S. vs. whatever system you’re talking about in Mexico?

          Are the benefits rich enough that pretty much anybody can get a permanent stay bed in a nursing home with so long as they qualify for Medicare and Social Security?

          P.S. In Mexico, the government clinics were free. That is a superior model.

          1. Medicare only pays for skilled nursing facility care for short term stays for rehabilitation after hospitalization (100 days max) and only under certain conditions and on a doctor’s order.

            Medicare does not pay for any long term residential care. Those who cannot afford to pay out of pocket need to rely on Medicaid and/or various state programs for the elderly. None of them pay for top tier or even mid tier assisted living or other care.

            In the US, no one “can get a permanent stay bed in a nursing home” simply because “they qualify for Medicare and Social Security”. Medicare won’t pay a dime and their total Social Security benefit won’t cover even half of the basic cost of Assisted Living. Skilled Nursing and Memory Care are even more expensive.

            1. Isaac,

              I worked reimbursement in a hospital for years and helped write the software for the largest hospitals and hospital chains in the country.

              We brought elderly patients on a Medi/Medi basis in from the nursing home all the time. These were poor neighborhoods. The patients had nothing else but social security. Even if the place wasn’t billing social security directly, these people were living on Medicare, Medicaid, social security and other programs. They weren’t being supported by their kids, and they were way too old to work for a living. They had no savings. They were on government programs.

              We discharged such people to long-term care facilities. Do we really need to get into the minutia of such funding? Isn’t it enough for lay people to understand that we’re talking about things like Medicare, Medicaid, and Social Security? Are you trying to say that these things have nothing to do with the way elderly people are treated by their children in this country? That there’s no moral hazard associated with dumping your parents off on the government?

              Are you saying that this isn’t a major reason why health care costs have exploded since 1965–because Medicare only pays for the first few weeks of your stay and then it’s taken over by another government program?

              What’s the word I’m looking for–is it “pedantic”? Maybe we should stop counting individual trees and look at the forest.

          2. Obviously Mexico has a less comprehensive public system than we do. They are FAR FAR poorer. Use an example of a rich country – eg Germany. There – 70% of the elderly who need extra care live in private homes – 80% of them with their kids (mostly daughters or daughters-in-law doing the care), 20% rely on in-home nursing. Which leaves 30% in some sort of ‘professional’ facility – and much of that is late-term stuff where dementia makes private care near impossible.

            They actually have more comprehensive ‘long-term care insurance’ than we do – but unlike here it is designed to help out families who want to care for their parents. Vs here where EVERY FUCKING THING about our medical system is some cronyist BS designed to enrich those who have professional lobbyist pigs who want their trough filled. And the last thing any of those folks want is a system that controls spending. It is NOT ‘socialism’ that is the problem here. It is corruption and cronyism.

            1. Socialism is the part that takes from workers higher taxes to pay for family members to help their elderly family members.

              Why can’t families pay for that themselves? This would lower the tax burden on workers to SAVE FOR FUTURE MEDICAL PROBLEMS that they have to pay for.

              1. The government being the middle TOP MEN in medical care and medical insurance costs millions, billions, trillions.

              2. Your complete blindness about what medical care actually costs in this country is why the Medicare-for-all folks are going to win. Shame too – but YOU ARE TO BLAME FOR THAT.

                We already have the most expensive medical system on the planet. 2nd ain’t even remotely close. And our system delivers very mediocre (optimistic case) outcomes.

                We spend roughly the same in our public system (as % of GDP) as most countries – except that they manage to cover close to 100% of the population with that level of spending and we can only manage to cover the elderly and poor. In every other country, private spending is viewed/used as a supplement to the necessary constraints of the public system

                Because of the way we finance that public spending piece, our near-poor would actually be far better off in most Third World countries than here – and they have the life expectancy of that too.

                1. I pay cash for my medical care, so I have a better handle on health care costs actually are than many Americans.

                  IIRC, Stossel did a video on an a la carte medical facility that charged set prices in cash for radiology and lab services.

                  Those prices were far lower than what even Medicare and medicaid pays medical facilities.

                  Socialized medicine sucks. If you have never lived in an area like Europe that has socialized medicine, try it. That experience will blow your faulty positions away.

                  1. If you have never lived in an area like Europe that has socialized medicine, try it. That experience will blow your faulty positions away.

