Two things motivate me to expand on the idea that fixing medical care is the key to our financial woes. One is that despite all my words, even some of my blog correspondents do not understand the central concept of what aspect of medical care needs fixing, and the second, which dovetails nicely, is an editorial in
Tea-party Zeal, via Wikipedia
today’s Globe by Morton Kondracke, a national columnist who has become my favorite in the current bunch. Mr. Kondracke discusses how the Congressional GOP firebrands in Congress are planning to cut many essential programs in their Tea-party-inspired zeal to fix the nation’s fiscal woes. Included in their plans are cuts in essential science and medical programs known for having exceptional leverage. Among other things the GOP wants to cut research, which amounts to only 0.04 percent (that’s a multiplier of 0.004) of all government spending. It is much like taking an obese patient and trying to reduce his weight by slicing out some muscle!
Image by giveawayboy via Flickr
Here’s the deal. Before the Tea Party destroys our governmental infrastructure, including the medical parts which are among the best-working, we need to fix the the greatest threat to our financial stability, and that is, as I have posted previously, medical-care costs. I submit that America has all the pieces needed for the world’s best medical system. We have centers of excellence, brilliant innovators, effective government regulation such as the NLM, CDC, PHS and NIH, the Mayo Clinics, and so on, but the pieces are bundled like Frankenstein’s monster in an incredibly inefficient paperwork bureaucracy and, most-important, a system design which lacks an essential ingredient: capitalism.
That’s right, capitalism is why our economic system, awkward as it is, trumps Communism. At least for small companies, the entrepreneur sinks or swims on his own in a free-for-all with his competitors and, just like in evolution, the fittest survive. Controlling costs is key to such success, but that factor is lacking in the current system for that majority who are covered by insurance. A patient who is covered by insurance has no incentive to ask the key questions. How much does the test/medicine/procedure/operation cost? Do I need a second opinion? Are there alternatives to pills/procedures? Would life-style changes make medicine or procedures unnecessary?
It is my opinion after 74 years of life on this planet that the majority of visits to doctors are unnecessary. It is just human nature to want to fix health problems with magic pills or by asking an expert (read, doctor) to fix them for us, when the real answer is to change our behavior.
Telomere Caps, via Wikipedia
Our life spans are largely determined by our genes. Each of our genes has so-called “junk DNA” on their ends, and these ends are slowly lost over time. When the ends are gone, we die. Therefore, each of us has a built-in life span (and I’m glad I don’t know mine), and it is ours to have and ours to diminish depending on the environmental treatment we give it. By that I mean smoking, excessive drinking, drug abuse, excessive stress (including lack of sleep), lack of exercise and poor nutrition (too much processed food and lack of portion-control). And the latter of course results in obesity, which leads naturally to heart disease and diabetes.
Image by Mr.Thomas via Flickr
All these things are under our control without going to the doctor. We don’t need to go to the doctor for colds, or for obesity either for that matter. Colds last two weeks but can be limited to about 14 days with treatment. Antibiotics don’t work on viruses. We also get little or no real value from most over-the-counter medicines, including the pseudoephedrine that are so much in the news. Most such “remedies” work through the placebo effect.
One of the most-prescribed kinds of medicines of all, and one of the more-expensive too, is statins. If we exercise and eat right, most of the need for statins would disappear, along with a big chunk of medical costs.
What’s left for doctors to treat? I’m not a doctor, but as I said, I’ve got experience. Off the top of my head, appendicitis, tetanus, gaul or kidney stones, rare diseases, broken bones, cancer from genetic weaknesses (including allergies) or environmental toxins, and general genetically-caused problems. I believe that most doctors, if they are candid, will agree that these are small in number compared what patients could deal with themselves, if they only would.
