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A Bug In Health Care, A Feature In Everything Else

July 25, 2009, 2:49 pm

One of the burning reasons we apparently need a government takeover of health care is that it is "expensive," or more precisely, we spend a lot of money on it.

So what?  In everything else I can think of, rising per capita spending and higher spending in the US than elsewhere is a sign of wealth and prosperity, not a "problem."  We spend a lot of money on a lot of sometimes trivial sh*t, and no one blinks.  We spend more money because we have more beyond what we need to keep ourselves alive.  Or we spend more money because technology provides us new options and frontiers.  But when we spend a lot of money on our health and well-being and longevity, its a problem requiring massive government intervention?

health-care2

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Category: Health Care
  • http://www.dustbury.com/ CGHill

    For some of those things - air conditioning, car seats - they actually demand that we overspend, in the name of some dubious common good.

  • Me

    Ah - huge differences in between the items compared in this oversimplified statement (and, shame on you Coyote, I expect vastly more from you based on all your previous posts! ;)

    In the US, we spend about 10x more on healthcare that ranks at 31 significantly behind the rest of the world compared to the rest of the first world (and compared to the folks who're at rank 1). If healthcare were a free market and I could just go into business and offer cheaper better care or decide not to accept the care hospital one was offering, that wouldn't be a problem (and we wouldn't have this issue).

    But - we have a highly regulated system that provides care at least an order of magnitude worse at at least an order of magnitude higher price than any contender.

    All three are reasons to investigate why this is and attempt to fix the system:
    1. Regulation doesn't appear to benefit us - deregulate, regulate differently?
    2. Why is our care so much more costly?
    3. Why is our care so much worse?

    Sadly, none of the plans currently under discussion appear to tackle any of this. (color me angry)

    And computer here are actually vastly cheaper than in China ;)

    Other reasons healthcare requires oversight and change: It's not a free market with participants being aware of the cost upfront and able to chose between options. Try to get the cost of a procedure out of hospital staff before agreeing to have it done and you'll see what I mean. The physicians, nurses and administrative staff do not know and oftentimes the backoffice staff won't either - until they see the full bill and doctor (no pun intended) it to meet financing requirements.

    Other than that - if a simple appendectomy costs 10 times as much as in other first world countries (with higher general cost of living), it is reasonable to inquire as to why that is.

  • N

    Although I'm generally in agreement with you on many things, it's simple.

    Spending on organic baby food goes up, that is just fine. Spending on ALL baby food goes up, people start to complain.

    Spending on LASIK and breast implants go up, that is just peachy. Spending on emergency services and basic medical care goes up, that might be a problem.

  • wintercow20

    How come when Hoover was running for President, he was promising a "Chicken in Every Pot" and not cheap and accessible emergency services and basic medical care? How come JFK or Nixon didn't run on giving health insurance to everybody?

    Well said Coyote.

  • DKH

    @ "Me":

    I'd love to see your data. All I saw was a lot of unsupported assertions and "questions" that you apparently have but haven't bothered to look into.

  • richabbs

    I would recoomend everyone read this article on health care. It not only covers all the fallacies on health care reform, but it is hilarious. I think the majority of people who come here will love it.
    http://www.realclearpolitics.com/articles/2009/07/23/health_care_mythology_97552.html

  • richabbs

    OK, maybe DKH won't like the article. lol

  • Me

    DKH@8:55 - yes, that was one of those quicker and more emotional posts, sorry ;)

    Check out http://dll.umaine.edu/ble/U.S.%20HCweb.pdf for some more objective data.

    My samples (and, yes, I am aware that the plural of anecdote isn't "data" ;) were
    (1) Getting an appendectomy in Washington state, total cost 46k USD. Maximal billing for appendectomies in Germany is 3k Euro. That's a rather huge disparity.
    (2) Receiving care in ERs in Germany, China and the US. both Germany and China had much quicker responses (saw doctor shortly after arriving as opposed to half a day later - although in China, apparently waving money around and paying upfront are part of the way things work, so that might have helped ;) .

    I think the questions that I ask are fair ones and should be asked - I am a big fan of free markets, but I have to accept that it's hard to have a free market in healthcare because of the typical constraints of OMG-get-me-treatment-soonest. So, if it can't be free and needs to be regulated, asking if the current regulation or planned regulation is efficient and comparing results internationally is appropriate, IMHO.

