There is plenty of blame to go around. But the foundational bad actors are the providers and the reason is the incentives put in under Obamacare make such actions almost impossible to resist. Providing full dollar coverage to everyone for everything is the road to ruin -- and it is unreasonable to think that people will look at free money and just ignore it.
Health plans make money, but there are limits on what they are allowed to make...unlike providers where there are none. Pharmas are their own problem, but under the Trump administration they actually have retreated on many of the drugs that are most used, bringing prices down substantially and, one hopes continuing to do so because of the new inability to differentially price from other countries....MFN is a great way to lower costs.
The foundational issue is the complete decoupling of patients from ANY financial decision with regard to their health. This puts large numbers of people (not including the unfortunate middle class that cannot get free insurance like illegals, anyone that claims to be poor, etc.) in the enviable position of requiring every procedure known to man for every ache and pain every day. I could tell you stories that would make your blood curdle.
The health systems have a spigot that always pays -- the wonder of government. In fact, the only modest impediment is health plans who try to restrict payouts, usually to the hew and cry of everyone who is agitated that great grandma is not getting her third hip surgery.
Remove the government intervention and this all self cures easily. Go back to selling catastrophic insurance....there are catastrophes and it is good that they can be covered. But that is NOT the expensive part of health. Let everyone (not just high deductible plan folks) keep an HSA where they can put discretionary dollars away for health.. They can then spend it on more insurance, the gym, doctor's visits -- what ever makes sense to them. And return to Direct Primary Care (really taking off...no insurance involved) for better, family-oriented care at at fraction of what is being spent now.
When offered an MRI with a 0,1% chance of finding something, patients will likely say no if it is their first dollar to decide; today they say yes because why not? When offered exactly the same colonoscopy with exactly the same anesthesia/doctors/etc. as an outpatient for $1000 or as a "hospital outpatient" for $15,000 (fairly real numbers) they will likely take the regular out patient option if they are paying first dollar. Today, the hospitals make a ridiculous amount of undeserved money from the HOPD business (with these kinds of price differentials for, essentially, indistinguishable services) and there is nothing to stop it because the actual consumer has no skin in the game. Heaven knows the insurers have tried. Doctors cannot fix this because Obamacare forced them all to be hospital employees so they just nod their heads and watch the impossibly overpriced colonoscopy feed $$ to the administration for important things like DEI officers and very high salaries.
In short, people are not mad enough because they control nothing. The substantive changes to fix this are not that difficult. But they will take away a lot of wealth transfer and thus a lot of cheap votes. As long as Obamacare forces me to buy a sex change inclusive policy (as Obamacare does) and insists on full coverage of anything someone in the mental health industry (yes it is an industry) decides to label in the next DSM as a disease instead of living normal life, this will go on. The question is, will anyone upset the apple cart? You are trying, so this should give you more directions to think through.
I agree: "Remove the government intervention and this all self cures easily." In a free market, we could hold catastrophic insurance, and pay cash for services. I would add that we should decouple health insurance from employment.
We need to swing in the opposite direction of thinking of health care as a human right, because that leads to the notion that every individual deserves the best care out there (while in practice, in a socialized system, everyone gets the worst care out there). It should be acceptable for there to be "good," "better," and "best," as there is with any product, with the price reflecting the quality. Medical care is a service, and we should be paying for it as such.
I believe that as Americans, we have asserted, and defended three fundamental rights: the right to life, to liberty, and to the pursuit of happiness, although, surprisingly, some of our fellow citizens would even dispute the first, most foundational right. I certainly do not believe we are given by God the right to rob Peter to pay Paul. Amiright?
Human rights include life, liberty and the pursuit of happiness. No one has a right to anyone else’s labor or property. A right to someone else’s labor is called slavery.
Health care can't ever be a "human right"; it is a service that requires resources. Payment for at least some healthcare is an entitlement--ie government health insurance programs. But we should view health insurance like we do other insurances--payments in case of something catastrophic happening in the future, but we don't expect car or home insurance to pay for everything our cars or homes need; we should not expect health insurance to pay for everything we need for our health either.
no, Bernie, health care is NOT a human right. health care at this stage of the game is a for profit grift, a criminal enterprise that profits off of suffering. the government should get ENTIRELY out of healthcare and allow that market to decide the price. i used to think that we needed socialized medicine like they have in europe, but after seeing how the public health bureaucracy literally murdered people during covid, the only thing i want is libertarian free market health care with NO government greasy fingers on the scale.
i'm 73 so of course, i'm now on medicare which i reserve for things that conventional medicine does well- broken bones, car accidents, gun shot wounds and some surgeries. for all the mission creep stuff, i go to doctors who got so frustrated with the system that they dropped out, got training in nutrition and functional medicine and started over. acupuncture, naturopathy and homeopathy works for me. if it's snake oil, well at least it's my choice and i'll live with the consequences.