                    I lived overseas MOST OF MY LIFE. Both as a kid of expats – and then working off and on. I was born in Venezuela. Had my tonsils removed and a lot of childhood stuff in Iran. Had wisdom teeth extracted and ER for a knife wound by the NHS. I’ve seen bad doctors and good doctors – and many who don’t speaka da Engrish well very much is clear? Your scare stories are just more ignorant CRAP.

                    And the reality is that if I needed a medical procedure NOW where I had the ability to travel to it and I was on the hook for the bill, I would probably head to Thailand or Singapore or Spain. Because their private systems – a supplemental to their public tax-paid system for those who want to avoid lines/rationing – are identical to ours but far cheaper – and far better post-op/recuperation. The only thing that’s truly ‘best’ about the US system is Mayo and a couple of the other specialized/research hospitals – and that is seriously specialized/tertiary care for when no one else can even diagnose the problem. Those won’t disappear or be harmed in any ‘reform’ of our system.

                    1. Jfree, cant give blood can you?

                      Got hepatitis perhaps?

                      Other lasting effects of receiving medical care outside the USA?

                    2. Other lasting effects of receiving medical care outside the USA?

                      None at all. My childhood was right when all the different childhood vaccines were created – so in some cases I got a ton of vaccines/boosters, in other cases I got the childhood disease (mumps, etc). But that was a function of where we lived not those other medical systems.

                      Americans are really very deluded about medicine. Outside Africa, medical practices/standards are prob 95% identical around the world. Doctors who are actually govt-paid are generally no more bureaucratic than the bloated paperwork US. The US is drowning in capital equipment (MRI’s, etc) but I never had to wait-in-line elsewhere for more than 1-2 people – at a cost that is a negligible fraction of what the same stuff costs here. My wife had a few more problems than I but even that was more a function of male attitudes towards women in those places not anything purely medical.

                      I really am not a fan of socialized medicine – here in the US. But that is because the US govt is corrupt/cronyist and Americans, uniquely, either really prefer that or just don’t care.

                2. And by cover close to 100% of the population you of course mean they all have govt issued insurance cards, not that they get timely or quality care comparable to the US, especially when dealing with long term, deadly illnesses.

                  1. not that they get timely or quality care comparable to the US, especially when dealing with long term, deadly illnesses.

                    No. I mean they ACTUALLY cover people so that people don’t have to decide between food/rent this month v going to the doctor – at a cost that is little more than half of what it is here. And in virtually all cases, with a private supplemental system that can deal with whatever rationing constraints (always on the specialist side – not the GP side as we have here) the public system has. And yeah – the public system HAS to have that sort of rationing constraint. Otherwise you have the corrupt clusterfuck of the US system with high prices AND mediocre care AND GP’s that don’t even exist for much of the population.

                    1. Jfree, sorry you dont understand that free market has past and current methods to make average health care for people affordable.

                      I pay less than $2000 per year for all my medical needs and catastrophic health insurance coverage.

                      People like you pay more because you do what you do. Good luck with that.

                    2. No you don’t pay $2000/year for catastrophic coverage. You pay $2000 for a POLICY that says they will cover catastrophic – but you haven’t used it yet and been denied claim payment and then been denied coverage at year-end for the following year.

                      You are presumably healthy and don’t use medical system much. I’m same and have been for my adult life. So are most adults. 50% of Americans incur an average of $275/year in actual medical expenses. 40% incur less spending than any insurance premiums they will pay. Half of the remaining 10% incur expenses that kind of balance out over time.

                      It’s the remaining 5% – average $51,000 in spending each year with $15,000 out-of-pocket. Who quickly become too sick to work. So lose insurance coverage AND income the next year. So will face either bankruptcy when their assets drain out and/or end up in the wretched refuse category where govt ends up picking up the bill (while also doing NOTHING to actually control that spending/utilization in future). THAT is catastrophic and your policy doesn’t deal with the real consequences of that at all. And it can’t because the US is entirely based on an annual enrollment that resets everything every year and govt programs that fail to even be financially responsible.

                      You’re patting yourself on the back for buying something bogus – where any catastrophic bill WILL end up being paid by govt (ie someone else) – while breaking your arm patting yourself on the back yapping about how the free market works.

