Duffbert's Random Musings

1 - "I'm guessing my niece isn't viewing capitalism too fondly right now."

Tom, I seriously hope you aren't trying to characterize the current US healthcare system as "capitalism." It's about as comparable to a free market as the banking system -- which is to say: not even remotely.

In a market, there's a buyer and a seller. They reach agreement on what to buy and sell based on the cost/benefit analysis of each party. This has NOTHING to do with how the healthcare system in the US "works" today.

"If all this had happened to me (who has insurance), I would have been billed the $55,000, paid maybe $200 in co-payments, and the insurance company would have paid most of the remainder."

This is 100% of the problem. For those with insurance (and this is still a majority,) there is absolutely zero consideration of price for anything. If you had been in the same situation, the hospital would collect $55K without a second thought. And thus they design their billing and payment plans ENTIRELY around the principle of "money is no object." Because if you'd been the patient, money really would have been no object. It isn't YOUR money -- it's the insurance company's collective pool.

There's a huge list wrong with what happened here. The hospital mis-diagnosed the problem; they overcharged for treatment; your niece wasn't yet eligible for coverage. And fundamentally, we start with the assumption that for her to even HAVE insurance is tied to an employer. Why couldn't she have coverage through her school, her bank, her car insurer, her church or her parents?

The answer is because health insurance is tightly bound to income tax rules, and because of this, the only way anyone GETS insurance is through employers. This is the most vicious aspect of the present system.

All that being said, when reading this story, I think one key point is that the hospital behaved as if she had a heart attack, when it turned out that all cardiac diagnostics came back negative. And that's an interesting point. If the angiogram had shown something terribly wrong, and she'd immediately been given a life-saving treatment, would $50,000 really be too much to pay? Is that literally a fate worse than death?

But, of course, the angiogram showed nothing. Which is really an interesting point, because the hospital and doctor can be cavalier about performing tests and pass the expense on to the patient even when they guess wrong. Would that ever work in another context? I'm trying to imagine a customer reporting a problem in an application, and me coming back with "well, I spent $50,000 on checking out whether the problem was your SSL keys, and it wasn't, but you still have to pay for that check." I'd be laughed out of the room.

Why do doctors get a pass? It makes very little sense, unless you start with a premise of "a person has immeasurable value" and therefore we grant an infinite blank check to a doctor or hospital in the name of saving any one patient. At the very least, the provider should bear the price of a bad guess.

And the notion of bearing the cost of a bad decision is, of course, fundamental to a free market. If healthcare were truly "capitalism," then the provider would never be able to charge for what turned out to be totally unnecessary tests. There was never any informed consent by the affected party, was there?

2 - Disaster insurance which is what your niece needed to cover this unfortunate event is around $150 a month. With that any ER visit or hospital stay a free no copay. Buying meds at walmart dropped my script cost from $432 to $48. I keep $1000 in account to see doctor if just sick.

3 - Just happy I live in the UK. Everybody bemoans our National Health Service but on the whole it's far better for society at large. Last I heard a similar concept was supposed to be launching in the US. What ever happened to it?
Oh, and don't think that this is the only kind of health cover. You can still go private if you want to skip the queues and spend the insurers' monies.

4 - this is one of the main reason i left USA in 2005. I toke a taxi in 2010 (Lotusphere) to the airport and the taxi driver told me his story : 4 days in hospital with pneumonia, he got bill for 45.000. No insurance , no Tests was done other then for the pneumonia, got some drugs for his pneumonia.

I was 9 days in the hospital this year ( iceland) , 2 operations , heavy medication. my total bill was around 300 $ and that was just for coming 6 times for followup.(2 x week)

I have had lots of sleepless night of having no insurance coverage for my family of five when i was in USA. I too fear for the future for USA. its not going to get any better sorry to say.

5 - The US is alone in the list of industrialised nations in not having free healthcare for all. Lets not forget who benefits from this system - follow the money.

If most folks are covered - fine. But lets face it - less and less folks in the US are covered. Is it below 50% yet?

Which makes it all the stranger that the GOP can derail Obamas Healthcare reforms. Do the middle to right wing in the US not understand that unless they are one of the 1%, it acts against their interests?