sure, i have to pay them directly but they actually set their prices and can tell you what things cost. i've been to conventional doctors who have an entire staff dedicated to "book keeping" but when you ask them what something is going to cost you, it can take them 2 or 3 weeks to figure it out yet they expect you to sign something saying you'll pay the costs (could be thousands!) if your insurance doesn't approve.
i solve this problem by refusing to sign. if you can't tell me what your service is going to cost beforehand, i can't promise that i'll buy it no matter what it costs. suddenly, they find out real quick! if they refuse, i cancel the appointment and walk out. this nonsense doesn't stop until we make it stop.
i've never had a mammogram or a colonoscopy; i never get flu shots and didn't take any covid shots, which cost me my job of 40 years. i can imagine a socialized medicine plan that forced certain "routine" procedures on people. there was certainly talk during the "pandemic" about charging unvaccinated people more for their insurance since they were likely to "swamp the system"- unlike all the overweight type 2 diabetics. trust me, when i did have covid (2 days of mild flu, nothing worth destroying the Constitution over), the "system" was the LAST place i would have gone for "care!"
rather than being charged more, frankly i'm owed a refund for all the "routine" care i haven't made use of and i'm healthier for it!
"Stop subsidizing health care" - what does that even mean? Not give health care to people? give it only to the rich? I understand your point about useless or harmful health care, but there is some that is beneficial. People mange to have access to it in countries such as France (though the system is straining). But we do not live in an idealized world where all research is good and where we only implement useful drugs and care. So what do we do in the world we were born into (here's where the Catholc concept of original sin explains things -- it means we are born into an imperfect world).
With all my heart, with every second of the near-50 years I have served as a physician. I emphatically disagree.
I don’t like private schools or “legacy” university admission’s policies, whether publicly proclaimed or subterranean inclinations. I don’t like multitiered medicine. I have no use for concierge medicine. Everyone – everyone – deserves an equal shot and equal opportunity for equitable healthcare and an equitable start in becoming educated. After that… it’s all up to you. I do not “owe“ you a home, exclusion from standardized tests, a dollar when I pass you begging on the street, etc.
But I have done all I can to make sure every one of you who has been my patient for the past 5 decades had received from me the best I have to give. And, moreover, the best I can do in terms of improving the healthcare system I work within.
I am a firm believer in capitalism, and more power to you if you live in the Hamptons and take your concierge physician with you when you travel to Capri. Just know that I will never be that physician.
Vinay, Brilliant Piece.
There is plenty of blame to go around. But the foundational bad actors are the providers and the reason is the incentives put in under Obamacare make such actions almost impossible to resist. Providing full dollar coverage to everyone for everything is the road to ruin -- and it is unreasonable to think that people will look at free money and just ignore it.
Health plans make money, but there are limits on what they are allowed to make...unlike providers where there are none. Pharmas are their own problem, but under the Trump administration they actually have retreated on many of the drugs that are most used, bringing prices down substantially and, one hopes continuing to do so because of the new inability to differentially price from other countries....MFN is a great way to lower costs.
The foundational issue is the complete decoupling of patients from ANY financial decision with regard to their health. This puts large numbers of people (not including the unfortunate middle class that cannot get free insurance like illegals, anyone that claims to be poor, etc.) in the enviable position of requiring every procedure known to man for every ache and pain every day. I could tell you stories that would make your blood curdle.
The health systems have a spigot that always pays -- the wonder of government. In fact, the only modest impediment is health plans who try to restrict payouts, usually to the hew and cry of everyone who is agitated that great grandma is not getting her third hip surgery.
Remove the government intervention and this all self cures easily. Go back to selling catastrophic insurance....there are catastrophes and it is good that they can be covered. But that is NOT the expensive part of health. Let everyone (not just high deductible plan folks) keep an HSA where they can put discretionary dollars away for health.. They can then spend it on more insurance, the gym, doctor's visits -- what ever makes sense to them. And return to Direct Primary Care (really taking off...no insurance involved) for better, family-oriented care at at fraction of what is being spent now.
When offered an MRI with a 0,1% chance of finding something, patients will likely say no if it is their first dollar to decide; today they say yes because why not? When offered exactly the same colonoscopy with exactly the same anesthesia/doctors/etc. as an outpatient for $1000 or as a "hospital outpatient" for $15,000 (fairly real numbers) they will likely take the regular out patient option if they are paying first dollar. Today, the hospitals make a ridiculous amount of undeserved money from the HOPD business (with these kinds of price differentials for, essentially, indistinguishable services) and there is nothing to stop it because the actual consumer has no skin in the game. Heaven knows the insurers have tried. Doctors cannot fix this because Obamacare forced them all to be hospital employees so they just nod their heads and watch the impossibly overpriced colonoscopy feed $$ to the administration for important things like DEI officers and very high salaries.
In short, people are not mad enough because they control nothing. The substantive changes to fix this are not that difficult. But they will take away a lot of wealth transfer and thus a lot of cheap votes. As long as Obamacare forces me to buy a sex change inclusive policy (as Obamacare does) and insists on full coverage of anything someone in the mental health industry (yes it is an industry) decides to label in the next DSM as a disease instead of living normal life, this will go on. The question is, will anyone upset the apple cart? You are trying, so this should give you more directions to think through.
