Because of cases like this, because of poor immigrants that never saw a doctor until they came here (where emergency rooms will treat them with little expectation of ever collecting their bill), and because of wealthy sick foreigners who come here for procedures that are on a waiting list at home, it’s hard to know whether health statistics from other countries can be fairly compared to American statistics at all. So when someone claims that we have worse infant mortality, etc., than Sweden (for instance), I think that’s just that neither the population (overfed and underexercised) nor the statistics are entirely comparable, and if we could compare apples to apples, we’d come out a little better. OTOH, it’s very clear that we don’t get anywhere near 50% better health results for 50% more expenditure. Anyone familiar with how doctor’s order tests just to cover their rear against malpractice suits, and how neither patient nor doctor considers the cost of anything insurance covers can see how we’ve gone far past the point of diminishing returns.

But substituting some bureaucrat’s judgement (whether in government or an insurance company) for the doctor’s best judgement is not going to improve health care. It might slash the cost. So does the UK’s practice of putting cancer patients on a waiting list – the sooner they die, the less they cost! What we need is:

1) To return more control of medical spending decisions to the patient and family, along with more of the costs. To begin with, insurance should be only for rare and unusually expensive treatment. Things you know you’re likely to need should come out of your pocket – just like your car insurance doesn’t pay for a brake job.

2) To break the link between employment and insurance. You should be able to shop for alternate insurance plans without taking a bath on the cost.

3) Transparency in insurance coverage, so comparison shopping can become meaningful. That is, plan A costs less but allows only one day of recovery from having several pounds of flesh removed, plan B costs more but gives you more recovery time, which do you want? (If your employer gets to choose, it’ll be plan A – and with the present system, won’t even know what the problems with it are until they hear from employees that tried to use it…) I’m not sure how this transparency can be achieved, but it’s badly needed.

4) Tort reform, so doctors spend less time covering their rears, and more doing something that is actually likely to be useful. (Including maybe helping you read those insurance plans.)
a) Damage caps. Rather than having the court go through a grotesque process of trying to figure out what a life is worth based on future earnings, I’d set a fixed value – say $2 million. Then, anything that doesn’t kill you must be worth less.
b) Arbitration process: Put a doctor, a Biology professor, a lawyer, and a couple of laymen on a panel and have them look at all the cases of bad medical outcomes where physician’s mistakes might have contributed over an area and a period of time. They will get the experience to assign damages or reject cases consistently – unlike the present system, which is pretty much a lottery.
c) If someone doesn’t like the arbitration verdict, then they can pay all the costs (their own, the other side’s, the court’s) of taking it to a jury trial, but we’ll change the jury selection process. Jurors aren’t picked at random – college degrees will be required, technical fields preferred. Lawyers don’t get to arbitrarily throw out jurors (maybe because they seem too intelligent or believe in personal responsibility).

Consider the point about doctors getting rich off of numbers of services. They aren’t working harder. It is actually a pseudo-fraudulent unbundling of claims. It is hard to draw the line between fraud and just aggressively gaming the system. Either way, that system is basically all a product of medicare, and they are indeed gaming it — not providing better services to more people or some such thing as that (i.e. working harder). They’re rushing people through a revolving door and over-charging the insurance companies (and, to a usually negligible degree, their patients, for that matter). All of this is true, and it all exists because the government has provided massive subsidy to this sector of the economy and because of large government programs like medicare. But — make no mistake — it is the *doctors* making gobs of money for less service that are benefiting the most from it right now. A typical visit to the doctor probably costs something like $150-$200 now. Ten years ago it was more like $100. (Of course, this all depends entirely on location and specialty and so on.) It really should cost more like $50 or even $20, but the cost is so inflated relative to other goods and services because of incredibly high utilization (a combination of consumer response to government subsidy and provider exploitation of widely adopted and highly complicated and bureaucratic government reimbursement methodologies).

At any rate, it is all a big debacle *because of* the *great deal of* government influence that already exists in it here in America. Is the government as involved in our health care system as the government in Canada is in theirs? I have no idea (which also means that I don’t know that it *isn’t*). But, health care and health insurance certainly isn’t even close to, say, investment banking in terms of being untrammeled capitalism (which given the efficiency of something like the stock exchange is relatively good). And, the major benefactors of the inefficient health care market are the providers of health care. How would it work if the stock market wasn’t efficient? Imagine if the government wanted to make sure everyone held some stock (compare to accessibility of health care) and didn’t tax the transactions between brokers and consumers (compare to the tax subsidies for employer sponsored health programs and the tax deductible nature of services for individuals). Of course the demand for stocks would sore and the prices would all unilaterally rise. And who would really profit? Companies that sell their $1 shares for $2 which corresponds precisely to the doctors, nurses, etc. (To some extent, insurance companies do, too, just like brokers would in the analogy since their commission is a percentage of a larger pie.)

So, I think that’s why this study is worth noting by libertarians — it sort of proves that point that it’s the *doctors* that are the real bandits here which kind of takes the wind out of the pro-socialized-health-care folks (who see doctors as saintly which is why we should all go see one RIGHT NOW whether we need to or not).

1. Is mealey-mouthed on free markets.
2. Has poor quality and honesty of issue analysis.
3. has way, way overblown “knowledge development”, with Global Institute included.

Woohoo! Magic three! Ok, 2 and 3 may not be “ME”

I do not approve of running to the government to force any business, even an insurer, to do anything outside of their business choice. Ultimately, all businesses must fulfill their customer’s needs or be out of business. So, on principle I refused to petititon whichever politician I was urged to write. But is my free market inclination misdirected in this instance?

I believe the porblems of health care costs create the very cost-cutting regulations that this petition sought to redress.

Interesting that this came up on your blog. In my lovely state of Texas the required cervical cancer vaccination that was supposed to cost about $350 is costing $500 – $900 at the doctor’s offices. Why? Transportation, shipping, spoiled vaccination, overhead, their own insurance premiums, etc.

When cavemen had to use up all their energy to meet their needs for living needs did they consider it an evil conspiracy or a fact of life? Today when living is expensive it’s gotta be someone’s fault.

The health care industry isn’t even capable of resonding to normal consumer inquiries. Ask, “how much will this procedure cost me?” And they can’t pull it up on a computer and tell you, you get transferred to different departments, stuck in voice mail, and in a few weeks somebody might get back with you after they check it out with your insurance company first. What other industry is incapable of quoting a price?