      3. “”For instance, in countries that don’t have Medicare and Social Security, taking care of one’s parents is a high responsibility like taking care of one’s children.”‘

        I have a friend that has family back in Germany. He told me a story where a cousin of his received a notice to pay father support. The father was out of work, so the government expects the kids to pick up some of the tab. The interesting thing about the story was his dad was a dead beat dad that he never saw. But the gov expected him to pay anyway. It worked out because the dad got another job before the father support was to kick in.

        1. Ah Socialism.

          At least the guy knows what will come someday. The bill to support his deadbeat father.

      4. I work for a medical equipment company. We have a lot of dual-eligible(Medicare & Medicaid) patients who get incontinence supplies, which are covered by Medicaid. Some of these people live as you might expect, in tiny apartments or mobile homes. Increasingly, we are seeing patients who live in their children’s half-million dollar homes. And those children are the biggest complainers, if the state won’t cover as many diapers as they think Mom should have, or if the diapers aren’t as absorbent as the brand name ones that they used to buy her before they found out that the state would pay for them. It’s disheartening.

    3. Seems to me the last guy who said he wanted to start “a more rational end of life discussion” got accused of trying to set up “death panels.”

      1. “Medical Necessity” is already a thing.

        “Medicare pays for medical items and services that are “reasonable and necessary” for a variety of purposes. By statute, Medicare may only pay for items and services that are “reasonable and necessary”for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member”, unless there is another statutory authorization for payment.[1]

        Medicare has a number of policies, including National coverage determinations (NCDs) and Local Coverage Determinations (LCDs), formerly known as Local Medical Review Policies (LMRP), that describe coverage criteria.[2]

        http://en.wikipedia.org/wiki/Medical_necessity

        Government bureaucrats making decisions about whether people on Medicare and Medicaid can get a hip replacement or a wheelchair is already a real thing and has been for a long time.

        As rationing increases and more people are brought under Medicaid’s sway, those kinds of bureaucratic decisions will impact more and more people.

        These issues are real regardless of whether some politician fucked up the explanation in the past. The mechanism by which these things happen has already been in existence for a very long time.

        1. Incidentally, the reason Medicare and Medicaid wouldn’t pay for mammograms back when the HMOs were giving them away for free (it’s cheaper to treat cancer when you catch it sooner), is because until someone showed symptoms of cancer, it wasn’t considered medically “necessary” to screen for it.

          The survival rates of HMO patients were so much higher than they were for Medicaid and Medicare patients, that it embarrassed the bureaucrats at CMS, et. al. to start paying for them–because of the bad publicity and the politics.

          1. Medicare does not pay for preventive services.

            I like to remind the Medicare for all people that.

            1. Medicare won’t cover a bath chair, but will pay to fix your hip when you fall in the shower.

  11. “In the end, [the GOP’s repeal push] failed by a slim margin, with holdout lawmakers worried that no suitable replacement had been drawn up.”

    It is a fact that John McCain and a few other senators voted against the last attempts at repeal because it didn’t offer a replacement for the ObamaCare Medicaid expansion.

    It’s also a fact that some misguided libertarianish Republicans voted against cutting $772 billion from Medicaid in the ObamaCare reform bill because they fell for the perfect solution fallacy–hook, line, and sinker.

    http://en.wikipedia.org/wiki/N…..on_fallacy

    Incidentally, if the appeal to authority is the fallacy to which libertarians are least susceptible, surely, the perfect solution fallacy is the one we’re most susceptible. But that doesn’t make falling for it any less stupid.

    1. Those people were elected from 2010 to 2016 for the express purpose of repealing Obamacare in it’s entirety. There shouldn’t have had to be a replacement or any bill that didn’t do exactly what they promised for 6 freaking years.

      1. Yeah, but the world isn’t the way it should be, and Mukowski, Susan Collins, and Trump arch-enemy John McCain were deciding votes against it.

        We do the best with the world we have.

        Regardless, the alternative to reform was not repeal–even if it should have been.

        The alternative to reform was ObamaCare.

  12. It is not “health” care. It is medical care that we do when our health fails, in part because our government is giving such bad health advice, and forcing their advice on an entire generation of children. To put it more plainly, low fat diets are causing metabolic syndrome, and metabolic syndrome is eating our nation.

