Imagine this scenario. As you hang in your driveway a large tree branch snaps and falls directly on top of you. You survive, kinda like an episode from the Oregon Trail, but need medical care. You think you’ve broken your arm. A broken arm, unless broken in multiple and unusual places, is pretty simple to treat from a medical standpoint. The arm needs to be isolated and prevented from moving so that the bone can heal and fuse back from whatever break exists. Ninety-percent of the time, that means a splint or cast. Yet, I bet, none of us know in advance, how much it will cost to treat the simple broken arm.
A quick check on google reveals countless stories of broken arm costs. $12,000 and counting here. $20,000 here. Granted both stories involve surgery and pins, but nothing out there in a 20 minute google search revealed a price list, national or local, that outlined what the cost of a broken arm should be. That is the underlying problem in healthcare right now. Despite all the talk about nationalizing healthcare, universal healthcare and free markets, no one is talking about the obvious flaw in how medical care is priced. You don’t know until you go, and rarely if ever, do you get an estimate for what that care could cost. In short, we don’t really have choice in healthcare once past the “choice” we make in health insurance provider.
Meanwhile, when it comes to nationalized health care, if you actually look at the numbers, we are pretty much there. Daniel Gross writes in a 2006 New York Times article that after looking at the numbers, we tax payers already pay for healthcare for about half of all U.S. workers. Is this right? He explains:
Out of a total population of about 300 million, 35.6 million elderly Americans were on Medicare in 2005. Of the working-age population, which reached 257.8 million in 2005, some 45.5 million were covered by Medicare, Medicaid or military health programs, according to the benefits institute. An additional 18.2 million workers had health insurance through jobs in the public sector, which includes state, federal and local governments, public schools and state universities, according to Paul Fronstin, director of the institute’s health research and education program. Millions of those workers’ dependents are covered as well. Even if those dependents are not included in the tally, taxpayers paid the bill for almost two-fifths of all Americans with insurance in 2005.
When you total up all these federal expenditures, you get the startling conclusion that government spending alone, exceeds the spending of nationalized healthcare programs in places like Canada, at least according to the experts quoted by Gross:
The government spends money as if there were a national health insurance program. In 2004, government spending on health care equaled 9.6 percent of the gross domestic product, compared with 6.9 percent in Canada, which has a single-payer universal health care program, said David Himmelstein, associate professor of medicine at Harvard Medical School. And yet some significant components of federal support are not efficient methods of providing health insurance to the people who most need it. Higher-income workers are likely to have higher rates of coverage, higher premiums and higher taxes, all of which means that the tax break for compensation disproportionately helps the well-off.
“We’re paying for national health insurance, but we’re not getting it,”ť Dr. Himmelstein added.
So if the numbers don’t lie, the arguments for or against federalized healthcare are somewhat false. The better argument would be how to make what federal dollars we do spend obtain better results. So we’re paying for national healthcare already, yet aren’t getting any of the benefits of service, unless you are a senior or veteran.
The truth about the health debate is that healthcare costs are beyond the control of government as long as the present system of private insurance is used to pay for basic health care. There is no debate that serious health issues require the common good of shared costs distributed through some form of insurance. But basic care that includes things like broken bones, colds and flus, sprains and allergies should be delivered in more cost effective formats.
That’s why we really need to take a look at an industry that has figured out how to commoditize basic stuff, like food delivery. I don’t mean Walmart, but McDonald’s. Immediate medical care facilities that offer fixed price care for a menu of services. Fast, no waiting service and 24 hour service would fill the need to support people who have difficulty fitting in a visit to the doctor. The ability to refer more complicated cases that would invariably come in to other care givers whether hospital or private practice. Sure, there are more details to be sorted through, but the framework exists in other industries and once did for healthcare too. Manufacturing plants were once well aware that providing low cost on premise healthcare to its workers kept the plant productive.
But this scenario will not work as long as the payment for services trickles through the insurance middlemen. There is no incentive for health care providers to reduce costs when they have to play the game of filing paperwork in order to get paid, if they get paid. There is no incentive for patietns, that is you and me, to pick the most cost effective treatment because we don’t know what the treatment costs are.
The insurance industry should be required to pay bills submitted by any facility that posts a fixed fee for treatment immediately. Why not eliminate the administrative costs of the basic most routine care? Why force itemization of treatment on a broken arm?
Affordable basic care should be available to everyone, and under our health care insurance system its not and won’t be until the industry and government starts talking about how the consumer can see what the costs truly are. Under proposed health care reform, the cost of a broken arm is still unknown. That is a problem.
New York Times National Health Care? We’re Halfway There By DANIEL GROSS Published: December 3, 2006
It depends on where you go for treatment and also which part of the arm is broken. If it is a simple, clean fracture of the forearm requiring an elbow to wrist cast and you go to the Emergency Room it will cost you a set amount but you could be billed for additonal services, such as ambulance, X-ray and sometimes medications.
