Eric Boehm: Why Is American Health Care So Dysfunctional?

The host of Why We Can't Have Nice Things returns to discuss the podcast's second season, which focuses on how government makes Americans poorer and sicker.

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Eric Boehm: Why Is American Health Care So Dysfunctional?

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Today's guest is Reason's Eric Boehm, a reporter and the host of the podcast Why We Can't Have Nice Things. The first season of the podcast exposed how little-understood trade policies and regulations screwed with the pricing and availability of everything from baby formula to women's underwear to frozen chicken.

The new season focuses on laws and policies that screw up the supply and costs of health care. It debuts on Thursday, September 5, with the first episode featuring billionaire Mark Cuban talking about his company Cost Plus Drugs, which sells prescription drugs directly to consumers at super-low prices. Coming episodes cover how "certificate of need" laws increase the price and reduce the availability of hospital beds, why bans on organ donor compensation cause the death of thousands every year, how restrictions on telemedicine hurt patients with no gain in safety, and how the Food and Drug Administration and Drug Enforcement Administration make legal pharmaceuticals like Adderall tougher and tougher to get.

Today's sponsors:

• The Dispatch: Is former President Donald Trump really going to jail? Does President Joe Biden really have what it takes for a second term? Do these questions even matter in the 2024 election? Get past the bluster and get back to the facts by joining The Dispatch.
• The Reason Speakeasy: The Reason Speakeasy is a monthly, unscripted conversation in New York City with outspoken defenders of free thinking and heterodoxy that doubles as a live taping of The Reason Interview With Nick Gillespie. The next event is scheduled for Wednesday, September 11, and features Fox News' Kat Timpf, whose new book is I Used To Like You Until…(How Binary Thinking Divides Us). Tickets are $15 and include beer, wine, soft drinks, and food. Go here for details.

• Audio Production: Ian Keyser

Comments

[Rick James]

Because the Republicans didn't have anything with which to replace ObamaCare.

[JesseAz (5-30 Banana Republic Day)]

I hate this argument so much. Being against ACA but requiring ending it to be replaced with the exact same plan. It is like UBI, social welfare, or any other program. Everyone knows it's failing but everyone demands it is replaced with a mirror of the program.

[MasterThief]

Suderman on line 2

[Stupid Government Tricks]

I think he was being sarcastic.

No matter how disastrously some policy has turned out, anyone who criticizes it can expect to hear: "But what would you replace it with?" When you put out a fire, what do you replace it with?

-- Thomas Sowell

But more to the point, he's right in practice. No government program ever disappears. The only way to get rid of one is to hide it under another layer of bureaucracy, and since the Republicans didn't have anything on offer, and the Democrats did, that's what happened.

[JesseAz (5-30 Banana Republic Day)]

I know it was sarcasm. But hate it because idiots have been saying it since 2012. Got it was mockery. Was just commenting on it.

[JFree]

Anything 'new' solves some existing problem. Otherwise it wouldn't have gone anywhere. And Obamacare DID solve a couple of existing problems. Specifically - preexisting conditions and a broken individual risk pool.

Further, R's have long said that entitlements need reform and that means Medicare and Medicaid. And they have hinted that they have an idea for reforming them. Which could have been an opportunity to have the big reform of govt healthcare. Or at least talk about it

Rather than have any ideas at all, they waved their dick around and proved they got nothing.

[JesseAz (5-30 Banana Republic Day)]

How are you not a hig government loving authoritarian?

ACA “solved” a problem that was only a problem due to prior government solutions, ie taxation on corporate benefits. And it didn’t even solve the issue as it simply made plans uniform and more costly.

Pre existing conditions were also not actually a problem, just an excuse for a market take over. Individuals could always join a company or appeal to charity or pay more for coverage. That isn’t the government’s problem. Many of those with pre existing conditions chose to drop coverage to party in their 20s.

As for your other bullshit, for decades the gop has tried reforms but never had 60 congressional votes dumbass. Then your favorite corporate media masters claimed they wanted to kill grandma.

So fuck off statist.

[JFree]

ACA “solved” a problem that was only a problem due to prior government solutions, ie taxation on corporate benefits.

Then THAT is the solution that is proposed in the repeal of ACA.

Of course you're wrong and you know it which is why you put 'solved' in scare quotes.

Pre existing conditions were also not actually a problem, just an excuse for a market take over.

Ya sure ya betcha.

Individuals could always join a company or appeal to charity or pay more for coverage.

They had plenty more options. For one, they could die. Golly I wonder why your nihilist school of 'libertarian' has all the appeal of projectile diarrhea.

