The Tyranny of Medical Bills in America

[Rob C]

Rob,

Life has a strange habit of getting in the way of romantic notions pretty quickly. Once a doctor goes bankrupt, what's the point of his vocation? And doctors going bankrupt is happening here more and more often. Then the doctor is forced to work for a hospital, where his vocation will be managed by beancounters who are going to force him to spend a specific limited time per patient, among other things, and force him to order unnecessary and costly procedures. If the good doctor continues to follow his vocation and defies the management orders, he will be fired. At this point, he/she could join Médecins Sans Frontières in the jungles of Amazon, for instance, to follow their vocation.

Hi Slobodan,

Indeed, and that's perhaps largely due to the American way with law. The transatlantic example has spread throughout Britain too, that jumping to court whenever there's a chance. And our lawyers run tv commercials touting you do just that. OMG! I said touting! But it fits, sadly.

Was a time some years back in Britain, or at least in Scotland AFAIK that the 'professions' were not permitted to advertise; lawyers, doctors, surveyors, none of those professions did it; it wasn't just banned, it was deeply thought to be infra dig to boot, not British, if you like. Now, every cheapskate runs commercials trying to make you sue a bank, an insurance company, your employer, even your mother if you feel like it. As for running a business - I carried a small insurance that covered gear, third party and models, and should I be going off to shoot somewhere, special policies were to be had covering cost of a reshoot. Apparently, you now need to carry so much professional liability cover that it's crippling.

Like I've said elsewhere, this all boils down to the result of human greed, the constant looking for some way to profit from another's disaster. No wonder I tend to walk pretty much alone these days.

Rob C

[amolitor]

On a completely separate note, Rob, my somewhat blurry memory keeps nagging me that you had a wife not all that long ago, and now it appears that you do not.

My condolences in all cases, but all the moreso if this is a recent event.

[DeanChriss]

I live in New Jersey where the state requires a helmet when riding a motorcycle.  If you go right over the border into Pennsylvania, that state allows you to ride without a helmet if you're over 21 and passed a test.  Of course it's safer with a helmet.  But many are willing to risk not using a helmet in order to be free to decide what they want to do and how they wish to feel.   http://www.fastfreds.com/helmetlawmap.htm


It's the same with medical care and how it's delivered.


I think the issue with most Americans is not what's necessarily best for them.  It's much about not having the government telling us what to do and how to live.  I think that independent spirit is more ingrained in Americans than Europeans although lately Americans seem to be willing to give up their independence to a greater degree than before.  So many of the arguments about socialized health care are about freedom to choose.   Unfortunately, with Obamacare, we've put the final nail in the coffin of private health care.  We're eventual going to have a one-payer system run by the government much like Medicare.   Most Americans don't trust their government or the people who run it who they think are in it only for themselves.  Whether public schooling, the post office or the Veterans Administration, when the government gets involved, not only do you lose your ability to choose, you wind up with worse services that costs more, which is what's going to happen with medical care as well.  When more countries begin to look like Greece and Venezuela politically as well as economically, than my point might be taken more seriously.  Until then, everyone is going to believe what they want to believe.

Choosing to not wear a helmet and not have medical insurance is choosing to force everyone else to pay higher medical bills for one's irresponsible choices if anything bad happens. The only way that's not true is if hospitals let people die when they can't afford their own care. Like it or not, as independent as we'd like to think we are, we're all hooked together via economics. I'm not allowed to pile junk cars in my front yard because it brings down the value of every house in the area. My neighbor's freedom to not pay for me being a slob trumps my freedom to do whatever I want in my own yard. Everything is like that, including healthcare, no matter what system we have. It's just a matter of choosing the system that can actually help the most people rather than costing them all they have when a major illness comes along.

The same evil government that most people distrust is a government of, by, and for those same people. You'd think they'd give themselves a little healthcare security for the $3.8 trillion they spend each year. Of course it might be hard to do that and still have a defense budget that's as big as next 10 biggest countries combined. Maybe a defense budget that's only as big as the next 8 biggest countries combined would keep us secure enough?

[amolitor]

Living, as I did for a time, in Norfolk, VA, the site of the largest naval base on earth, I learned the following interesting facts.