    Doctors do two things that materially alter our physical well-being — they perform operations (cut open our flesh), and they give us medicine. The majority of people opt for medicine if they can. That’s what doctors mostly do — give us pills. The pills they give us stress our livers and kidneys, deplete our vitamins, block critical metabolic pathways. Our body is like a thermostat — it struggles to maintain the balance that is natural for it, and when we give it medications, it fights to put things back the way it likes it. None of that is “healthy”. Meanwhile, almost all of these medications are studied alone, yet doctors give them in combination. Giving medications in combination is not based in science. They don’t actually know what will happen, as the world learned to their horror when the Phen/Phen combination caused permanent damage. What we do know is that polypharmacy contributes to senility.

    Pills are not “health”. We take way too many pills.

    1. Your point about “healthcare” is well taken. The term even doesn’t appear in Webster’s Dictionary from the 1970s. It is a governmental euphemism, like “provider”, with the goal being to have diminished the power of physicians over delivery of medical care. Unfortunately for patients and the public, the politicians and bureaucrats have been successful.

    2. “Our body is like a thermostat — it struggles to maintain the balance that is natural for it, and when we give it medications, it fights to put things back the way it likes it.”

      This is pseudoscience garbage, along with everything else you wrote.

      medications are intended to alter specific chemical pathways within our bodies to accomplish a goal. disrupt pain sensors, block uptake of another chemical, etc etc.
      It is true that the broader impacts of many medications are poorly understood, but the vast majority are quite good at what they do and have hugely improved quality of living for the developed world.
      Doctors are fallible humans. Most make the best recommendations they can based on the limited knowledge we have, and yes there have been notable mistakes. But you’ll only take my ibuprofen from my cold dead fingers.

  13. Science, Anyone?

    G. Benefits for All
    Consider the benefits of a scientifically-based, scientifically-driven, detailed plan for delivery of universal, competitive medical care by the private sector characterized by the following attributes:
    1) Simple;
    2) Straightforward;
    3) Free of special taxes;
    4) Minimal regulations;
    5) Minimal bureaucracy;
    6) Free of fraud at taxpayers’ expense; and
    7) Acceptable to insurance companies.
    Achieving those attributes demands properly managed contingencies. Put into play, a well-designed, comprehensive plan for delivery of medical care can manage those contingent consequences properly ? consequences governing the behavior of the four participating parties; namely, government, intermediary, physician or hospital, and patient. It can do so while benefitting each of the parties concerned via positive control.

    ARTICLE XXXI.
    Section 1.
    In the matter of delivery of medical care, these United States of America shall issue annually a non-transferable voucher in the name of each citizen adult and minor. Each voucher shall be of equal relative-value geographically. Said vouchers shall not be issued to anyone who is not a citizen. All monies funding said voucher shall be drawn from the general revenue only. Funds marked for delivery of medical care may be diverted to other purposes in the case of national emergency declared by the Congress.

  14. If there is no appetite for fixing the problem in any news outlet then there won’t be change. Why would politicians risk their gravy train when every indication they’re given is they will be crucified by all involved if they stop or even slow the benefits train.

    People like Sudderman are part of the problem. If the current system is failing and too costly then they posit any change must be to a new system that covers everyone for everything but just isn’t failing and somehow isn’t too costly. How those contradictory goals are to be achieved aren’t his problem.

    1. People like Suderman are the propagandists who tell everyone that politicians will be crucified during elections if they do ____ without factual supporting evidence.

      Politicians tend to use incrementalism with adding or scaling back laws because they can bob and weave to avoid political ramifications.

      Sometimes that does not work. It is pretty clear that a bunch of Republicans were voted in to repeal ObamaCare. Republicans have failed to do that. Many RINOs who did not vote to repeal ObamaCare got voted out or quit.

      The statists and Lefty propagandists dont want ObamaCare repealed so they say and do whatever will further that goal.

  15. Socialism always runs out of other people’s money.

    The past 50 years have seen many expensive advances in medical procedures, like transplants, and diagnostic and treatment equipment, on top of a huge increase in patient load. Counting their American born children, almost a 100 million new immigrants, with 10 to 20 million illegal, and hospitals required to care for them whether they can pay or not. Not only have medical costs increased, but the treatments and drugs have extended the average life span to 76 for men and 81 for women. This age gap is a disaster for Social Security, Medicare, and pensions.