Many of those with pre existing conditions chose to drop coverage to party in their 20s.

No. Most of them had employer coverage until maybe their 40's or so. And then employers fired them once they started incurring medical bills. And then - hey presto - they now have pre-existing conditions - in a risk pool of one.

for decades the gop has tried reforms but never had 60 congressional votes dumbass.

No. For decades, the R's have had periodic farting episodes where they mention reform. And then they lose so many R's that whatever they claim to propose doesn't even have enough co-sponsors to get a bill into committee.

R's are not a serious governing party. They have ONCE been serious about that - in 1994 when Gingrich/etc put together their Contract America and managed to capture the House for the first time in 50 years or so.

D's are unfortunately a serious governing party.

[Stupid Government Tricks]

It "fixed" government problems by adding new problems, not by curing the old ones.

You don't fix a festering bandage by adding a new one on top of it. You remove the old one, clean the wound, and if necessary, you put a new bandage on it.

You statists have no common sense.

[JFree]

You don’t fix a festering bandage by adding a new one on top of it. You remove the old one, clean the wound, and if necessary, you put a new bandage on it.

Fine. Then the repeal of ACA includes the stuff in bold.

Unless R's really have no ideas about anything.

[DesigNate]

Preexisting conditions, by definition, aren’t insurable. You know, cause insurance is something that provides financial protection against specific risks or events that might happen at some point in the future.

So Obamacare didn’t “fix” that problem so much as strong arm insurance companies to take a loss on those cases by guaranteeing them customers (through the mandate).

I disagree that the GOP needs to have a plan for rolling back government overreach, especially when reaching so far back as 2012. This seems like a convenient way to shrug and say “guess we’ll just stick with the current status quo instead of the status quo of 5 or 10 years ago” (which, let’s be honest, weren’t some anarchic days of the Postman or something.)

[JFree]

Insurable is all about the risk pool not the individual. The reason our medical financing system is broken is because we allow private groups (employers, insurers, etc) to cherry pick risk pools and throw everyone else into the 'government is the payer of last resort' risk pool. So government pays for the disabled, the terminally ill, pre-existing conditions, the destitute, the permanently unemployable/elderly, the demented, the individual, etc -- iow the 100% individually uninsurable. Without any legal ability for government to even act as a fiduciary for taxpayers or future generations (debt) or a medical case manager. Our system is cronyist with government/taxpayers/future as the sucker.

All other governments in the world understand this. As did Hayek et al. Germany/Switzerland/Austria have an insurance based system and they prohibit all cherry picking of the risk pool. Other countries have different approaches. Libertarians in the US don't understand this at all - and they are mostly nihilist - which is why 'let us enhance the liberty to let all sick people - esp grandma - die' is a very accurate portrayal of their 'ideas'. And is why no one gives a shit what libertarians say re this topic.

On the bright side. our government functionaries and political parties are entirely corrupt. Which is why we spend nearly 50% more on medical than any other wealth country (for worse results) - and nearly double the amount the average rich country spends. Alternatively, we spend as much on medical - via our government - as anyone else in the world - but that only covers a small fraction of the population. And we don't care. Spendspendspend. USA USA USA!

[Don't look at me!]

… groups (employers, insurers, etc) to cherry pick risk pools and throw everyone else into the ‘government is the payer of last resort’ risk pool.

Really? I wish I knew how to do that with my employees.

[JFree]

Hire people in their 20s and fire them in their 50s and the insurance cost will show that. That's how smaller tech companies do it. If your company is large enough it will be self-insured and the insurance company will merely be a third party administrator. If you don't understand this, then it's your insurance company that is cherry picking the risk pool and choosing their customers by setting the price for coverage.

[Rev Arthur L kuckland (5-30-24 banana republic day)]

Fuck you the goal of aca was to destroy small practices, and ruin American health care. The people that wrote the bill said the goal was to make people want universal healthcare

[MJBinAL]

No, "anything ‘new’ solves some existing problem. " is not correct.

Anything new was SOLD as solving some existing problem. Usually the "solution" created more problems than it solved (if in fact it solved anything).

[Fire up the Woodchippers! (5-30 Banana Republic Day)]

No more government programs. No more taxes.

And no more goddamn Democrats.

[Diarrheality]

Why Is American Health Care So Dysfunctional?

Because government's solution to any problem is to make it a bigger, more expensive problem?

[Uncle Jay]

"Why Is American Health Care So Dysfunctional?"

Could it be because there are so many state, local and federal regulations governing health care?

[Chipper Chunked Chile Con Congress (ex NCW)]

Yes. Also, allowing the AMA to artificially limit the number of med schools, and med school grads.

