“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.
Heh! Oh, please, Lathechuck, let me have my fun!
Uh, Einstein, Columbia is a UNIVERSITY of higher learning in the late great state of New York, right here in the good old USA!
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.
If you have life insurance tied in, it could be profitable.
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.
Yup. Talked to one nurse that flew everywhere and made mad bank. Lives in town.
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
Very interesting. The generic names are not too bad so have to give these ladies credit for a reasonably coherent system. For brand names, there almost has to be at least some LSD involved.
Can you imagine having to come up with a brand name for LSD?
I wonder if they take bribes? If so, I’d like to slip them a few hundred bucks so they insert part of my ex-wife’s name into that of a generic hemorrhoid cream.
weGOVy, now what GOVernment moron prick son of a bitch named that drug.
And maybe one to refill for GloboLeftists: Knutsaxkz.
The biggest problem is the Depression / anti Psychotic drugs. Half the country are zombies.
Do people who are cheerful get prescribed Conzac?
Those drugs are a huge problem. 95% of problems could be solved by lifting weights (men) and getting married and having a baby (men and women).
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.”
Perfectly, perfectly said.
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.
Wow. Broken system.
Completely Agree. The new Urgent Care at the end of my street has a sign, listing ALL the $$$ prices for ‘cash in hand’ and then an * at the bottom that states something to the affect of “Insurance Plan Prices May Vary as Well as Co-Pays” Gretchen needed a visit w/out Health Insurance (she was between plans at the time) and I paid $100 OOP, with $25 for the shot, and $5 for the script, with filling the script costing me $40. Total Cost: like call it $180+/- as there was some taxes as I recall on the meds.
We had to go again after her new Health Plan Kicked in: Total cost, no bullshit was like $1200+, with the Co-Pay being $50 ‘cos it was an Urgent Care visit.
Extortion/Overcharging, just because they can.
And thank God they busted the kid for the CEO hit. That very day it happened, We got a denial from United Health for Gretchen’s ALMOST bleed-out, the ER visit and subsequent 2x days on inpatient care. $25k.
I told people I had witnesses and an alibi.
Yup. And so much is defensive.
“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!
Thank you! It was a last minute add!
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)?
That should also apply to insurance as well. Car insurance doesn’t cover general maintenance or oil changes so no reason health care should cover routine care either. Medical insurance should only be carried for very expensive things like surgery. If people have to pay for basic office visits out of pocket, then costs will come down quickly as they seek out the best value.
Absolutely. I referenced them in a (way) earlier article. Good people.
The whole corrupt, cluster fuck can be laid at the feet of Oammykare.
Oh, Ted Kennedy did a number. And so did Hart-Cellar.
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.
I paid a medical bill, and for an in-full payment they had a “tax return special” of something like 50% off. Not kidding.
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.
https://www.reddit.com/media?url=https%3A%2F%2Fexternal-preview.redd.it%2F1tLglKA7CQSpKw6H8T8XhODtvP118uj_mlHQ1dviaDA.jpg%3Fwidth%3D1080%26crop%3Dsmart%26auto%3Dwebp%26s%3Da469ed37b8dd265ea9dd38dfef1102b9f7e1e315
https://www.reddit.com/media?url=https%3A%2F%2Fpreview.redd.it%2Fhbd1c4pxir131.jpg%3Fauto%3Dwebp%26s%3De4e1b400bbc7ec20d1cc51889a1b05d0c6d9dfd9
https://www.reddit.com/media?url=https%3A%2F%2Fpreview.redd.it%2Fi5hghc8fqhn41.jpg%3Fwidth%3D1080%26crop%3Dsmart%26auto%3Dwebp%26s%3D901ae82947219d0573566aadbf67be50c02f85c2
https://www.reddit.com/r/TheWayWeWere/comments/13qzk1l/hospital_bill_1950/#lightbox
Note the tax charged
Yes. Our system is so sick.
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.
Yup, here! I recommend it!
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.
The “approved” get paid by those same systems.
The problem with outlawing insurance is that it is a good idea to mitigate risk, which was it’s original purpose. The ability to pay $X/ month and not have to worry that you might need $9999999999X to save your kid some day is worth the cost. Much of the modern problem with insurance is that it got away from this and became a power unto itself, along with the medical malpractice industry. They don’t just provide a service, they make rules about how people must live their lives and how companies can run their businesses. Rein those things in somehow, and it could still be workable.
Perhaps make things more local. For example, a previous employer’s dental insurance was terrible, so I dropped it after doing some research. There was a local dentist who offered a yearly membership at $X. The price of 2 cleanings was $X. So it basically paid for itself. Then on top of that, you got 40% off every service. No prior authorizations, no paperwork, just make appointment, go to appointment, pay, done.
But it became widespread because of wage and price controls during WWII. We’d be better off without it.
Don’t forget employers dock your overall pay whether you take their proffered insurance or not, with a very few tossing a bone back if you “opt out” of the plan.
IIRC, you pay about a quarter or so of the total insurance cost, so you’d get back about 4x your monthly vig and most likely enough to pay OOP anyway.
A visit with a NP and a spot of bloodwork costed me $500 because I only go once a year and don’t come close to my $3500 deductible.
I pay a shit-ton more in monthly premiums.
Yup. Some folks pay a grand or more.