    Problems with no easy solutions.

  16. So, how much is a human life supposed to be worth, anyway?

  17. The day Democrats rammed through Medicare without a single Republican vote, was a day that will live in infamy. From that day on the price of health care skyrocketed.

    1. Nice try. The bill was passed with a 70 Republican votes in the House.

  18. Can you really spend too much on people’s health and well-being?

    1. Yes.

      You can even spend too much on women, pizza, and motorcycles.

    2. A good portion of the $21 trillion national debt was spent on people’s health and well-being, so there’s that.

  19. It doesn’t matter who pays for it if the supply is controlled by the government. We need to lower the standards for doctors. Seriously.

    Now, before you say we’ll have worse outcomes, consider that we really have a doctor shortage, so the simple cases (say, a hairline fracture in the ulna) are treated by the same doctors who handle the complex cases (compound fracture with multiple breaks). If we had more doctors (not just NPs or PAs), we could tier the system up where the simple cases could be handled by the less qualified doctors, but we can only do that if we have far more doctors.

    Make it where you can get a MD directly in 5 years right after high school.

    1. If we’re going to have licensing boards and examinations, anyone should be able to take the test. What would be the fundamental difference between a 20 year old that passes the test with no formal education and a 28 year old that went to John Hopkins and failed the test 3 times before passing?

    2. I got poison ivy one time, badly. I have had it before and needed the medication. Government says I can’t just buy the Meds, I need a prescription. Government says only a doc can write a scrip. Government says a doctor has 8 years of schooling, about 4 yrs of residency, and has passed a board certification. This is why healthcare costs so much. Because I can’t a) go to the pharmacy and buy without a scrip or b) get a scrip from a nurse who takes 1 second to look at me and say “Crawling around in the woods again Mr. Hero?”

      1. Worse. I need a prescription for CPAP supplies. I.e.: corrugated hose and some silicone bits. It’s not even an actual fucking *medication*, but I have to go through the doctor visit gateway.

      2. I agree that a lot more Rx should be over-the-counter.

  20. Following is one of the best assessments of the wholly amateurish “journalism” of Reason:

    “I have come across men of letters who have written history without taking part in public affairs, and politicians who have concerned themselves with producing events without thinking about them. I have observed that the first are always inclined to find general causes whereas the second, living in the midst of disconnected daily facts, are prone to imagine that everything is attributable to particular incidents, and that the wires they pull are the same as those that move the world. It is to be presumed that both are equally deceived.”
    -Alexis de Tocqueville-

    The point?
    The American medical industry was screwed up long before Medicare.
    Medicare was an attempt to fix a completely broken PRIVATE system.

    That said, Medicare has been a near total disaster itself.

    “Free Marketers” are those whom “are always inclined to find general causes…”,
    Whereas Bureaucrats and Politicians creating failed policies in response are those whom live “in the midst of disconnected daily facts”.

    1. Both are total failures.

      I have engaged in successful Project Management for a long time, and a systematic failure does not require a total abandonment and reconstruction of totally new systems.
      Often, evaluation of the mere failed parts of those systems, and a revision to those specific failures is a much more logical and effective approach.

      You don’t completely abandon and re-conceive of the entire wheel just because a few flat spots exist, preventing it from rolling smoothly.

      The folks at Reason.com REALLY need to learn to better hone their reasoning skills.
      Start by reading Plato, Aristotle, then Hobbes, Locke, Hume, Descartes, Kant, Nietzsche, Heidegger, and others.

      1. You’re a fucking robot. You haven’t ever done anything you weren’t programmed for, and that’s just shitposting and goat sodomy.

      2. You’re a fucking robot. You haven’t ever done anything you weren’t programmed for, and that’s just shitposting and goat sodomy.

      3. None of those philosophers help with the patient non responsive.

  21. I’m interested if correlation = causation… not sure if there are good ways to compare increased costs to other nations? The time period also coincided with the rise of TV, processed food, an increase in jobs that required less physical activity, etc.

  22. “In 1960, six years before the start of Medicare and Medicaid, America spent about $27 billion on health care. That figure represented just under 5 percent of an economy that was about $543 billion in total. By 2016, combined public and private spending on health care had reached more than $3.3 trillion, or nearly 18 percent of the total economy, with almost half the bill paid by government.”

