Where would meals be better and cheaper? A city where customers could choose between restaurants competing in a free market? Or a city where everyone was forced to buy all their meals at a few mafia-controlled restaurants?
Like the mafia, Congress wants to make you an offer you can’t refuse. At least the mafia doesn’t pretend that it’s acting for your own good.
Hey, it’s the Chicago Way.
Al Capone lives.
I guess that makes the SEIU the mob.
Except that our “restaurants” (aka, Hospitals) …
1. Don’t have prices on the menu, destroying price discipline, and charge those without “meal insurance” as much as 1,000% more than those who do.
2. Charge a la carte for each square of toilet paper.
3. Aren’t allowed to turn away bums that show up hungry and can’t pay, but are required to provide them the same level of service as a paying customer.
4. Aren’t required to disclose how often they accidentally give their customers food poisoning.
5. Are required to honor government-provided meal coupons for 10% below the cost of services.
6. Serve some of the shittiest food found in America. (That’s not part of the analogy, just truth).
Etc. etc.
We actually do need healthcare reform in this country. Just not the reform we’re getting. Hospitals are very much protected from competition in price and quality, and our insurance market is highly fragmented and would benefit greatly from the creation of a national market.
Czech Border Guars in Stripes: “Chicago! Bang, Bang!!”
If everyone shopped, even with vouchers or HSAs, then most of Brock’s complaints would go away. Hidden pricing and bad customer service is only possible when the government stifles competition. Any doctor or hospital would easily make a killing by simply stopping those practices. but right now there is zero incentive to end those anti customer practices, because people don’t pay attention, someone else is paying. As long as someone else pays those problems will continue, it’s human behavior. No amount of regulation or laws will ever stop that.
Ah I think that was your point. 🙂
plutosdad,
Yeah, the government currently “stifles” competition in a number of ways, mostly by failing to enforce a competitive market. Markets are good, but they need transparency to function (so that consumers have the information necessary to make demand-side decisions). B analogy, the SEC plays a vital role in our being the capital markets capital of the world (even if they overplay that role occasionally) and the FTC is nothing but good.
There’s a proper role for government in the health care space. Consider how cars are required to undergo crash safety testing and disclosure; we could use a similar testing and disclosure system in healthcare, where prices and outcomes are disclosed in a fair and same-across-the-board manner. We can’t really rely on the private sector to do that voluntarily though, because each provider will always have a (short term at least) incentive to cheat.
You’re 100% correct though about consumer behavior. One of the single best things Congress could do to improve the efficiency of healthcare would be to outlaw any “insurance” policy with co-pays/deductibles of less than $1,000.
I still don’t understand the “certificate of need” system that affects hospital placement in Georgia and, apparently, a great many other states.
Like all legislative restrictions on market entry, it serves a dual purpose.
First, it makes hospitals more profitable. By keeping new entry from occurring, it allows the existing market participants (the already established hospitals) to charge higher prices than they could in a competitive market. After all, it’s price competition from Toyota and Hyundai that’s putting GM and Chrysler out of business, and who wants to go out of business?
Second, what’s profitable for the beneficiaries of regulatory protection is also profitable for the regulators – in the form of campaign contributions, free tickets to black tie events, free dinners, and other sorts of kick-backs. After all, you can’t afford caviar and private schools on a civil servant’s salary, so the money has to come from somewhere.
Of course, from the voter/consumer’s point of view it’s all waste, fraud and theft. But the current electoral system is set up such that you get to choose between two near-identical Parties that have maintained a controlling cartel on the political money spigot since before the Civil War, so you can’t really expect “Change” from ever arriving. “One man, One vote, Plurality Wins” is just another form of protection from market entry for the incumbent Party. You can follow the link to my blog in my name for more examples, and solutions.
Christ, yes, Brock. Right on.