    That said, the above post was way to dramatic, apologies for that.

  • Me
  • Me

    [this post got lost earlier, reposting]

    DKH@8:55 - yes, that was one of those quicker and more emotional posts, sorry ;)

    Check out http://dll.umaine.edu/ble/U.S.%20HCweb.pdf for some more objective data.

    My samples (and, yes, I am aware that the plural of anecdote isn't "data" ;) were
    (1) Getting an appendectomy in Washington state, total cost 46k USD. Maximal billing for appendectomies in Germany is 3k Euro. That's a rather huge disparity.
    (2) Receiving care in ERs in Germany, China and the US. both Germany and China had much quicker responses (saw doctor shortly after arriving as opposed to half a day later - although in China, apparently waving money around and paying upfront are part of the way things work, so that might have helped ;) .

    I think the questions that I ask are fair ones and should be asked - I am a big fan of free markets, but I have to accept that it's hard to have a free market in healthcare because of the typical constraints of OMG-get-me-treatment-soonest. So, if it can't be free and needs to be regulated, asking if the current regulation or planned regulation is efficient and comparing results internationally is appropriate, IMHO.

    That said, the above post was way to dramatic, apologies for that.

  • Me

    [the posting system on the blog is weird - this is the third time today I post this, the other two got eaten apparently, while a quick follow up earlier made it through]

    DKH@8:55 - yes, that was one of those quicker and more emotional posts, sorry ;)

    Check out http://dll.umaine.edu/ble/U.S.%20HCweb.pdf for some more objective data.

    My samples (and, yes, I am aware that the plural of anecdote isn't "data" ;) were
    (1) Getting an appendectomy in Washington state, total cost 46k USD. Maximal billing for appendectomies in Germany is 3k Euro. That's a rather huge disparity.
    (2) Receiving care in ERs in Germany, China and the US. both Germany and China had much quicker responses (saw doctor shortly after arriving as opposed to half a day later - although in China, apparently waving money around and paying upfront are part of the way things work, so that might have helped ;) .

    I think the questions that I ask are fair ones and should be asked - I am a big fan of free markets, but I have to accept that it's hard to have a free market in healthcare because of the typical constraints of OMG-get-me-treatment-soonest. So, if it can't be free and needs to be regulated, asking if the current regulation or planned regulation is efficient and comparing results internationally is appropriate, IMHO.

    That said, the above post was way to dramatic, apologies for that.

  • Doug

    My apologies for this ultra-long post, but please bear with me.

    This is not the first time I've heard this argument, but for some reason, Warren's logic hit a chord with me today. I realized why: all I have to do is look at the two surgeries that I have had in the last 30 months for the answer.

    I work in high tech, Silicon Valley. 30 months ago I was diagnosed with prostate cancer. "Scared" does not adequately describe my reaction. The diagnosing urologist was decidedly low-tech. He proposed to operate "the old fashioned way": making an incision in my gut big enough for both hands to fit in, to get to my prostate. "It's all done 'by feel,' " he said. "What about a microscope?" I asked him, being the high tech guy I am. "There's barely enough room for both hands in that opening, much less a microscope," was his response. That unnerved me. I wanted a microscope down there because I use stereo microscopes in my line of work and can testify to the incredible accuracy that they provide.

    I went looking for an alternative.. If you have never heard of the DaVinci Surgical System then you should. A second-opinion urologist dangled this option in front of me. When I found out about this robot, and the 30x stereo magnification it provided (not to mention the ultra-tiny "tools" that this thing uses), I was sold. I had the surgery using the DaVinci. I'm exaggerating a little bit when I say that the night after the surgery I could have done sit-ups, but it was pretty close. This high tech machine is incredible, and it made my CANCER surgery almost easy. I am cancer-free 30 months later.

    My insurance company never batted an eye when 1) I sought out a second opinion, or 2) opted for this machine to assist in my surgery. Can you do that in Canada?

    Second surgery: I had problems with my heart rate suddenly racing at about 180 beats per minute, almost like someone flipped a switch. It had been going on for years, but got pretty bad about 18 months ago. It was highly random and elusive, lasting only 5-10 minutes, making it impossible to record. When each episode hit, I was never sure if this was "it" — my last moments on earth. But we finally caught it in March of last year with an EKG. I now knew what it was, and what could be done about it. In January of this year, I had more amazing surgery to repair it. They sent probes up through my groin and mapped the heart for about 2 hours, then they burned a couple of spots in my heart using RF probes. I was instantly cured and went home 18 hours later. "Astonishing" does not adequately describe it.