So there is the challenge. If people were incentivized to care about medical costs, might they step up their own responsibility for their own health? It won’t be easy because we are talking about human nature here, but unless we provide people with an incentive to be proactive about their health, there is ZERO chance of fixing the system. Such a change will take leadership, but all the leadership in the world won’t work unless people are incentivized to listen. Having the patient pay at least part of her doctor’s bill is that incentive. If the poor need help in paying, fine, give them help. But everyone, and I mean everyone, needs to pay something out of their own pocket!
Now open wide, America, and take your medicine. This is your Dutch uncle talking. Get a good night’s sleep and you’ll feel better in the morning. Tomorrow we exercise. And Tea-partiers? Wake up, you meat-heads! You’re cutting into our muscle!
Still Skeptical After All These Years 
Jim, Jim,
You have two blogs in one. Kondracke and controlling medical costs. I only address the latter herein but would love to “take you on” as well as Kondracke, to a degree.
NOW you suggest that EVERYONE pay SOMETHING for medical care, right. Well you and I “pay” $96 dollars a month for Medicare, right out of our SS checks. And before that we “paid” some kind of Medicare tax on earnings, at least for part of our lifetime.
So while your very broad call for all to pay something. it is already being done to a great degree. It is just that the “something” does NOTHING to control the costs. Hell, I have already paid my $96 each month so of course I “deserve” anything the doctor orders or the emergency room charges, right?? No questions asked by me once I pay (or the government deducts, rather) my monthly stipend.
Listen to younger folks today. I have already “paid” into SS so how can you suggest that I don’t get what you get???
So the real answer to your solution is HOW MUCH should EACH person “pay” for medical care. Well how much should a person pay for a car?? The government doesn’t pay for cars, people do. Yes, government can certainly drive up the prices of cars through regulations but…..
Both cases suggest government get out of the “paying’ business for sure and be very careful with regulations that (from a cost benefit standpoint) are not effective either. If I purchased today a 100 mile per gallon car I would probably get a big “rebate” at least on taxes from government. Why should I? If it becomes cost effective for me to pay for such a car and save the money on gas, that should be my decision.
As well, my suggestion to means test on a sliding scale such that EVERYONE must pay a lot, based on real income, not the “fake” thing with every deduction in the world, then means guess what?
As for the really poor whom government provides all health care, well start deducting WHAT health care government will pay for. Anyone going in for a respiratory problem first gets a nicotine test. Test positive, no government money for the treatment. OMG listen to the liberals scream over that one.
Test positive for drugs of any sort, no government money for ANY health care at all. I don’t get my military retirement if I become a felon. Why should lawbreakers get government subsidies?
Harsh ,yes. Will people die as a result, yes. But until we the people “toughen up” how we dole out money, well here we are today, right?
Anson
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Good, good, Anson. At least you are engaged in the gist of it now. Excellent.
Two blogs in one? But they are related in an exquisite dance of necessity. Unless we tame medical costs the Tea Party will continue to cannibalize our infrastructure!
By paying something I mean in effect an incremental payment which would incentivize the patient to shop. Your Medicare premium doesn’t do that because you have to pay it whether you seek treatment or not. The incentive resides in your wallet. It’s the same incentive that makes you drive three more blocks down the street to get gasoline that’s 2 cents cheaper per gallon. This is human psychology 101.
To make this work I recommend means testing – negotiate it out, whatever it takes. For the poor, even those on Medicaid, give them money for it if we need to, but then require them to take it out of their purses and pay it. That’s capitalism. And it can work, BTW, while leaving Medicare, Medicaid and Tricare virtually unchanged. Come on, Anson, work with me here! Let’s think outside the box. I’m telling you, this can work!
Jim
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Except for programs having to do with children, I see nothing in the GOP proposed budget cutbacks that bothers me all that much. The “medical research” spigot is one that could use quite a lot of turning back as far as I’m concerned. Government (i.e. tax money) finances tremendous amounts of speculative hypothesis proving which should be covered by private concerns who stand to benefit the most from monetary outcomes.