Just imagine a world in which, instead of fscking around with 1,100 page Whole Earth Solution bills almost guaranteed to really bugger things up, we had a rational and helpful government that did things like set, researched, and published hospital and doctor efficiency and efficacy standards, blew the whistle on sneaky and collusive practises, kept the big providers honest.
You could go to a nice government web site and look up in four clicks which of the two local hospitals has a better survival rate for people who come in the ER door with chest-pain. You could look up which health-insurance company gets sued by irate customers more often and gets hammered in court by irate juries more often. You could find out which urologist in your area has done more prostate surgeries, and which have had better patient outcome.
I don’t doubt that some of this can be — and already is — being done privately, but one of the virtues of government in terms of information collection and dissemination is that it can do it over a huge area and time, it can be subsidized from tax money so that everyone, not just the well-off, can get the information they need to make good decisions, and it can force disclosure when that would not be in the self-interest of the providers (e.g. if they are no good).
Or imagine a nice government-certification program. Physicians or hospitals could submit evidence of proficiency and training, and earn certification ratings. You don’t have to, but if the ratings are worthwhile — reflect what people really value — then the market would clearly set a higher price on the certified provider, and it would be worth your while.
Well, we could go on. But just imagine a government that wanted to help you decide instead of deciding for you. Wouldn’t that be a wonderful change?
Al Capone wouldn’t sock us with carbon taxes. I’d vote for him over Obama.
Racist!
The 2010 commercial writes itself.
A crew of hardened thugs right off the set of “OZ,” all comparing notes – “What you in for?” We get the favorites; murder, kidnapping, rape, etc.
Last person to answer’s a nervous college-aged kid, who replies “I, uh, didn’t have enough money to buy health insurance.”
Hardened thugs stop, look at the kid, and smile as widely as they possibly can.
Damn, Titus, you’re right. I forgot to use “change” in the official Minitru-approved fashion. I better flag myself immediately.
And just in time for today’s debate, the AP helpfully lets us know what life would be like under GovernmentCare right here. The essence:
Most women don’t need a mammogram in their 40s and should get one every two years starting at 50, a government task force said Monday. It’s a major reversal that conflicts with the American Cancer Society’s long-standing position.
Now as long as that’s a recommendation, then whatever, this is fine. Healthy debate between professional organizations and all that. The consumer can only benefit from more than one point of view.
However…under ObamaCare, what do you suppose are the odds that a “recommendation” like this from government turns into a requirement? After all, government needs to define what insurance plans are “acceptable” for government subsidy, i.e. which people will actually be able to buy, since their health-insurance money was taxed away, and they don’t have it to spend unless the government generously returns it as a “subsidy.” Who can doubt that a “recommendation” like this — that reduces government costs! — will be quickly folded by Congress into the definition of “acceptable” health-insurance plan?
I see I have no suckers raising their hands to take that bet. So now a second survey. Raise your hand, any of you whose woman had a mammogram well before age 50, and whose life was thereby saved because a tumor was found when it was small and treatable?
I’m raising my hand, folks.
Funny, I read everything before that last part and thought about the Group W bench instead, with all the mother-killers and father-rapists shifting as far away from the kid as they could get.
Brock, insert a #7: Restaurants that have high-priced lawyers waiting in the lobby to help you, when you have a touch of indigestion, to sue the restaurant for a hundred times the price of the meal you just ate – with a very high chance of winning the suit, because all the jurists think that restaurant owners are thieves.
Health care reform is just not going to work without tort reform. Making “no win no fee” arrangements would go a long way.
Evidence? The opposite change was made in the UK some years ago – and the cost of public liability insurance, for any business at all, skyrocketed.
Fletcher,
Tort reform would benefit different practices to different extents. Ob/Gyn’s seem particularly susceptible, but many practices are largely unaffected. CT scanning labs don’t get sued often, but they still cost 500% more than what other countries pay. Reforming the other bits would get 95% of the benefits, even leaving tort reform the way it is.
That’s not to say that the current tort laws are socially optimal. Far from it. But reform absolutely can improve our system without it.