[Stupid Government Tricks]

"Why Is American Health Care So Dysfunctional?"

That has got to be one of the dumbest recent headlines for a libertarian rag.

Government. It's always government. The exact mechanisms are immaterial; you could fix every last single one of them, and as long as government was still involved, it would invent new meddles and revive the old ones.

[GroundTruth]

Government is the tool in this case, but the root cause is that politicians have lied to the public since (at least) FDR's New Deal that told people they should have more than they have earned, and that someone else should (and can) pay for it.

Medical care and drugs are expensive as a function of the highly individualized nature of the product. While some (now) routine tasks can be automated, anything out of the ordinary requires a team of bright, educated, motivated, focused practicetioners ; and that means money. If someone wants that kind of service, they need to realized that it is expensive, and they need to pony up and get decent insurance; not just while they are sick, but over a lifetime so that it is there when they are sick. But.... "tax the rich" is so much easier, and "you can have your smart phone, AND your 32 hour work week and let someone else pick up the tab on your medical costs" is such a very sweet thing to hear.

[Sarah Palin's Buttplug - Jan 6 = 9/11 (same motive)]

Medicare fucked everything up.

Okay, workers, you will pay X amount every month to cover the medical costs of the oldest, sickest people. On top of that you pay for your own health insurance costs.

So Johnny stacking shelves for $18 an hour pays for retirees health costs and he pays for his own too.

Then Dumbya and the GOP made it even worse with the Medicare Welfare Prescription Drug Pharma Enrichment Program.

So Johnny pays for another program that retirees use.

The Bushpigs wrecked this goddamn country, Peanuts.

I know, I know BUT GEORGE WAS ON TEAM RED! HE WAS GREAT!

No No no.. He wasn’t.

[DesigNate]

So sad. So predictable.

Oh, and you support all the same people that brought us Medicare AND Part D, Neocon Bushpig.

[Sarah Palin's Buttplug - Jan 6 = 9/11 (same motive)]

I hated the Bushpigs before it was cool, you dimwit.

Now everyone does.

[JesseAz (5-30 Banana Republic Day)]

You are a bushpig lol. Look at the media you support now. People like bill kristol.

Which parties have ever tried to reform these programs dummy? Your favorite president even expanded Medicaid and made the system worse retard.

[DesigNate]

And yet you suck Liz Cheney’s dick while rimming people like Bill Kristol.

lol, you hate the Bushpigs so much you became one. Hahahahahahaha

[MJBinAL]

And, by the way, who passed Medicare?

"On July 30, 1965, President Lyndon Johnson traveled to the Truman Library in Independence, Missouri, to sign Medicare into law. His gesture drew attention to the 20 years it had taken Congress to enact government health insurance for senior citizens after Harry Truman had proposed it."

https://www.senate.gov/artandhistory/history/minute/Medicare_Signed_Into_Law.htm

Guess those damned Republicans did it, right, Butthead?

[Fire up the Woodchippers! (5-30 Banana Republic Day)]

Yawn

[TJJ2000]

Maybe it's all the [Na]tional So[zi]al[ism] in it???

All be darn; maybe the founders knew what they were doing when they didn't give the 'Union of States' any enumerated power for Commie-Healthcare.

The fact anyone has to ask this question just demonstrates how far the ship has sunk already.

[AT]

Why Is American Health Care So Dysfunctional?

Because America forgot that there is no right to health care.. When they started pretending otherwise, when they made it an entitlement, when they declared it a "basic need" - they necessitated government involvement, established a method of paying for it that tapped into (and redistributes) the American tax dollars, which allowed the health care industry to radically inflate its prices, overvalue its services, bloat its administrative staff, and left the people powerless to do anything about it.

Then, in response to a growing demand, they lowered the quality of service in order to find the personnel to meet it. This is especially noticeable in nursing (and to a lesser but still noticeable extent, techs), where the educational/experience requirements have dropped so low that each and every one of you should be terrified of ever walking (or being wheeled) into an ER. The most sought after skill in nursing these days? Ability to speak a foreign language. My jaw dropped the first time I read that.

The problem with American health care is that we forgot what health care is.

Health care is a service. It's no different - in any way - than that of a mechanic, or a landscaper, or a barber, or HVAC tech, or chef, or teacher, or a dog sitter. They have a skill that you do not possess, or a willingness to perform a job that you either can't or don't wish to. That's it. Nothing more.

Yes, the level of skill required to do medicine is one that should be admired and respected (and well compensated) - but that doesn't change the fact that it's still just a service.