    This is what a socialist would call “progress.”

  23. Our wonderful government and the amount of costs that they have cause me to bear over the years is going to force me out of retirement into what will likely be a shit manual labor job.

    thanks government.

  24. Bring back competition:
    High deductibles so folks shop around – also forces providers into transparent pricing
    Tax-free HSAs to encourage saving for health care
    Remove corporate tax break for providing health care – encourage individual policies with commensurate pay raises
    If you can’t afford, then use gov-provided clinics that may have long lines & limitations (non-libertarian concession). These would be no worse than if we moved to a single-payer system anyway.

  25. What a socialist would call progress. Nope I am not giving socialism credit.

    Since 1960 short list.

    Diagnostics – CT did not exist which is now at the point where 3D imaging is expected. MRI, diagnostic ultrasound, Position Emission Tomography, did not exist.

    Surgery – where to start. Endoscopic surgery and diagnostic procedures did not exist. Angioplasty and stents did not exist.

    Orthopedics- joint replacement was at best in infancy and failed. Now look at what has happened.

    Oncology- drop radiation therapy and new medical oncologic treatment and go back.

    Internal medicine and drug therapy – do not even start there. We have far better to treat and prevent disease than could be imagined then.

    If you want to walk back and spend what we did then you are going to get medicine as it was in 1960.

  26. Of course no one is going to advocate actually reducing the power of the US health care monopoly by repealing FDR’s 1938 prescription laws that gave doctors a legal government enforced monopoly over access to medical drugs. That’s something the AMA wouldn’t like!

  27. Of course it has consumed the political debate! Health care & education are the few economic sectors which Joe 6-Pack needs, but which himself cannot be part of the labor force (aside from simple care that anyone could do). He cannot flood the labor force for those sectors to drive wages down, and his own driven-down wages are not enough to pay for it himself – with the inevitable result that in a one-man-one-vote democracy, he will vote himself benefits from these sectors, paid for from the common weal. And while the explosion of technology & interconnectedness is starting to hack away at the education sector, aside from some AI systems taking the place of a few radiologists, there is no such efficiency paradigm to keep a lid on health care costs.

    And of course, there is the ironic situation that the somewhat de facto paradigm of employer-provided coverage has only continued to flourish (aside from the tax deductions that assist it, and the fact that employers can choose who to let in its risk pool, like only young employees, etc.) because employers institute a de facto mandate that all its employees “buy” coverage in the form of (mostly) giving away the health coverage for free and not allowing any employee to choose to get that portion of the compensation given to them in cash. IOW, it works because it is SINGLE PAYER! Every other non-poor country has figured out that this is the most efficient, but ‘MERICANS are individualists, dag-gamit.

  28. Health Care didn’t eat America.
    The medical mafia’s government enabled rent seeking did.

    Reason bemoans government healthcare programs, but when will they come out against the corporate medical mafia?
    When will they come out in favor of health care freedom?

  29. I guess the author thinks GDP needs to be 10% or more smaller, and lots of progression college graduates need to be unemployed, or paid half as much.

  30. It is the most socialized sector of the American economy . Ergo it is the most dysfunctional

  31. I’m old enough to remember the debate about Medicare, and “liberals” swearing on Eleanor Roosevelt’s grave that contrary to what pro-freedom zanies like Barry Goldwater were telling us, they only wanted to increase the power of the State just a teensy-weensy bit, to help poor old sick Americans. Once we allowed Medicare. they would leave us alone. Socialized Medicine? A Bircher hobgoblin! And yet in the decades since, all they’ve done is work to expand Big Brother’s role in healthcare.

    The debate pretty such set the pattern for future expansion of State power: “Liberals” propose statist measure A, and when opposed, say that only mean-spirited paranoids would oppose A, or claim that A will lead to B. Then they get A (usually with the collaboration of the Me-Too Republicans), but before long they’re claiming A is inadequate, and we must have B! Then they get B, and–you guessed it–soon they want C! And the State rolls on. . . .

  32. Peter should look for data on how the Harrison Act of 1914 created a medical cartel. China stopped the dumping of narcotics there in 1912. The ensuing glut prompted dumping of opiates in These States so the Harrison act was a tax to at least buy leather upholstery for Congress out of the deal. Doctors who refused to play ball were indicted and their practices threatened. Organized crime found in this a windfall, and European refiners were soon in a shooting war with Balkan poppy growers out of which blossomed World War I and plenty of demand for morphine.