Loons like the Tea Party (funded by the Koch brothers and Rupert Murdoch) do a grand job in persuading middle-income and lower voters that free healthcare isn't good for them.

Isn't it time folks woke up to this shamelessly wrong propaganda?

(I also echo Dragons' comment about our own UK NHS system. There's lots that could be fixed, but when the chips are down - it works, and it works well. When my Mother was diagnosed with Liver cancer, she got world-class care. And zero bills)

---* Bill

6 - Bill, honestly, the reason the healthcare bill got washed down here was as much democrats as republicans. The democrats had the house and the senate, but greed and lobbying made them pretty much screw up all of Obamas proposals. It was a great example to me of how lobbying and money controls government here and not the people. Basically they had no balls. Very sad.

7 - The weird part is that emergency rooms have to take a person in, so if they cant pay then the hospital takes the lose which is then added to the rest of us as the cost of doing business. So basically everyone can get emergency care and the rest of us pay for it. Go to the county run hospitals and see how many patients cant pay for services. Our tax dollars pay for it. It would be cheaper to go to a doctor then the ER.

8 - @David: The Walmart approach works if it's a prescription you're filling. When you're in ICU and they pop a couple of Plavix in you, Walmart doesn't come into play. And yes, a temporary major medical temporary policy would have been nice. I'm not sure I'd try to go without one these days.

@other countries: I agree... it may not be "the best", but it's there and it's functional. That's the safety net that is needed. Yes, it's gonna cost more in taxes, but the current system is unsustainable as is.

@Bruce... Agreed. More and more services are popping up to allow you to see a doctor and pay a single charge in cash at the time of the visit. These alternative systems work well for non-time-critical health events, but sadly break down as soon as the ambulance becomes involved. :(

9 - Thank goodness I live in Australia where everyone has access to quality healthcare.

10 - Nathan +1

I must admit, I'm amazed by the amount of life-saving procedure and technology available these days. It's a blessing that your niece was in an area where that level of expertise could be brought to bear immediately.

But medicine is no longer a free-market business. Just like banking and the military-industrial complex.

There is no doctor-patient relationship anymore. The miles and miles of rules and regulations, perpetuated by all of the huge companies that lobby, foster this type of "max it out, *somebody* will pay" treatment. The drug companies, insurance companies, and lawyers will fight with each other to decide which of them will be the richest, but they will collectively ensure that they all bleed as much cash as possible from the individual to get that money into their circle. And the doctors are at the mercy of all of this.

As long as drug companies and insurance companies can influence high-power-wielding politicians things will never improve.

11 - I am glad I live in Denmark where it is free for all, rich or poor.

Curing people for a profit... it is just a bad mix.

12 - FYI The Disaster health insurance al meds givne in hospital are covered.

90% of medical research in world is done in US using the for profit system we have. But we give most away as good will to rest of world. I say start charging. We can't cover the bill for finding the worlds cures any more.

13 - FYI The Disaster health insurance all meds given in hospital are covered. <br /><br />90% of medical research in world is done in US using the for profit system we have. But we give most away as good will to rest of world. I say start charging. We can't cover the bill for finding the worlds cures any more.

14 - I removed the personal attack on one of commenters. Next off-base comment will cause all your comments to be removed. - Tom

Let's be blunt: it totally sucks that your niece got a giant hospital bill. It's very likely that the bill was inflated beyond any reasonable proportion. Fundamentally, the problem is that she can be burdened by this atrocious debt without personal consent. Maybe she would have agreed to 40 thousand dollars worth of tests -- but probably she wouldn't have -- and that the hospital can force upon her this absurd burden of ridiculous debt is criminal. It is only by the assumption that doctors own you that this kind of scheduled slavery is even allowed in the first place.

But watch the next reporter to put this question in front of a candidate. It will be asked as "should we just let this person die?"

And the answer is "of course not." But it's never that simple in a national debate.

15 - Its always reassuring to hear that Nathan thinks I'm wrong.

---* Bill

16 -

17 - @14 Nathan you had me with some of your arguments until you went personal. I don't see the need for it to be honest, if you arguments can't stand on their own why bother? Feel free to call up some other quote from my past to invalidate this comment.

18 - @14 Nathan you had me with some of your arguments until you went personal. I don't see the need for it to be honest, if you arguments can't stand on their own why bother? Feel free to call up some other quote from my past to invalidate this comment.