And if you can't pay for it, you shouldn't get it. Period. End of sentence. Defying that basic market principle - THAT is what has screwed up American health care.

[Lester75]

Yea let anyone who can't afford insurance die in the streets, including their friggin babies. Wait, maybe we should eat the babies too.

[SRG2]

It is dysfunctional partly because there can be no free market in healthcare owing to asymmetry of bargaining power, informational asymmetry and inelasticity of demand, partly because of general unwillingness to be rational about treatment and treatment costs, particularly end-of-life care, partly because inevitably the greater the demand for medical services the greater the dysfunction – and over 40% of adult Americans are fat fucks clinically obese – though here the cost of dysfunction is partly offset by the savings in social security costs thanks to declining life expectancy of the obese.

FWIW Trump promised a better and cheaper system than Obamacare but unsurprisingly was unable to produce one. Then he said,“Nobody knew health care could be so complicated.” – except of course anyone who’d studied it for more than 5 minutes. I suspect that this promise has vanished down the Trumpist memory hole.

FWIW 2: two related long-term benefits of removing the link between healthcare and employment and making it easier for individuals to get individual coverage are: increased mobility of labour – people will be more able to move from job to job knowing they won’t lose coverage if they leave one job before going to another, and increased small entrepreneurship – more people willing to set up their own companies knowing that they’re not risking their health or coverage by doing so. If you remove extraneous – i.e., not-financial – risks from entrepreneurship, you encourage it. This is a good thing.

[docduracoat]

I am a physician and I work in Broward county, Florida.
Our system here is excellent!
Whether you have insurance or not, you get world class care in the hospitals run by The North Broward Hospital District.
If you have insurance, we charge your insurance.
If you do not have insurance, we get paid for providing care by the Health Care District.
The District gets its funds from a tax on homeowners.
The mileage rate is about 1 which means you pay $1 for every $1,000 of assessed value.
Check my math, that is $1,000 for a million dollar house.
While it makes home ownership a little more expensive, the people of Broward county have an excellent trauma center, stroke center, outpatient surgery center and birthing center.

Our nurses are great and they have access to language line so no language skills are needed.
Language line has trained interpreters in basically every language.
We have advanced technology and up to date equipment.
I think this is a model for the rest of the country to emulate

[JFree]

Good municipal health care is exactly a model that can work well.

[TJJ2000]

Yeah dude…. If you pay for your own healthcare we just charge that and if you don’t want to pay for it we just Gov-Gun down your neighbors at $83/month to pay your bills for you…..

Totes cool man. Gov-Gunning other people’s labors is totes cool. /s
Oh. Here’s a better plan. When you use ‘Guns’ on your neighbors to pay for your own bills you should get shot on spot or at the least thrown in prison where you belong.

Ya know; something something about ensuring Liberty and Justice for all instead of ensuring criminals get-away with crime against their neighbors.

[MJBinAL]

Well Doc, since you are all in on providing services to those who can't pay for them, I have a plan you will love.

Anytime you provide services to someone who does not pay, you eat it. You generosity will indeed be your generosity. Maybe you can start a charity to help you cover it.

Used to be the CHURCHES did that, Catholics, Baptists, Methodists, etc. In short, the system worked, until you "fixed" it.

[Oscar Wilder]

Because, Democrats!

[DaveM]

The healthcare in the US is excellent. What’s completely messed up is how we pay for it.

The next time you get a statement of benefits on a medical bill, look for an “adjustment” column. This will be a huge number. There will be no explanation. It is just an “adjustment” of the difference between the price the medicos charged vs what the insurer paid.

The true cost of the healthcare is what the insurer paid. The retail price is a complete fiction.

Now, the sad part of all this is why are there fictional prices at all? It’s because of back-scratching. Literally every business office, provider, insurer, pharmacy, manufacturer, you name it, they ALL must participate in this completely fictional game of prices as a way of making sure they get their cut of the discounts and special pricing agreements that crisscross the industry like spools of thread in a fabric factory.

Medicare is the ONLY insurer that unpacks all this up front where the consumer can see it. They are the ONLY insurer who publishes the exact prices they will pay for the specific procedures, and the ONLY insurer who will tell you precisely what they will and will not cover IN ADVANCE, not after long arguments with insurance adjusters, multiple visits to doctors to "pre-approve" care, etc. It's published for all to see.

The private insurers hate straight-up Medicare because it literally removes all their opportunities for gaming the prices.

There is HUGE room for improvement in how this is all done. COSTCO and Walmart are vital here, as long as you don't use insurance and pay out of pocket for a generic drug, you can get meds for literally pennies on the dollar vs. traditional pharmacies.