    I requested the surgery the day before Thanksgiving, and it was performed two months later.

    My two surgeries were impossible a mere decade ago; the technology was not available then. I seriously doubt that Canada, for instance, has many, if any, DaVinci robots in their country, and for a good reason: they cost about $1.5 million per copy. If "cutting costs" is your main focus, a DaVinci is the last thing you want to consider on your budget. Does Michael Moore think that Cuba has a DaVinci in the Havana State hospital?

    This logic leads me to offer the following idea to cut down on costs: if the democrats want to compare our healthcare system to other socialist countries, then fine. Let's level the playing field and compare ABILITIES of each country's system, then price the coverage accordingly.

    So to keep costs down, why don't the democrats create a system which offers 1960s-style healthcare, like the Canadians and British have. All technology is frozen to THEIR level of care. No MRI. No CT scans. No DaVinci robots. Your primary focus is to keep costs down, because you are mad about the cost of your policy. Eliminate all modern (read: "expensive") technology from this healthcare policy, then offer it to the people who are bitching and whining that they have no coverage "like the Canadians." Got a problem with your heart? Let the cardiologist just take a guess like they did back in 1965, rather than hook you up to some expensive machines which CAN tell you what's wrong with you. Or better yet: follow Obama's dictate: take the pill (nitroglycerin, in this case) instead of the surgery. You may die, or have to endure a life in pain, or die waiting for the surgery, but at least you're covered.

    If you're unhappy your with your healthcare policy price, then either 1) you don't value your life, or 2) you've never faced death. Maybe the more appropriate question is: what's your life worth to you?

    Thank you, United Healthcare, and my employer, who offers the UH package.

  • Methinks

    In the US, we spend about 10x more on healthcare that ranks at 31 significantly behind the rest of the world compared to the rest of the first world (and compared to the folks who’re at rank 1).

    Bullshit. 37.5% of the weight in the WHO ranking is given to single-payer systems. Thus, if the country has a single payer system, It's already ranked much higher than any other system no matter how shitty the health care ACTUALLY is. So, the U.S. gets dinged significantly despite having the highest standard of care in world. This is such a tired meme of the left, I'm surprised they muster the energy to keep bringing it up.

    If healthcare were a free market and I could just go into business and offer cheaper better care or decide not to accept the care hospital one was offering, that wouldn’t be a problem (and we wouldn’t have this issue).
    But - we have a highly regulated system that provides care at least an order of magnitude worse at at least an order of magnitude higher price than any contender.

    Right. Regulation screws everything up. Get rid of it.

    All three are reasons to investigate why this is and attempt to fix the system:
    1. Regulation doesn’t appear to benefit us - deregulate, regulate differently?
    2. Why is our care so much more costly?
    3. Why is our care so much worse?

    Is number three a joke? You haven't a clue what you're talking about.

    1.) Yes. Absolutely. Spot on.
    2.) because we offer the best, most cutting edge (and, thus, most expensive) medical care in the world. If it's not offered, then doctors and insurance companies are sued. According to the CBO, about half of the increase in healthcare spending in the U.S. over the past few decades is associated with changes in medical care made possible by advances in medical technology.
    3.) We have better healthcare outcomes AT THE POINT OF DIAGNOSIS than any other country on earth with the possible exception of Singapore, which has a relatively free market healthcare system and which spends less than any other developed country - 4%. Of course, unlike the United States, half the women don't have silicone bodies, so that means they spend a lot less on boobs, noses, butts and thighs and their medical spending is way lower.

    Sadly, none of the plans currently under discussion appear to tackle any of this. (color me angry)

    You're right. I agree. Colour me livid - and colour me on an active campaign to bring down this bill.

    Other reasons healthcare requires oversight and change: It’s not a free market with participants being aware of the cost upfront and able to chose between options. Try to get the cost of a procedure out of hospital staff before agreeing to have it done and you’ll see what I mean. The physicians, nurses and administrative staff do not know and oftentimes the backoffice staff won’t either - until they see the full bill and doctor (no pun intended) it to meet financing requirements.

    That's a function of insurance regulation.

    Other than that - if a simple appendectomy costs 10 times as much as in other first world countries (with higher general cost of living), it is reasonable to inquire as to why that is.