  33. Can someone please explain to me how this works:

    “According to the report, Medicare accounted for just 16 percent of EVZIO units sold in the first quarter of 2017, but 56 percent of the revenue. Likewise, Medicaid was 8 percent of the units moved, but 19 percent of the revenue.

    Commercial payers, meanwhile, represented 66 percent of the units sold, but just 25 percent of the revenue.”

    https://tinyurl.com/y7dr7rdt

    Are Medicare and Medicaid really paying 8 times more per unit for drugs than private commercial payers?
    If so, it seems that the first step towards fixing US healthcare must be addressing costs. Medicare for all will fail quickly and catastrophically at current price points.

    JFree wrote:

    “We spend roughly the same in our public system the same % of GDP as most countries – except that they manage to cover close to 100% of the population with that level of spending and we can only manage to cover the elderly and poor…”

    Is this true – the US is already publicly spending the same % of GDP on healthcare as other developed nations? While only covering a fraction of the population and delivering poor outcomes? If so, all the political effort needs to address cost – not coverage.

  34. In the 60s or 70s you did not have MRI machines, CT scans, genetic analysis, drugs that cost $10,000 per shot. You had a stroke or cancer, you died. It was a better market in that prices were not all over the place like they are today. Now, if you are having chemotherapy and get the Neulasta shot the day after (the one marketed all over TV these days) and don’t have insurance its about $10,000. So for each treatment, you will receive a $10K bill and typically you will receive 4-6 of these in a standard course of treatment. If you have insurance the company will get them down to $2,000 per dose. Amazingly this is an older drug leaving patent protection! So this is not a functioning market, its a monopoly or at best an oligarchy.

    The fact that American employers are the providers of healthcare is another important drag on the economy. The ability of someone to branch out and start a business are much lower when you have a family and need to maintain medical coverage. Working in a multi-national company I am told all the time that they are moving most development work out of the USA because we are a high-cost region. High-cost region, high-cost region … Poland is much cheaper, even France has a few advantages over the USA. Over there the government taxes and provides health insurance. Over here it’s on the bottom line and it discourages companies from hiring full-time workers. Instead, they want everyone to be a part-time worker, but always on call.

  35. One more thing

    People that have health insurance sit back in the security they will be taken care of if something happens. Why worry about someone else? Until something happens of course and they are out of work. Short-term disability ends (6-mo). Then you are out of a job and lose health care coverage. Sure you can buy something, but you are bleeding money at this point trying to live and maintain your family. This happened to an impressive guy in our company who was one of the top triathletes in the USA in the 40-45 bracket when he keeled over at his desk with – a glioblastoma like John McCain. He is gone for two years but they have a charity run every year and a go fund me page for the family that is destitute. Unless you are in Donald Trumps tax bracket your family is a heartbeat away from ruin.

    1. This happened to an impressive guy in our company who was one of the top triathletes in the USA in the 40-45 bracket when he keeled over at his desk with – a glioblastoma like John McCain.

      Uh, if he died at his desk, all the healthcare treatment in the world isn’t going to bring him back to life.

  36. I would love to hear how we can have a private system that works. Unfortunately at the present time, and I acknowledge that Obamacare destroyed what was a system hanging on by a thread, I think that a workable private system is no longer feasible. I am considered an arch conservative by my friends, but I have come to conclude that we are going to have to have a national health system, despite the drawbacks, and there are many. It crystallized for me when I inadvertently caught one of these idiotic political ads during election season. One of the GOP candidates was attemtping to besmirch a Dem by saying they supported universal health care which would cost every family in the state over $8000. And I am thinking well lets see, next year just my insurance premiums will be almost $30,000 and that is before we actually use any health care. If next year is like this year that means I will spend near $35,000 on insurance copayments and coninsurance. God if I could be taxed $8000 instead of that I would gladly take the trade. The thing is that in 2010 we needed health care reform. As a wealthy nation we cannot watch uninsured people die nor people who suffer “pre-existing conditions” which is farcical in the insurance worl struggle to be able to pay. The only way it works is if you have the largest possible risk pool. And that pool is the entire country.

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