There is a legal requirement that the US Navy keep two carrier groups at sea at all times.
In order to accomplish this mission, we need 11 aircraft carriers. No, 10 will not do. We will not be able to keep 2 at sea 100% of the time, we must have 11.

I know what *I* would do if I were the Commander in Chief, but I'm not.

[Alan Klein]

Choosing to not wear a helmet and not have medical insurance is choosing to force everyone else to pay higher medical bills for one's irresponsible choices if anything bad happens.

You've got that anyway.  The cost of insurance is going up by leaps and bounds because of Obamacare.  So everyone is paying more because of government intervention.  Hello-o.

[Alan Klein]

The cost of defense spending as a percent of GDP and a percent of government spending is almost at the lowest level it's been since the beginning of WWII.  It's still going down and slated to be at the lowest point in a couple of more years.  http://www.usgovernmentspending.com/defense_spending 

The money for health care will have to come from other places - your taxes for the most part and a larger part of your income.     

[Isaac]

You're usually so insistent that other people should demonstrate they have experience of what they speak.

Yes. I'll always insist that people demonstrate proficiency in a discipline they have the cojones to critique. I'm not in a position to critique medicine, so I don't do it.

Do you have demonstrated proficiency in writing photography books? Do you critique photography books?



Meanwhile the question was experience of receiving "government-controlled" healthcare, not experience of providing healthcare.

Someone may have benefited throughout their life from "government-controlled" healthcare for them and their family but be ideologically opposed to the provision of "government-controlled" healthcare for other citizens.

Someone else may not have actual experience of "government-controlled" healthcare but be opposed to the provision of "government-controlled" healthcare because they've heard stories that make it seem like "bad" healthcare.

Someone else may be opposed to the provision of "government-controlled" healthcare neither for ideological reasons nor because they fear "bad" healthcare, but they pessimistically expect that any change will mean they personally will have to pay more for healthcare.

etc etc

In itself, the fact that someone opposes "government-controlled" healthcare isn't interesting, but the reasons can be interesting.

[Slobodan Blagojevic]

...the "healthcare system" that makes the excellent "healthcare" inaccessible for so many.

Now that is a distinction I can fully agree with. Far be it from me to be seen as a defender of the "system." I tend to actually lean toward socialized, single payer, etc. systems. My point was that the beast is rather complex and multi-faceted, and that any simplification, regardless of the direction (worse/best) is bound to be challenged.

[amolitor]

Protip: If you want to hide egregious growth, measure against another rapidly growing metric. If you want to hide a disastrous decline, measure against something that's also falling.

Also, if large changes over time tend to to your thesis, base your chart as far as possible from zero, to visually amplify the changes. If the changes over time contradict your thesis, base the chart near zero. Or near -1000000000 if you think you can get away with it.

[Alan Klein]

Competition lowers cost.  It also drives up quality and innovation. Single-provider systems do the opposite.

[amolitor]

Generalities are not universals.

[DeanChriss]

Competition lowers cost.  It also drives up quality and innovation. Single-provider systems do the opposite.

Since long before anyone knew who Obama was the US has had higher rates of infant mortality and mortality amenable to medical care, and lower healthy life expectancy at age 60 than other developed countries with single provider systems. The US has also had the most expensive healthcare system in the world since long before anyone knew who Obama was. If competition in healthcare systems lowers cost, why didn't it work in America? If Single-provider systems do the opposite, then why is healthcare in countries with single provider systems so much cheaper than ours?

[amolitor]

Driven by the profit motive, humans and their institutions will strive mightily to eliminate competition or to render it moot.

Simplistic slogans do not, as a general rule, accurately capture human behavior or the behavior of economic systems in practice. In fact, it's not clear that economic systems in practice can be described at all in any terms simpler than themselves.

[RSL]

My point was that the beast is rather complex and multi-faceted. . .

Exactly, Slobodan, and if you want it controlled by government you want it controlled by people who are some of the dimmest bulbs in the room.

[graeme]

Can't really see what the big argument is about: Europeans ( & Aussies ) have decided that they're happy for healthcare to be provided by public bodies ( along with defence, emergency services etc ) & are mostly OK about paying extra tax to cover this. US citizens would rather arrange their own healthcare arrangements & expect to pay extra insurance to cover this. They both vote for the political parties which embrace these arrangements. Democracy. Cool.

