“Life insurance pays off triple, if you die on a business trip.” – Fight Club
Now these are the results that a functioning health care system should provide. Including the hat.
The health industry in the United States is a mess, probably worse than a woke vampire movie where vampires use pronouns like undead/cursed and make their victims go to DEI training (Death, Exsanguination and Immortality) before selecting them based on their social privilege score. Talk about sucking!
But back to the point: the system is a mess. Case in point, the insurance companies are for-profit institutions. As, um, you might have noticed from recent events this leads to almost inevitable conflict between the patient and “their” insurance company.
This has created some really perverse incentives, especially for the company. If they can successfully deny enough claims, their profit goes up, so their best bet to make the most money is to not allow claims, just like the best way for some specialists and hospitals to make the most money is to do the most testing. “Hey, this is the machine that goes ‘ping’, and it’s useful to see if you have the Hong Pong flu.”
For no reason at all.
Oh, and lawyers? We didn’t even mention them. Lawyers just love to find that doctors missed giving the right test so that they can sue them. So, we have the groups all competing for an economic slice of the pie. How big is the pie? In 1960, it was a manageable 5% of the economy of the United States. The average life expectancy then was somewhere around 70 years old.
In 2019, healthcare costs were over three times as much, at 17.6% of the economy. Lifespan had gone up to almost (not quite) 79 years.
So, 12.6% of the economy for an extra 8 point something years? Is that a good deal?
Well, not exactly. Lifespan is certainly extended by modern medical care to some extent, but a huge amount of that uplift is due to factors that have nothing to do with the increased costs of health care. But some of it is better health care: much better trauma care has also made events like gunshot wounds and car accidents more survivable, so the average is going to go up because people aren’t dying young in car crashes as often.
What did the CEO know about the Clintons?
But people aren’t smoking as much, either. Also, cars and roads are objectively safer than in 1960 by an order of magnitude, and since car deaths are skewed to young men, that really helps the average life expectancy. And all of these things have increased life expectancy:
- Nutrition
- Clean Water
- Sanitation
- Neonatal Healthcare
- Antibiotics
- Vaccines
As you can see, many of these things aren’t healthcare, and with the exception of neonatal healthcare, they’re all stupidly cheap. So, a big part of why health care costs so much more is that people are living longer and consuming more health care. If a smoker didn’t die of a heart attack from smoking at age 45 at nearly zero medical cost, now they’re living longer and using medical care at age 80.
This is not a bad problem.
Looks like I picked the wrong week to give up dad jokes.
The other part, though, is that there are so many more vampires surrounding the money trough than there were back in the day.
- Insurance Companies (as noted earlier, insurance companies actually make more “shareholder return” by denying claims and treatments, so if they spend $1 to deny $2 in claims, they’re still up $1)
- Ambulance Chasers (attorneys produce great benefits against those who practice irresponsible care, but the lottery attitude of many juries giving ludicrous awards raises costs for everyone)
- Big Pharma® (Goldman-Sachs actually asked the question if curing diseases is a sustainable business model, versus forever dispensing medicine to be people who are just sick enough to not die, so the model is to sell more drugs)
- Hospital Administration (which has to be doubled to account for insurance claims, government required paperwork, Ambulance Chasers and managing television doctors)
- The AMA (who has artificially limited the number of doctors produced by American schools to keep doctor salaries up and hide the stethoscope shortage)
- The Government (who builds entire bureaucracies to regulate medical care and administer payments and . . . to hire more bureaucrats)
- Illegals and Deadbeats (the system must treat them, by law, in an emergency setting, and guess who pays the bills?)
The current medical system is like a vampire-hydra: cut off one group sucking money out of the system, and another two will emerge.
In the 1980s, healthcare went from a still-manageable 6.9% (1970) to 12.1% (1990) – nearly doubling in size. This was largely driven by a 1986 law (EMTALA) that made emergency treatment a right at any hospital that receives Medicare, whether or not the patient had any ability to pay. It’s like saying that if I’m really thirsty, that McDonald’s™ has to give me an iced tea.
What do you call a talkative Columbian? Hablo Escobar.