19 - @Carl, so a disparaging remark about another commenter invalidates my logic? Is that some kind of weird inversion of an ad hominem fallacy?

I sincerely apologize to Bill. I clearly should have kept my reply civil and courteous when referring to an individual. Only collectives, not people, should be called "loons."

20 - ["If all this had happened to me (who has insurance), I would have been billed the $55,000, paid maybe $200 in co-payments, and the insurance company would have paid most of the remainder."

"This is 100% of the problem. For those with insurance (and this is still a majority,) there is absolutely zero consideration of price for anything."]

Exactly. Duffbert (ironically) illustrates why the negative comment regarding Capitalism is misplaced. Nathan covered most of the points I would've made -- suffice it to add that ignorance of how the free market actually works is probably the source of most of the confusion about who/what to blame.

Duffbert, you take the example of what happened to your niece and then quickly generalize that the "Capitalist" system must be to blame. Your niece is obviously an adult -- did she ever question the cost of any of the procedures? You aren't obliged to take every proposed test. I always ask the cost of a procedure *prior* to it being performed.

No system is perfect but one of the redeeming values of the current American system is that you still have the freedom to choose what healthcare or insurance you want to purchase. That freedom is priceless. Once the politicians take that freedom, you won't get it back. Put another way, what is your sale price for your own freedom to make healthcare/insurance decisions?

21 - I know I'm kind of late to the party since most of the comments were made over the weekend.

From my perspective, it looks like a choice between pretty good health care in the US for those who have the ability and discipline to play by the rules (I'm not saying the rules are fair) and mediocre healthcare for everyone in the other countries being cited above.

For those of you outside the US that think healtcare is great in your country, that could be because it is and it's about to bankrupt your country. Or it may seem great because its shortcomings haven't killed anyone you know. It's quite possible that you live in some country that has figured out how to provide great healthcare without bankrupting the country, but that would mean you live in the exception to the rule.

Here's a few stats from Professor John Bryson, the McKnight Presidential Professor of Planning and Public Affairs at the University of Minnesota's Humphrey Institute of Public Affairs:

Overall, nearly 1.8 million Britons are waiting for hospital or outpatient treatments at any given time. In 2002–2004, dialysis patients waited an average of 16 days for permanent blood-vessel access in the U.S., 20 days in Europe, and 62 days in Canada. In 2000, Norwegian patients waited an average of 133 days for hip replacement, 63 days for cataract surgery, 160 days for a knee replacement, and 46 days for bypass surgery after being approved for treatment. Short waits for cataract surgery produce better outcomes, prompt coronary-artery bypass reduces mortality, and rapid hip replacement reduces disability and death. Studies show that only 5 percent of Americans wait more than four months for surgery, compared with 23 percent of Australians, 26 percent of New Zealanders, 27 percent of Canadians, and 36 percent of Britons.

But read the entire article, "Socialized Failure" at { Link }

Does the healthcare system in the US need changes? I think so. You would be hard pressed to find someone who doesn't. But will the average person be better off under a "European" style system. All the numbers I've seen say "No". YMMV.

22 - @19 It makes you appear immature, and yes for me it makes me not want to read/listen to the rest of your argument as it may be just as unrelated as the insult.

23 - Wow - @19 - great argument. So the US is the only major industrialised nation without healthcare for all, and its correct ?

You assume that your figures actually show that all other healthcare systems throughout the world actually don't work?

As a person who lives in a country with a working healthcare system, I'm rather taken aback at this new knowledge that I live with broken healthcare.

Or I could just go on believing and trusting in something I know and see's works.

Perhaps the latter.

---* Bill

24 - Next month I will be making the final of my monthly payments for this fun little event { Link }

The frustrating thing is I HAD insurance. The reason (as explained to me that evening while speaking with one of the nurses in the ICU) for the insane cost is that I was one of the only people there who had any insurance at all. The vast majority of the patients had zero insurance. They were getting medical care -but had no way to pay for it. So the crazy high costs are there so the hospital can make up for their losses by billing those who have insurance.

This isn't right, but it is how things are. How do we fix it? I don't know.

I'm extremely grateful for the care I received, and I'm glad your niece received the care she did as well.