Re: taking responsibility for one's own health. I have a couple of ongoing medical conditions - nothing terrible or life threatening but enough for me to lose working days. I deal with this stuff with some lifestyle changes ( being self - employed makes this easier ). No prescription drugs or professional medical intervention ( apart from the odd bit of NHS physio every few years ). I'm good at this. But, I'm not good at dealing with insurance jargon, small print & legalese which sounds like what taking responsibility for one's own health in the US entails. So the UK system suits me.

Interesting discussion.

Graeme

[Otto Phocus]

There is a legal requirement that the US Navy keep two carrier groups at sea at all times.

I know there is a law setting the fleet number to 11 carriers, but I can't find any law that states that two of of them have to be at sea at all times.  Do you have a citation for that law?

[amolitor]

The 'two deployed' rule appeared in some piece I read a couple years ago. Perhaps I misunderstood it? The general principle that we can only have about 1 in 3 or 4 deployed at any one time is oft cited, however, and that's the problematic part.

If I owned backhoes and my crews told me I could only be using 1 in 3 of them at any given time, if get new crews.

[Rob C]

On a completely separate note, Rob, my somewhat blurry memory keeps nagging me that you had a wife not all that long ago, and now it appears that you do not.

My condolences in all cases, but all the moreso if this is a recent event.

Hi Andrew,

Yes, until six years and ten months ago.

One November she found a lump; four Novembers later, five cancer ops and one broken hip on her card, she quietly left us.

Thanks for the sympathy - these things are often difficult for others to express - always feels either plain awkward or even, in some cases, almost an intrusion.

We became an item when she was fifteen; she died in her sixties. It was a wonderful time together that I wouldn't exchange for the world; hell, I had the world.

The first four cancer ops were on private insurance; when she broke her hip she had the choice: private or public hospital. Private was 60 klicks away, public twenty minutes by road. She chose public to cut the time, and we discovered that public was every bit as good - if not better - than the private experiences. During checks for the hip they discovered cancer had returned. We asked the oncologist (public) about the differences in meds availability on the two sytems, and he said what you need you will get in the public service. Within ten days she had a new hip and the cancer out. During the many private visits for chemo, radiation etc. we were told by one private onco. that it was a constant battle between himself and the insurance companies over meds... and that's only inside hospital: out in the wild, you're on your own in private care.

It was that last pair of ops that led her to suggest we cancel the private premiums, which we did.

Here (Mallorca), my own public GP used to run his own private practice too, and consult in both the state service one as well as his own. I've never asked him - not my business - but I'm led to believe that part of being put through medical school means a public practice responibility too. Irony: after dealing with me and my own problems for a few years, during a consultation he told me he'd joined the club. I thought he meant the yacht one or perhaps the art one to which I'd belonged for a couple of years, and he laughed, said no, heart attack! Now, whenever I have to see him officially, I never fail to give him a short consultation about hearts (been there first, more personal experience than has he!); he has a sense of humour, thank goodness.

Rob C

[Rob C]

I know there is a law setting the fleet number to 11 carriers, but I can't find any law that states that two of of them have to be at sea at all times.  Do you have a citation for that law?

.............................................................................

I think the problem is that you can't keep more than two in good enough condition to be operationally useful. It's the same with bigger yachts: you can seldom just up and go - something always needs attention; the environment in which they live is simply so hostile to mechanical things.

Rob C

[tom b]

One of the questions that I ask myself is, is it working?

Most liveable cities:
Melbourne, Australia 97.5
Vienna, Austria 97.4
Vancouver, Canada 97.3
Toronto, Canada 97.2
Adelaide, Australia 96.6
Calgary, Canada 96.6
Sydney, Australia 96.1
Helsinki, Finland 96.0
Perth, Australia 95.9
Auckland, New Zealand 95.7

Socialised medicine that I can afford, a Pharmaceutical Benefits Scheme that makes drugs in my ageing years inexpensive. Government interference so we couldn't buy into the causes of the GFC.

Yes, there are problems. The Chinese are driving up housing market prices in Sydney. There are benefits, Sydney in spring is great and the Aussie dollar is falling.

Is it working? Compared to most countries, exceptionally well!

Cheers,