Just DON’T call it a Death Panel! I’m covering up my ears — la la la, I can’t hear you…
And here is today’s foreshadowing of the future, courtesy of the AP:
For the first time, a miniature heart pump shows the potential to become a widely used, permanent treatment for many older people with severe heart failure. But can we afford it? In a study… the new device increased by four times the number who survived at least two years…However, the HeartMate II costs $80,000 plus $45,000 or so for the surgery….Even now, “the amount of money spent in the care of advanced heart failure patients is extraordinary,” said Dr. Robert Harrington, heart research chief at Duke University, “These are societal questions– how much is too much?
Now, no one doubts that $125,000 is a lot of money. But it’s not that much. Probably most middle-class people over age 65 could take that out of the equity they have in their home, even if they hadn’t (for example) bought a private catastophic insurance policy that would cover most or all of it. It would mean a big reduction in what they leave their kids, of course. Probably some constraint in how they live their retirement. But what is the value of several more years of life? Or a more comfortable life, being able to go up stairs without assistance? Maybe the kids are already rich, and would prefer Pop get the widget so they can sing Happy Birthday to the old man a few more times. Or maybe Pop would rather the money go to help his grandson, who was born with a sad birth defect that needs expensive surgery. Who knows?
Now, you might think the one whose life it is and whose money will be spent ought to decide the answers to these seemingly very personal questions.
But you’d be wrong! Totally out of step with these bright new Hope ‘n’ Change times! As the good Dr. Harrington says (perhaps channeling the doctors of the Third Reich, or eugenics adherents from the 1920s), these are actually “societal” questions. You shouldn’t be deciding whether you want to spend your savings prolonging your life. It’s a societal question! Your elected representatives will decide for you, and let you know their decision by and by.
And don’t even think about going rogue and getting the procedure done without their approval. You can’t. They already took away the savings you might have used to pay for it, in the form of taxes on “the rich” to pay for our wonderful national healthcare.
Hey, what are you complaining about? Your health care is free! And universal!
Reading Carl’s post really, really depresses me. I wish secession were easier; I don’t see the Leftists letting Federalism ever really happen, but I bet an independent Texas wouldn’t go down this road. I hope.
Okay folks, next time someone decides to form a more perfect Union, make sure the Federal level gets the duty to enforce a 1st and 2nd Amendment against the States, running the military and nothing else. Clearly Congress critters just can’t be trusted to legislate on anything. The only voting that seems to get results is the “with feet” sort.
Of course, occasionally I really wish I could vote with my foot – by putting it 3′ up their collective asses.
Mother rapers. Father stabbers. Father rapers! Father rapers sitting right there on the bench next to me! And they was mean and nasty and ugly and horrible crime-type guys sitting on the bench next to me. And the meanest, ugliest, nastiest one, the meanest father raper of them all, was coming over to me and he was mean ‘n’ ugly ‘n’ nasty ‘n’ horrible and all kind of things and he sat down next to me and said, “Kid, whad’ya get?” I said, “I didn’t buy health insurance.”
OK, one more, just to bring these things into focus.
Now we all agree that the United States spend beacoup bucks on health care. I mean lots of cash. Not so much, of course, that anyone actually has to choose between buying food and buying antibiotics, or has to live in a cardboard box over a heating vent to be able to pay for his Lipitor.
But certainly a fair amount of the extra wealth we might have expected to reap from the improvements in our productivity over the past 20 years have been eaten up by a bigger and bigger chunk of our salaries that has to go to paying for our health plans. It’s routine that about 1/4 of a man’s total compensation these days goes straight into his health plan as premiums, paid either by himself (particularly if his self-employed) or by his employer. That’s impressive. And way more than our grandfathers paid, and (as ObamaCare groupies never tire of pointing out) way more than the Brits or Canadians pay.
So what do we get for all that dough? Does it just line the pockets of eeeevil doctors, nurses, and hospital CEOs? (I don’t doubt a good chunk of it lines the pockets of the teeming millions of trial lawyers, but that’s a story for another day.)