And, like usual, everyone points to cheap strawberries as the benefit, but skips the $19.75 Tylenol™ pill in the hospital. Healthcare in the United States is so expensive (at least in part) because to so many it’s free. This increases the recordkeeping, and hospitals have to spread their bills on decent hardworking non-deadbeats.
So, it’s broken. How do we fix it?
On insurance, The Mrs. has a simple idea: make it illegal.
All of it. Medical services are cash on the barrelhead. You pay for the services you get. That sounds drastic, but when I really thought about it, this would eliminate the entire medical billing bureaucracy. We talk about a capitalism, but health care tied to insurance is anything but capitalist, especially with all the mandates and cost shifting from programs like Medicare and Medicaid.
The Mrs.’ solution has some real-world evidence to show she might be on to something – real prices for services insurance doesn’t pay for like breast, um, augmentation and laser eye surgery have gone down in real terms. Force doctors to post prices, and for emergency services, well, I’m sure we can figure out ways that hospitals can’t create “pay $90,000 for this shot of anti-venom that cost us $125 or you die” scenarios.
They know a thing or two, because in hundreds of lifetimes they’ve seen a thing or two.
Cap malpractice awards to reasonable levels.
Pharmaceuticals are a bit stickier since we want to foster innovation, but how many of them take public institute research to make their drugs? And we can certainly streamline the FDA, especially for sketchy drugs that might help people that are otherwise terminal.
Get the federal government mostly out of health care, except to prosecute people for fraud. Like the people responsible for the Vaxx®. And make the penalties criminal.
Eliminate free care. If it’s so important to you that people who can’t afford to get treatment, get treatment, don’t use my wallet to assuage your feelings. Pay for it yourself, Sally Strothers.
A Christian cross might make a fictional vampire recoil in horror, but the lack of a money trough will make the health-care-hydra vampire wander away to try something else, hopefully by finding a real job, or, failing that, being paid to suck something else.
Doctor got his degree from Columbia. I told him I wanted one from America.
“Colombia” IS an American country. South American, to be slightly more precise.
True story: a friend of mine who lived in “Washington, District of Columbia” was on an official business trip as a NASA employee, with all arrangements made by the NASA travel office, when he was denied his rental car. The clerk said that they only rent to US citizens, and his driver’s license proved that he was from South America. It took an extra half-hour or so to find anyone at the rental agency who could over-ride the clerk. (And this has happened to him more than once! And he does not look or sound South American.)
Lathechuck
There is a specific US Army regulation stating that New Mexico is indeed one of the 50 United States, and that people from there are US citizens.
I’d call BS on this one, but I taught for years, and know that if ignorance is bliss, we have the happiest country in the world.
Brings to mind a book/novel i read as a kid. Cant remember the author or title
but it was kinda this with the genes from salmon that cause them to die after spawning
and making more money from patients dying. I hear that truth is stranger than fiction.
Our local hospital chain can’t retain nurses and staff because they don’t pay enough ( and also because they still require the COVID vax). Many leave medicine altogether as they can make more money in retail but many become “travelers” and will work at a hospital in another town for 3X the money (the only requirement for a traveler is that they must be 100 miles away).
The irony is that our local hospitals also end up having to hire a lot of travelers from other parts of the country to fill their ranks. So the nurses from our town are passing the nurses from neighboring cities as they go to work in each other’s cities.
The staff keep asking why the hospitals can’t just pay a more reasonable wage to existing staff as it would be much cheaper for the hospital, while also greatly improving morale and patient care. But apparently that level of mathematical computation is above the grifter/administrative class.
John, it is a side project, but at some point you should do a deep dive into where pharmaceuticals get their crazy names.
The last 5 drugs getting approval in 2024 were (trademark symbol omitted): Bizengri, Iomervu, Rapiblyk, Attruba and Zilhera. In the past, some of the names would often reflect the active chemical ingredient so I am willing to give them some leeway there. But they’ve gone full retard as these are just randomly generated letters (and no doubt an ad agency charged them a lot of money to come up with these absurdities).