If you go to your private physician, it’ll cost you another amount. The same is true if you go to an IMC. Clinics often base their bills on a sliding fee scale. Some HMO only cover part of the bill for certain portions of the services.
Break your upper arm, and you got a different cost because the cast will most likely be from shoulder to wrist and require more care.
It would be interesting to do a survey and see what it would cost to have a simple fracture cast vs. a more complicated fracture at the different venues.
Bic Macs don’t have too many variants. But 40 cents on the dollar is not spent on paperwork and lawyers. Since there are more lawyers in law school today than have passed the bar exams and there are fewer medical students adjusted for population growth, health care can only get more expensive and less predictable in terms of cost structures.
Prediction: we will get national health care which will amount to more taxes and more waste. Those who can afford premium health care will pay for it out of pocket on top of the taxes – just like is done now – and the status quo bellyaching of how unfair it is will never stop and we’ll have another million employees on the government payroll pushing paper.
Bryan–You GET it !
You want to see what government-sponsored health care would look like for the rest of us, just visit your local Veterans Hospitals.
If your government can’t even take care of its veterans properly, how do you expect it to take care of anyone else properly?
From what I hear government employees and members of Congress have a pretty sweet plan that works very well, so your attempt to politicize the topic falls flat.
So when you show up at the ER with your broken arm and they quote you a price you don’t like, just how many other ER’s do you plan on visiting before making your decision? Price transparancy may be helpful with proceedures such as Lasik but really doesnt’t help with emergency or urgent care situations.
#5 Members of Congress don’t want to be included in the national health care system.
Wonder why?
Yeah, #5, that’s why there was such a scandal last year about Walter Reed and the mistreatment of veterans there and at other veterans’ hospitals around the country. Guess you don’t read the news much. Or you only read what you are told. I saw a bumper sticker today that reminded me of you. It said “Can you think for yourself? Or do you need the media to do your thinking for you?”
Really? Where are you getting your opinions from, shit-fer-brains (#8)? Given your prejudice against the media, it must be the GOP. Well, from the GOP’s own beloved Heritage Foundation’s website:
“Federal employees and retirees covered through the FEHB (Federal Employees Health Benefits program) are not “hostage” to a single carrier selected by their employer. Instead, they enjoy a broad array of options. In 2003, 188 discrete options are being offered by 133 health plans.
An important and distinctive feature of the FEHB program is nationwide availability. No matter where one lives–from Portland, Maine, to Portland, Oregon–every enrollee can choose from at least a dozen options offered by nationwide fee-for-service/preferred provider organization (PPO) plans.
Some members may elect one of the six nationwide plans limited to members of sponsoring organizations (such as the Foreign Service Benefit Plan). Many may select a health maintenance organization (HMO) in their geographic area.
New Web-based tools in 2002 let federal employees and retirees get on-line premiums and compare benefits and customer satisfaction ratings of national and local health plans. They can make the comparisons from their homes, from their offices, or any other place they can surf the Web. By increasing access to information, we are encouraging our employees to get the facts so they can make the best choice for themselves and their families. We continue to expand our use of the Internet as a communication and resource tool.
This is the future of health care. We know that young people especially are turning to the Internet as a primary source of health information. But do not underestimate the seniors. We are finding our retirees are quite computer-savvy. Close to a million annuitants accessed the OPM Web site in 2001, and that number continues to grow.
Young or old, all Americans want quality health care choices and options. And that is one of the great strengths of the FEHB model.”
And as to the failure of the VA hospital system, you can look again to the turds lying in your own backyard as to why it has let down our soldiers:
“Bush’s Record on VA Funding
For his part, Bush stacked the VA with political cronies, such as former Republican National Committee chairman Jim Nicholson, who as VA Secretary defended a budget measure that sought major cuts in staffing for healthcare and at the Board of Veterans Appeals; slashed funding for nursing home care; and blocked four legislative measures aimed at streamlining the backlog of veterans benefits claims.
Of the 84,000 Iraq and Afghanistan war veterans diagnosed with post-traumatic stress disorder by VA, only half, about 42,000, had their disability claim approved by VA. Instead of expediting PTSD claims, Bush’s political appointees at VA actively fought against mental health claims.
Bush’s appointees also obstructed scientific research into the causes of Gulf War illnesses dating back 18 years to Operation Desert Storm and opposed medical research on treatment for 210,000 of those veterans.