Once again, the AP provides us with a nice story here that connects the dots:
“Malaria. Tuberculosis. Alzheimer’s disease. AIDS. Pandemic flu. Genital herpes. Urinary tract infections. Grass allergies. Traveler’s diarrhea. You name it, the pharmaceutical industry is working on a vaccine to prevent it. Many could be on the market in five years or less. Vaccines are no longer a sleepy, low-profit niche in a booming drug industry. Today…the lure of big profits, advances in technology and growing government support has been drawing in new companies, from nascent biotechs to Johnson & Johnson. That means recent remarkable strides in overcoming dreaded diseases and annoying afflictions likely will continue.”
That’s where at least some of all that money is going, folks. Big profits, as the AP says. Which means not just that J. Random CEO gets a new Bentley each year, but also that smart young people in college can see they’ll earn better money as PhD biochemists than lawyers or accountants, and lab techs have good wages and excellent benefits, and grannies holding biotech stock in their 401k’s worry less about the impending implosion of Social Security. (I mention that only because people seem stupid about the fact that, unlikely the huge amount of money we spend on imported oil, nearly every single health-care dollar spent by an American is earned by another American. It’s not like our wealth is going down some Middle Eastern dictator’s rathole, as it is when you fill up at Chevron perhaps. It’s helping some RN put a down payment on her house in Okalahoma City, or a smart guy with a PhD pay the tuition of his equally smart daughter at Princeton.)
And the lure of those big profits is — and I know all you leftists are going to have to sit down for this terrible surprising shock — driving tremendous innovation and creativity in the kind of technology that can add years or decades to your life in the near future, at the marvelously low cost of a one-time shot in the arm.
By the way, did you notice that the firms mentioned are all American? That’s the way it is in biotech. You can be quite sure you’ll never see a vaccine or new wonder-drug coming out of a European market, imported into the US. Why do you suppose that is? Good old American values? Our racial superiority? Or is it the fact that only in America is brilliant life-saving work in the field of medicine rewarded with big profits?
So here’s the choice before us all next year. The Democrats would like you to pay a smaller fraction of your take-home pay to the evil monstrous healthcare industry. They promise to use the force of lawyers and jail to squeeze all the big profits out of such things as R&D into vaccines for tuberculosis, or Alzheimer’s, AIDS or cancer.
But they solemnly promise that that does not mean that the research into those things will stop dead cold, and your health care in 20 years will look pretty much exactly like it does today, without any of the marvelous technical advances we’ve seen in the last 20 years.
Really, they promise, cross their hearts. Don’t you believe them? Don’t you believe that if you clap your hands, Tinkerbell will live?
Brock,
Your info about the insurance liabilities of scanning labs may well be correct. However, what proportion of scans and tests(of any type) are carried out purely because the physician ordering them is trying to cover himself against the possibility of a negligence suit if the test is not ordered? A test that isn’t really needed at all is infinitely more expensive than it should be. Literally infinitely.
In the specific case of CAT scans, there is also the point that unnecessary use of X-rays (and a CAT scan uses far higher doses than a conventional X-ray) exposes the patient to an increased risk of many problems, the main one being cancer. So a test ordered because of possible legal problems has, at the extreme, the possibility of killing the patient some years later; and this means that the legal profession has killed that patient. Blood tests, of course, merely cost a great deal of money.
Legal problems have other consequences as well. One of my cousins is a trained nurse. She has been advised recently (at least since the lawyer-friendly “reforms” in the UK) that on no account should she render aid to an accident victim (for example) unless she is on duty or at least contacts her employers first. Why? Because a trained nurse is open to a neglicence suit. If on duty, the suit is against her employer – in this case the UK Government.
Shakespeare had it right, in Henry VI.
Christ, me thinks Carl Pham should compile a book of his diary, “My Life and Times In a Transterrestrial Comments Cage”.