I really hate the fact that my (and her) single night in an Intensive Care Cardio Unit costs more than most people earn in an entire year. Perhaps if more people could / would actually pay their medical bills the costs for all of us would go down. Perhaps not. As I said, I don't know the answer -but my instincts tell me that government control would provide exactly the opposite of what is needed.

25 - @23 - If you're actually referring to @21 instead of @19, I tried to say that healthcare in other countries appears to fall into one of three groups:
1) Good now, but the skyrocketing cost is forcing changes to be made
2) Mediocre now, but sustainable
3) Good now and sustainable

Comments like yours combined with headlines like this:
"Cataracts, hips, knees and tonsils: NHS begins rationing operations" { Link }
lead me to conclude that Great Britain falls into the second group; what NHS is doing may have been good in the past, but is not now sustainable and is going to get worse.

But I am genuinely glad to hear that it's working for you.

26 - @23... The question is whether we can go from #1 to #3, and I honestly don't think we will. Yes, we *can*, but I don't see that anyone is willing to sacrifice for the greater good. Hence, the best I think we'll ever see is #2. And right now, I think #2 beats #1, as far too many people get nothing under #1.

27 - @25 - Brain freeze. The sentence fragment "falls into the second group" should read "falls into the first group"

28 - @20 - Null... My capitalism viewpoint looked far beyond just the patient and doctor/hospital relationship. There are *many* customers and sellers in health care, and some of the parties play both roles. The hospital has to buy drugs and tech from other companies (customer) and then use those items to treat patients (seller). So if that's not capitalism (buying and selling on an open market), what is? Yes, the patient/provider relationship is muddled in that there's not much of a "free market", but it's still capitalism in its basic form. If you dig deep enough, you can still decide where to go based on price. Greed also comes into play big time, when pharmaceutical companies give drugs to providers to lock them into agreements to buy from a single source, and then the provider turns around and charges maximum prices for those free drugs as if they purchased at regular price. Even worse, they bill insurance (both private and Medicare) for those free drugs, breaking a number of laws in the process.

Again, I recommend you read Blood Feud for an example.

Furthermore, the assumption that a person can question everything that's done to them in a hospital is faulty. Say she had truly had a seizure or a heart attack that left her unable to communicate (as in had not regained consciousness yet). Do the hospital staff do nothing until the person can OK every test? If a cardiologist shows up and tells you that an angiogram is needed to save your life, do you engage him or her in a prolonged discussion about whether it's medically necessary, as well as what sort of pricing she'll incur for the test? Of course the doctor will tell her she needs it. My guess is they won't know the cost either. If you want to place the onus on the patient to question everything, then most of your patients end up dying in emergency situations.

Of course, that *will* cut down the costs to the surviving family members...

29 - Having some knowledge of who "null" is (which I'm confident was accidental, but it's up to that person to claim responsibility,) I'm perfectly comfortable contradicting said person, and agreeing with Tom's response...

"...the assumption that a person can question everything that's done to them in a hospital is faulty."

Absolutely correct. The provider should proceed under the assumption of FULL FINANCIAL RISK, especially when it comes to tests. And the gauge should be: did the test prove conclusive? If a doctor can say "I don't know what's wrong but I think it's cardiomyopathy, so let's do a test that costs $25,000" if the test proves negative, then HE should pay for the damn thing. Then either the doctor will drive the cost down, or he'll stop relying on expensive defensive tests and actually practice MEDICINE, which involves complex system diagnostics.

Fundamentally, it's not the patient that buys a test. It's the doctor. And he does it to satisfy mortality reviews which shield him from malpractice liability. In layman's terms, he has a blank check to make sure every driver on the road has maximum insurance so he can make his premiums as low as possible. If that doesn't immediately connect with you, read it all again and follow the cause & effect logic.

However, I will strongly disagree with Tom on the following statement...

"The hospital has to buy drugs and tech from other companies (customer) and then use those items to treat patients (seller). So if that's not capitalism (buying and selling on an open market), what is? Yes, the patient/provider relationship is muddled in that there's not much of a "free market", but it's still capitalism in its basic form."