You’re right, John – health insurance offered by one’s employer became widespread as a way to ‘get around’ wage controls during WWII. By paying the cost of health insurance for the employee – you ‘raised’ their compensation package, w/o breaking the wage/price control rules and w/o causing the employee to have to pay more taxes (the value of the insurance benefit wasn’t taxable). Plus, it enabled ‘pooling’ of folks to allow cheaper plans – making the cost to provide this new ‘benefit’ somewhat less than the employee would have paid as an individual. It was a clever way to, as they say: ‘work the system’. And as always, if this impacts the stakeholders with the money (big insurance, big government) – the rules will be eventually be changed to benefit them.
Yup. And look at what that one work around has done.
You got it mostly right:
1) Cash for all services. Just like every-effing-where else in America, for everything.
2) Repeal EMTALA. Healthcare isn’t a right, it’s a service. Cash or card?
You got the dough, you get Cadillac care. Not so much? You get Yugo care.
Just like every-effing-where else in America, including restaurants and car dealerships.. (Clever readers may spot a a trend building.)
3) No “reasonable” cap on malpractice. Just institute “loser pays”. You sue for $1M and lose, you don’t just owe the winner’s legal bills, you get fined $1M dollars. You will pay every last cent, even if it means you’ll live in a cardboard box under a bridge and eat dog food until you die. Now, think really hard before you come up with a settlement number. And Joe Average x minimum wage x 2000 hrs/yr x 50 yrs = <$2,000,000K. And that would be only if you were dead, or paralyzed, or the like, and it was done maliciously, or after gross negligence. So for most cases, work downward from that number – waaaaaaaaay downward – for a fair settlement amount, using your salary, and your working career years left as the baseline. No more lottery payouts.
And the other side gets to bring in the fact that you drink like a fish, smoke like a chimney, have 37 speeding tickets and ten arrests for violent crimes, and are 80 pounds overweight, and uses those modifiers on any number you think is fair. Own your poor life choices.
4) Medical services are a crap shoot. You accept that up front. You’re free to go to the doctor you think is best, you can have them independently rated, but there are no guarantees, and when things go pear-shaped, and you can’t prove malice or gross negligence, you suck it up, and move on. You came to us – we didn’t go to your house and drag you to the hospital kicking and screaming, and force you to get care. Own that, and expect that in good faith transactions, life – and medicine – is unpredictable. Lump it, Skippy. And unless the doctor sawed off the wrong leg in a drunken stupor, you get Jack and Sh*t if your budding kazoo career is tragically cut short by a bar room fight and lip laceration repair that leaves you with a lisp and a wicked ugly scar. And nobody gets out of here alive, so the baseline we agree on is that with no care, you might die, and work upward from that outcome.
5) After your third admission for intoxication or overdose, you get a permanent UV tattoo on your forehead that says “DNR – No 9-1-1”. You are free to f**k up your life as you see fit. But medical resources are finite. Three strikes, and you’re out. Now, you also own the consequences, and there will be no 4th dose of Narcan the next time you do all the carfentanil you can buy and then stop breathing, nor any more librium for your DTs when you start withdrawing from alcohol. Live on the curb, die on the curb. Too bad, so sad, and Requiescat In Pace, Loser.
6) In Napoleonic times, they had free healthcare for everyone, with one caveat: you had to follow the doctor’s orders for your care. You could always refuse, but once you did that, they picked your pallet up, carried you to the curb outside, set you down next to the gutter, and bid you “Adieu, Mssr. God be with you.” and you were done. We need to bring back that level of medical autonomy. You want to direct your care, instead of participating in the care dictated by the one person, between the two of you, with 10-15 years of medical training, board certification in their specialty, and any number of years of practice? DLTDHYITAOYWO.
Do those 6 things, and medical prices will drop like it was Disney stock, or ratings on any show on MS-LSD, and quality of care will skyrocket, not least of which because there’ll be 50% fewer deadbeats buying it.
7) For those that didn’t know this, drug names are given by the guy at the Amtrak station announcing the trains, and when he’s on vacation, they record alcoholics mumbling in their sleep, and select randomized phonic snippets. Pretty much like how the NSA generates 256-bit encryption based on random noise from background radiation in space.
I hope that clears it up for you.
You’re welcome. 😉
You’ll get no argument on these, especially when compared to what we have now.
That’s 30 years of first-hand experience talking.
I can count medical errors responsible for bad outcomes on my thumbs.
Patient’s errors, starting with poor life choices? I’d need a Cray supercomputer, and a staff bigger than the IRS.
There’s a reason I tell people that I work in the ER as a lifeguard for the shallow end of the gene pool.
I’m not kidding.
I believe it. How often do you come face to face with, “Well, that’s a new one.”?
95% of everything I see, I’ve seen 10,000 times.
There are new things under the sun, but they’re rare.
Since about a year into this job.
Times something comes in that nobody had seen or heard of:
Again, you could count them on your thumbs each year.
New ways to screw up? Sure.
New afflictions? Not so much.
And after the first 500 traumas, they’re all the same (in how they’re handled), even when they’re different.
COVID was new, in that people don’t normally come in with their oxygen at >96%, and drop into the 70% range within a shift, and get intubated before they crash.
But the internet is full of medical soopergeniuses earnestly assuring me not to trust my lying eyes for the first year of seeing that, because “it was just the flu”.
That was my guess – it’s unique to them, but to an experience pro it shakes out fairly quickly.