How often have we seen promising new cures or therapy result in them “still a long way off” from being put into use. How many more millions and millions are we going to put in from the public purse on ailments and disorders which, as Jim says, could well be staunched by improved personal responsibility.
Jim has it 100% correct when he points directly at the COST of health care, in ALL of its uncountable manifestations. Cost is the one thing that has not been slowed down, and will not be – because medical necessity is such a ripe target for usurious pricing. Greed is one of those human behaviors no form of legislation could ever possibly omit. There is no earthly good reason for a single suture to cost $200… a piece of sterile thread in a nice clean package which cannot possibly have cost more than (at most) a couple of dollars to research, manufacture, package, market and ship.
The ultimate fallacy of the “Affordable Health Care Act” is that in no way, NO way, will it have any effect on cost other than to drive it up much faster – as has already been noticed, and will continue to be noticed as more and more mandates of it kick in.
I have said it before here and elsewhere – it is EVERY bit as much the fault of the insured as the insurer. Anyone who knowingly buys something at a price lower than the going rate for a service or product with the idea that they will one day take out a service or product worth many times what was paid for it – is lying to themselves. In effect, they are ALL engaged in an exchange which is, by definition, “too good to be true.” And, what is worse, those who intentionally use their coverage to get a surgeon’s attention for their paper cuts are every bit as much to blame for the costs rising as those who are left with no option other than emergency room care.
Even if every single American village of any size had its own government-run Community Clinic there would be zero improvement in health outcomes for anyone. What there would be is longer lines, higher co-pays, and more taxation.
Since passage of “Obamacare” my mail box, like yours probably, has weekly been filled with an unending array of offers from health care industries of every conceivable description, as never before. Why? Because the legislation was intended to benefit those corporations, and to enact a swarming host of speculative pilot programs at our expense. Likewise, television ads selling medical insurance, pharmaceuticals (I hate those long-winded legal disclaimers that warn us we might die of heart failure even though the pill is so great) and – drum roll please – class action law suits against drug and device manufacturers.
We are truly hoisted on our own pittard with this, and there is not one damn thing any of us can do about it other than discuss how bad it is going to get and share excellent ideas that will never be implemented.
I’ve set myself up in the best way available to me here near life’s end – not so much to enjoy these years, but rather to survive them in as little pain as possible without bankrupting anyone other than myself. I do not expect to receive the best of care when in need. I will be lucky to get any at all – even with Medicare and VA in place.
Yet, in a certain way, it has ever been thus – even during the Dark Ages.
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You have an interesting point about “research”, Wing. A brief google search reveals that the government actually is not efficient at doing basic research itself. Here is a link to a Cato paper on the subject:
Click to access kremer.pdf
What the paper does say is that the most efficient way to fund medical research is probably through purchase commitments, prizes, and the like to incentivize big Pharma to undertake the expensive and uncertain projects.
I think you will find that such efforts are also listed under “R&D” in government budgets. Without government funding there is NO financial incentive for private industry to tackle projects such as vaccines for the diseases that threaten most of the world and which are beginning to affect us as the planet warms (for whatever reason).
The big three diseases are malaria, TB and AIDS, and the only work on those right now is being done because of government. It’s one of those things we simply take for granted, like clean water coming out of the tap. Moral: be careful whose budget you cut – it could affect you big time.
I agree with your comments about medical-insurance advertising. There is still big money to be made in that industry and they are aggressively pursuing it. But there are lots of people falling through the cracks. The financial impact of chronic illness is increasing, particularly diabetes, and the insurance companies don’t see any profit in insuring such “pre-existing conditions”. Why should they? Not only that, such people are more likely to be unemployed and to stay unemployed.
A former colleague of my son’s is overweight and sick – just had two toes amputated. He has been out of work for more than a year. You can tell just by looking at him that he’s a poor health risk. Who’s going to hire a walking liability? Such problems are only going to get worse unless we get a proactive healthcare system that works for everyone. The present one is moribund and ACA doesn’t address the root causes of accelerating costs. But, ACA is a start and the CBO says it will save money in the long run. Maybe so, maybe not, but we should get something else in hand before we throw it out. The Tea Party is playing with fire on that, IMO.