As for funding, Bush proposed a 0.5 percent budget increase for the VA for fiscal year 2006, which amounted to a “cruel mockery” of Bush’s promises to do everything to support veterans and soldiers, Rep. Lane Evans, D-Illinois, said at the time.” – from http://pubrecord.org/
Uh, it seems that only the first quote is from the Heritage Foundation site, which is actually an interesting read:
http://www.heritage.org/Research/HealthCare/HL792.cfm
Amazing how your straight forward article can be politicized by the zealots. As a layperson I wonder why doctors don’t have simple hourly rates. Like any other service provider, all they are selling is their time. Why should an hour of time spent on one person cost any different than an hour spent with another (medicare patient v. insurance covered patient)? If you are a brain surgeon – you get a very hefty hourly rate because you are dicking around in someone’s brain. If you are an internist – you get a much lower rate. If the broken arm in your example takes two hours to fix and write up – the doctor’s bill (not hospital and all the other charges) is two times his hourly rate – no matter how difficult or easy it was. People could plan ahead by researching the doctors they want by reputation and hourly rate. The better the doctor the higher the rate (good old capitalism), the bigger the city (geographic cost of living) the higher the rate.
Well of course, Steward; #9 is hoping to pass off the rest of his blather as unadulterated fact. Happens all the time here.
Memo to #11 & #12:
Please note that the followong contains only information & no personal invective.
The facts as to the atrocious conditions at Walter Reed is not blather. Neither is the fact that VA advocates were expressly forbidden to advise wounded vets as to all the services and options not just available, but due them as a result of their service incurrred wounds. Further, wounded service personal sent to Ft. Stewart, GA languished in the intense summer heat in un-air conditioned WWII era barrcks on acres of sand & scrub. Some went for weeks and months, according to reports, without any significant treatment for their wounds. Bush, who ran on better treatment for veterans, cut VA funding after gaining the White House. When forced by Congress to restore funding, he claimed it as an increases.
That said, the MediCare legislation that went through under Bush had a prescription drug component that was quite remarkable. The first thing was the inclusion of the infamous “donut hole”, which makes no sense to me. The other was the government decision to not seek negotiated Rx drug rates with the pharmaceutical companies. That deal is at least explainable…the legislation was written by Big Pharma. Rep. Billy Tauzin of Louisianna was one of the honchos on the committee. He left congress, even before the legislation was passed, to take a $2,000,000.00 a year job as the head of a DC lobbying firm that represented…class, let’s not always see the same hands…Big Pharma. However, the statement from his office said that no connection should be made between the two events. How much could seniors have saved if the gov’t could negotiate the cost of Rx med’s as do company & Union health care plans?
Avatar states: “The facts as to the atrocious conditions at Walter Reed is not blather.”
Thank you very much for proving the exact point I was attempting to make to Anonymous #5/#9.
Avatar, pearls before swine. Obviously some people with agendas only read as far as their comprehension allows before arriving at a pre-determined conclusion.
#14 – I don’t think you can say that I proved your point so much as I supported your point, although I obviously agree. However, I’m sure the reports of leaking pipes, standing water in rooms, paint peeling from walls & ceilings, etc., etc, can still be accessed via the internet (because nothing ever goes away) as can the Ft. Stewart, GA conditions as the existed a couple of years ago. I have a real problem with government – no matter which party – that uses service personnel for its own cynical purposes, fails to provide adequate protection in the field and then neglects them on the back end.
In that regard, I encourage you all to look into Operation Helmet. It was started by a Navy surgeon who saw that the helmet suspension and chin strap systems were improper for protecting against brain trauma caused by the cuncussive forces of IEDs. He designed a new system, tailored for both army & marine helmets (they’re different in some ways). The government deigned to go with them, so he set up Operation Helmet to receive donations to supply the new systems to the men & women in the field.
Also, you can rest assured that even though it’s all government health care programs, the level of care that the Executive, Legislative and Judicial branches receive is vastly different from what the military or the postal workers get.
Meanwhile – sometimes it’s hard to tell all you anonymous guys apart. Can’t you think up snappy screen names?
Ever see the movie “Born on the Fourth of July?” The VA Hospital system was a mess during the Viet Nam era so the problems are systemic.
The Bush administration was responsible for making the situation far worse – especially considering the numbers of service personnel that they put in harm’s way by virtue of having lied to justify the reasons for doing so.
Oh, right, I forgot, everything is George W. Bush’s fault.
Except that there were 7 other presidents –
Johnson, Nixon, Ford, Carter, Reagan, Bush #1, and Clinton – whose track record with VA hospitals is far worse than Bush’s, especially when you consider that the same conditions exist today that existed during the terms of each of every one of these presidents and NONE of them did anything to correct it.
They should ALL be taken to task, not just Bush. He merely inherited problems ignored and/or made worse by his predecessors.
Bush took a bad situation and AGGRESSIVELY went about makng it worse.
Uh-huh. Yeah.
Which doesn’t absolve any of the previous administrations’ ignoring of the existing situation. Quit trying to make Bush a scapegoat for everything gone wrong with this country. There were others before him who contributed just as much, if not more in some cases, than he did.