I don’t know about the random word generator that the drug companies use for brand names, but for the generics, it’s a couple of chicks.
https://www.mentalfloss.com/article/590700/meet-two-women-who-give-prescription-drugs-their-generic-names
The biggest problem is the Depression / anti Psychotic drugs. Half the country are zombies.
Cash on the barrelhead for medical services? That’s exactly what Obamacare was designed to put an end to. The government didn’t like that US citizens were spending so much money on healthcare of their own accord. The government that thinks they can run our lives better than we can wanted medical care to be rationed. But they didn’t want to be responsible for ‘death panels’ that might make them unpopular. So they insisted everyone buy health insurance, funneling huge sums of money to the health insurance industry. In exchange, they got the health insurers to run the de facto ‘death panels’ by denying claims. We now see that this puts the health insurance industry in the sights of the people who’ve gotten denied care. Convenient scapegoats for what politicians have done.
Person 1: You think it’s funny people are taking out Healthcare Insurance CEOs?”
Person 2: “I think it’s funny that Politicians aren’t as scared as they should be.”
That is completely accurate. Amish pay cash and often are charged, not kidding, 10% of what people with insurance are charged for the same services. They also shop around for the best deal instead of just whatever hospital is in their network. Get rid of insurance and you get rid of artificial pricing (the same basic idea holds true with getting rid of student loans).
When I was young, my dad was still practicing as a family doctor. It was him and another doc, maybe one nurse and a couple of girls working the front desk. After he retired the practice had a couple more docs but probably quadruple the staff and a lot of what they did was paperwork, not healthcare.
It’s worse than that – if a provider accepts Medicare/Medicaid patients – they aren’t allowed to charge LESS than what Medicare would pay. It is apparently part of the deal – the government doesn’t want to have to pay more than someone paying cash would pay.
FWIW – one of my providers left the ‘largish’ practice he used to belong to (and where I found out about the above horrifying billing info) – and he now can charge much less. And he does, because he won’t take patients that have Medicare as their ‘insurance’, so he can actually give cash payment discounts.
“or, failing that, being paid to suck something else.”
Timeless art, there sir. The Bards and Muses all weep… because their sides are hurting like mine. I have already begun celebrating your Pulitzer!
I read years ago about, iirc, the Surgery Center of Oklahoma, and that they have completely transparent pricing. That would also be a step in the right direction.
I’d like to see medical care pricing handled the same as automotive. Prices for normal things posted (e.g., annual check ups, cold/flu care, simple x-rays), a written estimate of all costs prior to anything starting, and no changes to anything without approval. As noted in the article, this setup currently works very well in the cosmetic surgery biz (I include lasix, etc. in this).
Obviously, emergency care would need a different arrangement, but how much is actually spent on truly emergency care vs the normal doctor visit (including ER visits that should be doctor visits)?
The whole corrupt, cluster fuck can be laid at the feet of Oammykare.
A friend at a church cookout from a few years back told me that, while his wife was in the hospital, the bed alone cost $7,000 a day.
Yeah, ZFG for the assassinated CEO.
Several years back Charles Hugh Smith posted a Natal Fee Schedule from the mid-1950s for a Cali hospital. Allowing for 10X inflation, stlll inexpensive.
Back then:
Normal Delivery. No Complications: $75, (I think)
C-Section, No Complications: $150 or so
Room, 1 Day: $7, +/-
IMO, Medicare was the beginning of the end.
I checked just now. Your book should be there, by the way.
If anyone’s curious, the book in question is The Mayor of Christ Mountain. It’s a revenge story based on the murder of Cannon Hinnant. You can read it free online starting here: https://zaklog.wordpress.com/2023/08/09/april-9-2010-arrival/ There’s a “Next chapter” link at the bottom of each page.
There’s also a print edition which I’m currently mailing out myself. If you’d like one, let me know. It’s $8 print costs, $4 shipping & however much you’d like to add to that for the writing.
A bit more on topic, it’s kind of funny to me watching “approved” right-wing commentators casting people cheering the assassination as strictly a left wing thing. Nope. There are many on the right who think this was an ugly kind of justice as well.
I get the arguments against handling it this way. But when the legal system has become entirely useless to the ordinary person, some people are going to try handling it other ways.