First, drugs are probably the most heavily regulated market in the US. We can start with the FDA, move on to the DEA, and end up with the DHS as the collective reason why you can't buy an asthma inhaler without documenting your name & address anymore. So calling it a "free market" is seriously disingenuous. The market in drugs is about as free as the market in, well, DRUGS. It's easier to buy cannabis than it is to buy Oxycodone.

Second, one of the basic ideas of markets is that buyers and sellers trade according to the relative value of what's being exchanged. If you walk into a store and want to buy a pack of gum, you might drop $0.50 on the counter without thinking about it. But if you picked up that gum and it was $50.00, odds are pretty good that you would just leave it on the shelf. The proposed price from the supplier doesn't meet with your personal valuation for the gum.

But what happens when you walk in the store and the price of the gum TO YOU is $0.50. But the store has an agreement with your uncle that he'll pay the other $49.50. Well, it's not YOUR money, it's his, so who cares? You drop your 50 cents on the counter and you're done with it.

What we know, of course, is that the rich uncle doesn't really pay $49.50. He's negotiated a different price. It's more like $29.50. So really it's a big discount, even if they still get $30 for a pack of gum.

Once in a while, someone comes in the store who's uncle doesn't have an agreement with the store. And when they want a pack of gum, it's $50. But, of course, the store basically just says "if you don't chew this gum you'll die" and everyone is too scared to say no. It's only after they finish the pack that the accountant comes along and says "congratulations! You just paid $50 for a pack of gum!"

Let's be clear: the only reason the pack of gum was $50 to start with was so that the uncle could negotiate a better price of $30 (which is still TOTALLY RIDICULOUS) and then pass off $0.50 to the person buying the gum.

Of course, what no one pays attention to is that the rich uncle is taking $5 a month from all his nieces and nephews to cover the $30 pack of gum, which fortunately for him all 12 only try to buy once a year. So he makes a tidy $60 a year in profit. The hospital makes $29.50/month from the "insured" patient, and negotiates with the rest. And even the nieces and nephews get to buy a $0.50 pack of gum for $0.50 once a year.

The only person truly screwed is the one not in on the racket.

So how do you get in on the racket? Easy -- get a job. Well, get a full time salary job with a company large enough to have a rich uncle. And if you can't find that because it's too expensive to hire American workers and no one can afford the 30% premium to pay for health insurance that's NOT through their employer?

Well, fuck you. You can pay $50.00 for a pack of gum. Maybe once in a while we'll use you as a case study for why this whole idea is wrong, but we can fix it by being wrong in just a slightly different way. At least then we'll be out of office by the time anyone realizes that nothing changed

Now everyone can have a rich uncle that charges you $7 a month to buy a pack of gum for $0.50 once a year that he only pays $24.50 for.

Isn't that progress?

30 - I am not about to read the novellas being posted back and forth, and I'm sure there's a healthy dose of ad hominem attacks thrown in there as well (once it gets a bit longer and we'll hit the "nazi wall", I'm sure ;) ).

First off, those of you who think the U.S. medical system is still "the best in the world" needs to think again. There are more innovations happening in Europe and the Far East than here. We've lost that edge because we now have profit-driven research, almost solely, including what used to be the last bastion of pure medical research - the college medical centers. So sad.

Second, those who think that socialized medicine is "bankrupting" their countries needs to, once again, wake up and smell the expresso. The medical system isn't the problem - it is the shitty economy as a whole.

There are so, so many things wrong with our healthcare system that it may not be "fixable". The "best medical care in the world" (ahem) in this country is available to only the privileged few. The profits-first nature where patient care is secondary - or tertiary, or worse - is literally killing us. The medical system is treading very deeply into the grey-area of the hippocratic oath, almost gutting its altruistic nature.

I think it would do a great deal of good for some Americans to live abroad for a bit before they beat the drums of medical superiority too loudly...

31 - @30 - In your opinion, what country gets healthcare right?

32 - @31 Not sure he said anywhere else gets it right, but I think he was implying others get it better.

33 - @30/32 - Ok, who gets it better?

BTW, found this headline in the Telegraph today:
"NHS bosses face sack for rationing treatments by delay
NHS managers have been banned from rationing treatments while patients wait to die or go private after Andrew Lansley, the Health Secretary, admitted that some hospitals were delaying operations."
{ Link }

34 - @33 I think it's pretty easy to find stories for every healthcare in the world where there is some kind of failure.