Jim
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Jim,
This is the part I have such a terrible time accepting:
“Without government funding there is NO financial incentive for private industry to tackle projects such as vaccines for the diseases that threaten most of the world and which are beginning to affect us as the planet warms (for whatever reason).”
I don’t buy that, at all. In fact, it seems to me that there are at least a few examples to the contrary – which may be just anecdotal of course. My other guess is that corporations have every possible incentive to ensure that somebody else does their R&D for them, and then they get to do some more and add that to the price, after patenting everything from widgets to stem cells.
I’d not get so radical as to declare that government should do NO transferrable R&D, but for heaven sake, if we are going to end up paying for all that research, seems to me like the beneficiaries ought to pony up about ten times what they do in return for it.
Anyhow, a little nip and tuck off that research budget I am confident will do next to nothing damaging to corporations or our economy. At this point, the private sector appears to be prospering and sitting on the proceeds while the rest of us cannot get Congress to come to their senses.
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@WW,
One article I read estimated that it typically costs a drug company $40 per shot to develop and distribute a vaccine and as Geoff and Anson will both tell you, Big Pharma is not in the game for philanthropy. They and their stockholders want profit, the more the better. At the same time the article said that government attempts at doing their own R&D on drugs have a very bad track record. Ergo, either government underwrites the efforts or the occasional philanthropist like Bill Gates does. It’s all about the money, as you say.
BTW, the part about tropical diseases moving northward is real. I recall doing a blog post on it some months ago.
Jim
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Jim,
Of course, this much is abundantly clear:
“… Big Pharma is not in the game for philanthropy.”
And, therefore for what reason is it in the best interest of tax payers to encourage their greed?
I know it isn’t going to change, but still, I do believe my logic is unassailable.
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Jim,
More than willing to work with you. Our goal is the same, to reduce the cost of health care.
I am smack in the middle of it now. Janet is in the hospital for a serious condition. I see both sides, quite visibly and very personally right now. But I remain firm in my principles of I, not the government, must determine what is needed for her, along with her doctors of course. And the only way I can even consider “cost benefit” for now, with all the stress, is to have a real stake in the game on the cost side.
Anson
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So sorry to hear about Janet, Anson. Mollie and I wish her a rapid recovery.
Jim
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Jim,
As I said in a private emai., just wait. I am acculumulating some private data that will, anecdotally, blow your socks off as well those on the left or right. More later, as I said, privately.
anson
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One of the best books I have read on the topic is “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.” http://www.amazon.com/Healing-America-Global-Better-Cheaper/dp/1594202346
The author visits several different countries and goes through their various health-care systems. The best one I saw in the book is the one that they employ through German (I liked it a lot better than the NHS in the UK or Canada). Everyone gets health insurance through their employer (the cost was $750/month for a family of four compared to $1,000/month in the U.S.). Health Insurance companies were non-profit, but could sell for-profit plans that included perks like private rooms in hospitals and stress-relief weekends at a spa. The unemployed and indigent get their premiums subsidized by the government (at various levels). Co-pays are posted in the doctors office, as are costs for various procedures (no guessing game). Co-pays are about $25 (depending on the Euro). High enough that most people avoid frivolous visits to the doctor but small enough that it’s not a burden to visit the doctor – again, those premiums can be subsidized by the government for the indigent, unemployed, and/or elderly.
They have better outcomes medically than Americans and no one goes bankrupt for getting sick (and their government spends less on health care than we do).
I like the personal responsibility factor, the cost element that limits frivolous visits, the real posting of costs (my doctor and his staff don’t really know how much stuff costs and when you’re sick, you don’t shop around), and the safety net involved.