    10X more? I highly doubt it - once you consider the standard of care, the infection rates and ability to cure infection post surgery, rationing, availability of pain medication and the free-riding on the U.S. health care consumer. Part of the reason that Europe can negotiate for lower prices on pharmaceuticals is because the lack of ability to resell them in the U.S. market allows Pharmaceutical companies to jack up prices to above market rates on U.S. consumers to make up on the U.S. market what they lose to discounts in Europe. And do we get a "thank you" from those ungrateful bitches in Europe? No. We get derision because Americans can all afford to shower daily.

  • http://none Eric

    Another reason why America spends the most on healtcare:

    http://www.msnbc.msn.com/id/32170526/ns/health-health_care/

    Americans are some of the fattest people in the world and it costs a lot of money to treat obesity-related diseases and ailments.

  • http://none Eric

    I realize that the the government could be hyping the obesity problem to try to get more research programs funded and the gullible media is falling for it once again. Still, you cannot deny that Americans have been getting fatter. I can see it by going to any public place like a mall or park and just looking around. I can eve see it in my own extended family members.

  • me

    The assertion that health care in the US is 'best' and therefore most expensive doesn't hold up to my personal experience in receiving care in 4 nations worldwide. I find the pharmaceutical cost argument very specious as well (why doesn't the same hold true for, say, software?)

    For one concrete example on which the US scores particularly badly: waiting time in ERs before encountering a medical professional.

  • Methinks

    I have received medical care in Western Europe, the Soviet Union and the United States - all for the same serious illness. The care in the U.S. trumps them all. The U.S. also gets 60,000 to 85,000 people coming here to get medical care that either has worse outcomes in their own countries or for which they are wait listed in their country.

    The same thing doesn't happen in software because the U.S. doesn't have re-importation prohibitions on software sold overseas. U.S. laws prohibits re-importation of pharmaceuticals.

    For one concrete example on which the US scores particularly badly: waiting time in ERs before encountering a medical professional.

    Evidence please. That data is too easy to manipulate - especially if you exclude ERs that are not near violent ghettos in the inner city or along the Mexican border.

    Why are we looking to Europe and or Canada? Why not Singapore? Singapore spends less than HALF what Europe spends and gets better healthcare outcomes than the even the U.S.

    Government forces everyone to contribute to their HSAs and taxes the entire population (thus, not relying on the top 2% to pay for everyone - which doesn't work) a small amount. If you get sick, the government lets you choose what kind of care you get and where you want to get it. However, it let's you know ahead of time exactly how much its willing to pay and if you want more medical care or at a fancier facility, you pay out of your HSA account or out of your pocket. So, the government keeps costs down by being upfront about how much it will spend, but doesn't prevent private spending. That encourages competition among providers and allows people access to as much health care as they are willing to buy. No lies, no bullshit, no bureaucracy.

    But these Marxist Democrats don't want to provide healthcare. That's not the point of this bill - as demonstrated by the pressure to pass this POS in two days. The point is to make every American a serf of the government - unable to buy health care even privately out of pocket because of the restrictions in the bill on who can own medical facilities. This gives bureaucrats and politicians the power of life and death over you. What greater power is there?

  • spiro

    "Me",

    Are you serious about the question between software and prescription meds? Do you know what goes into getting a prescription medication on the market from original cell cultures to animal studies to human studies to FDA approval to marketing? The costs and time involved EASILY justify the cost of brand name medication. Now, factor in the fact that the drug companies have a limited patent life on their work (think generic drugs) and you can quickly see how different this is from the software industry.
    That's not even mentioning the difference in quality control. 1 bug in a software program = update from the company, and this usually happens on a weekly basis. 1 mistake in a drug = massive recall and billion dollar class-action suits.

  • Me

    "Spiro" - that was precisely why I used that example. The cost involved in creating software usually far exceeds the profits to be made during the first few years of sales. At the same time, software publishing is a hit and miss business (especially in games), and software degrades quickly (anyone still using their original version of photoshop? Windows 95?).

    At the same time, software sales prices vary greatly by country - they are determined by what the local market can sustain. The idea is that making an additional copy is cheap once the initial cost in research and development has been sunk, much like in medicine. Hence, selling the same program that'll set you back $140 in the states will cost you $4 in Mexico. Not because those Mexicans are leeching off our American greatness, but because the sum total of income for the company is maximized at those price-points.