I agree: "Remove the government intervention and this all self cures easily." In a free market, we could hold catastrophic insurance, and pay cash for services. I would add that we should decouple health insurance from employment.
We need to swing in the opposite direction of thinking of health care as a human right, because that leads to the notion that every individual deserves the best care out there (while in practice, in a socialized system, everyone gets the worst care out there). It should be acceptable for there to be "good," "better," and "best," as there is with any product, with the price reflecting the quality. Medical care is a service, and we should be paying for it as such.
I believe that as Americans, we have asserted, and defended three fundamental rights: the right to life, to liberty, and to the pursuit of happiness, although, surprisingly, some of our fellow citizens would even dispute the first, most foundational right. I certainly do not believe we are given by God the right to rob Peter to pay Paul. Amiright?
Human rights include life, liberty and the pursuit of happiness. No one has a right to anyone else’s labor or property. A right to someone else’s labor is called slavery.
Is healthcare a human right? Wrong question.
Right question: Are overpriced million dollar cancer drugs (paid for by taxpayers) a pharma right?
When you ask the right question, the answer becomes more obvious.
Health care can't ever be a "human right"; it is a service that requires resources. Payment for at least some healthcare is an entitlement--ie government health insurance programs. But we should view health insurance like we do other insurances--payments in case of something catastrophic happening in the future, but we don't expect car or home insurance to pay for everything our cars or homes need; we should not expect health insurance to pay for everything we need for our health either.
no, Bernie, health care is NOT a human right. health care at this stage of the game is a for profit grift, a criminal enterprise that profits off of suffering. the government should get ENTIRELY out of healthcare and allow that market to decide the price. i used to think that we needed socialized medicine like they have in europe, but after seeing how the public health bureaucracy literally murdered people during covid, the only thing i want is libertarian free market health care with NO government greasy fingers on the scale.
i'm 73 so of course, i'm now on medicare which i reserve for things that conventional medicine does well- broken bones, car accidents, gun shot wounds and some surgeries. for all the mission creep stuff, i go to doctors who got so frustrated with the system that they dropped out, got training in nutrition and functional medicine and started over. acupuncture, naturopathy and homeopathy works for me. if it's snake oil, well at least it's my choice and i'll live with the consequences.
sure, i have to pay them directly but they actually set their prices and can tell you what things cost. i've been to conventional doctors who have an entire staff dedicated to "book keeping" but when you ask them what something is going to cost you, it can take them 2 or 3 weeks to figure it out yet they expect you to sign something saying you'll pay the costs (could be thousands!) if your insurance doesn't approve.
i solve this problem by refusing to sign. if you can't tell me what your service is going to cost beforehand, i can't promise that i'll buy it no matter what it costs. suddenly, they find out real quick! if they refuse, i cancel the appointment and walk out. this nonsense doesn't stop until we make it stop.
i've never had a mammogram or a colonoscopy; i never get flu shots and didn't take any covid shots, which cost me my job of 40 years. i can imagine a socialized medicine plan that forced certain "routine" procedures on people. there was certainly talk during the "pandemic" about charging unvaccinated people more for their insurance since they were likely to "swamp the system"- unlike all the overweight type 2 diabetics. trust me, when i did have covid (2 days of mild flu, nothing worth destroying the Constitution over), the "system" was the LAST place i would have gone for "care!"
rather than being charged more, frankly i'm owed a refund for all the "routine" care i haven't made use of and i'm healthier for it!
"Stop subsidizing health care" - what does that even mean? Not give health care to people? give it only to the rich? I understand your point about useless or harmful health care, but there is some that is beneficial. People mange to have access to it in countries such as France (though the system is straining). But we do not live in an idealized world where all research is good and where we only implement useful drugs and care. So what do we do in the world we were born into (here's where the Catholc concept of original sin explains things -- it means we are born into an imperfect world).
With all my heart, with every second of the near-50 years I have served as a physician. I emphatically disagree.
I don’t like private schools or “legacy” university admission’s policies, whether publicly proclaimed or subterranean inclinations. I don’t like multitiered medicine. I have no use for concierge medicine. Everyone – everyone – deserves an equal shot and equal opportunity for equitable healthcare and an equitable start in becoming educated. After that… it’s all up to you. I do not “owe“ you a home, exclusion from standardized tests, a dollar when I pass you begging on the street, etc.
But I have done all I can to make sure every one of you who has been my patient for the past 5 decades had received from me the best I have to give. And, moreover, the best I can do in terms of improving the healthcare system I work within.
I am a firm believer in capitalism, and more power to you if you live in the Hamptons and take your concierge physician with you when you travel to Capri. Just know that I will never be that physician.
Speak it Vinay!
Absolutely correct, and the right way to think and talk about it.
Dammit - so good to have you back but now I have to re-subscribe and also have the will NOT to scroll Substack crap. Thanks for continuing.