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We think alike on this topic, Jennifer. Medical costs are the core of our economic problems and must be pared somehow. Bureaucratic rationing won’t work, not in America, so the patient must have some “skin in the game”. The German plan sounds good to me. Of course, president Obama’s ACA is headed to a momentous hearing at the Supreme Court (eventually) and then we’ll know if we have to look for an alternative. I would not be at all surprised if the ACA is found unconstitutional.
Thanks for chiming in!
Jim
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Jennifer and Jim,
My first reaction to the above related to ermany (” ” key still not workin here) is the $750 a month for EVERYONE.
I pay about $96 a month for Medicare and NOTHIN for TriCare for life (other than bein underwater for some 7 years lon ao)..Now imaine the public reaction if every American had to couh up that amount each month and what the manmitude of government subsidies miht be for the poor to pay that bill for them. For sure with my income as a retiree I would apply for bein “poor” if I had to pay $1500 a month (for Janet and myself) for health care. It would be far more than my mortae payment and my food bill each month.,
I also wonder how the standard of livin of medical practioners, particularly doctors, might compare between ermany and America today. We all know how such standards of living were for doctors in the Soviet Union lon ao and they were usually terrible doctors based on my readin of history.
Take a look at the homes of doctors around Joplin. My uess is they averae over 4000 sq ft per home. Many start at 10,000 sq ft and o up from there. If somethin really controls cost of medical care my uess is doctors would be livin in 2,000 sq ft homes like the rest of “us”. Now how do you promote that social chane, politically. We can et into all kinds of income redistribution discussion on that subject alone and yes overnment has the “power” to make it happen.
But is such the “American way” to have overnment make those decisions? Should it NOW be a new “American way”?
oin back a couple of decades, Navy doctors that made it a career lived just about like I did as a senior naval officer. Our incomes were commisserate as well after all the nuclear and medical “bonouses” were entered into the pay checks. But many, many doctors would never consider remainin in the Navy for 20 years +. They could make far more money as civilians.
I would also add that my monthly paycheck more than doubled as soon as I left the Navy after 23 years and then tripled or more over time as well.
I keep reflectin on American health care of really lon ao before the Depression, the New Deal, Medicare, etc. Once overnment ot into healthcare look at the costs involved alone.
Complicated subject for sure and I don’t have the answers equally for sure. But a sinle payer system of any sort seems very costly today and for sure we the people don’t have the money to pay for such, yet. In that reard, I believe Jim and I both aree that patients MUST have “skin in the ame” if we ever have hopes of lowerin medical costs in a free society.
Anson
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The $750/month is the cost to a family of four. In the U.S., the average cost of health insurance premiums is $1,000/month (plus actual health care costs) – I stated both of these statistics above. So, Americans are already paying more than this. It’s about $200/month in premiums for an individual. My organization subsidized the entirety of my insurance premiums as a perk for working there. However, it is $608/month to add a spouse and $250/month to add a dependent. So, for a family of three I would pay $858/month. I have friends in California that pay $1,200/month in premiums and have a $5,000 deductible (then the insurance company picked up 60%) – their child broke his arm last year and the healthcare costs exceeded $10,000.
The reality is that this system costs *less* than American programs (and I’m sure you know that MediCare is already subsidized), provide greater choice (no such thing as ‘in-network’ or ‘out of network’), claims cannot be denied (except in case of fraud), and people know how much their healthcare will cost them going in. No one goes bankrupt due to health care costs (the #2 cause of bankruptcy in this country and likely will become #1 shortly). People *with* health insurance are the ones going bankrupt, not the poor. The reality is that other countries do it better and for less money than we do. It’s a sad day when Cuba has better health care than America (and yes, we live in that day as published by WHO).
Yes, doctors there make less money than they do here – although more than your average professional. However, they also do not come out of school with six figures in debt and they have very limited malpractice expenses.
The reality is that our health care system as it is is unsustainable.
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It is indeed, Jennifer. Thanks for commenting with real numbers.
Jim
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