A View From The Press Box

The free market doesn't work when it comes to hospitals or doctors.

Some don't have a choice. Others, once they choose a doctor, are forced to use a particular hospital and all must be an approved provider to get insurance payments--which, like most agents contracts, are written by the company for the company!

That's a free market for you, and the choice of auxiliary services is based on where primary care comes from.

I had surgery sometime back and saw a $19,000 bill being paid by my provider for less than $3,000 under the negotiated terms of their agreements. While I agree this is far less than might be considered "usual and customary," the providers make these choices when opting into the system at the start of their career.

The problem seems to be that once they have a lucrative practice going, they then opt out, so there is little or no coverage afforded the ordinary plan participant--unless you happen to be part of a specific group they favor, or, as has now been happening in California, buy into "Premier" services where you contract specifically with certain providers for elite services that are not available to the masses on any normal plans. This is over and above any medical plan you already have.

Finally, if you are illegal here in California, all the above is moot, since you will be afforded complete health care at no cost to you, and the taxpayers will pick up the tab. That includes specialists, maternity, pre- and post-natal care, etc. The hospital simply fills out the Federal Form 1011 paying special attention to the box below line 2 and viola...it's a done deal.

Check it out:

http://www.cms.hhs.gov/CMSforms/downloads/cms10130a.pdf

Everyone wants health care and everyone deserves a reasonable level. But some receive it all for free, some receive none at all, and some pay exorbitant prices for what should be mainstream care considering today's technology and procedures.

I think those most vociferous in favor of letting the market float at a "whatever the traffic will bear" level are those who can easily afford the cost, or who have never had to avail themselves of the emergency services you and I obviously have needed to save life and limb.

It's like the guy who doesn't care how much they raise the purchase price of his Mercedes AMG Hammer and the associated fuel costs as he's never had to worry about purchasing the car, fuel, insurance or maintenance--unlike most relatively ordinary people around him, who struggle with real world costs.

In my book, that's called an elitist attitude and one that fosters a lack of consideration for the masses who suffer from gouging by any group.

We have always been considered one of those groups and it's time we put forth a concerted effort to show a new side.

Yes, medical tourism is the future, and particularly India’s private health care system has made tremendous progress.

The availability of low-cost/ high-quality medical care at the state of the art, internationally accredited hospitals like Wockhardt Hospitals Group-- which is a part of Harvard Medical International-- is poised to make India a "global health care destination."

Recently one of my uncles went to India for hip surgery at Wockhardt Hospitals and his whole experience was really positive. The only option otherwise for him was to mortgage his house and raise money for surgery at a local hospital. So many U.S. patients are now taking this option--just check out testimonials on following weblink:

http://www.wockhardthospitals.net/general/pat_exp.asp

SAM RESPONDS:

The fact that medical "tourism" appears to be the future might in fact be true, but my point is that this takes the cake! It proves that the U.S. health care system is broken and in desperate need of repair. Americans should not have to leave the country to afford adequate, affordable services, regardless of the quality or cost of such care in other places.

Doctors are not slaves of the state. Licenses should not be documents by which doctors are stripped of their right, like any other economic actors, to sell their time, efforts and services to the highest bidders.

Licenses are only supposed to signal to the public, who otherwise have no way to judge the competence of people calling themselves doctors, that the individual is competent.

This ship won't be righted until all doctors and hospitals simply bill their customers--the patients. Let the customers worry about getting reimbursed by their insurance companies, above a reasonable deductible that should cover all the normal costs of health maintenance.

Health care services are like any other personal services-- those who can afford to buy the best should be able to do so; those who cannot must make do with other solutions.

SAM RESPONDS:

Slaves work for free. I am not suggesting that. All I want is for doctors to treat sick people who need their help at a reasonable cost.

Health care is most certainly not just any personal service--it is often a matter of life and death. The Constitution apparently guarantees everyone a lawyer if they find themselves accused of a crime. I think we should also be entitled to medical care if we are sick.

Also, lawyers are often required as officers of the court to do pro bono work to help the less fortunate. Doctors, I believe, owe society the same commitment.

We should not be merely licensing doctors so they can make a fortune from those able to pay them. To maintain a healthy society, they should be required to work for a reasonable fee (not for free) for everyone who needs their care and services.

MH GETS THE LAST WORD:

We have a fundamental point of disagreement.

You say "we should also be entitled to medical care if we are sick." I say that we should not make medical care an automatic entitlement, regardless of ability to pay for it.

That would make it a "free good", and you know what happens with "free goods." Everybody uses it and wastes it without limit, until it runs out.

There are lots of personal services that are "matters of life or death". Driving a car, or a truck, or a bus, or an airplane, for example. All require operators to be licensed for the safety of the public, just like doctors and insurance agents have to be licensed for the safety of the public.

A "reasonable price" is one that is set by the market on the basis of supply and demand. That's what determines the value of the service and brings supply and demand into balance with price. Not by someone's arbitrary view of what doctors "ought" to charge or what's "reasonable."

The price of their services should be determined by the market, where better services should be allowed to fetch a higher price, when the customer thinks it's worth it.

A law license is largely a device created by lawyers to maintain their fees by controlling the entry of lawyers into the market. Pro bono work is the price we make them pay for this privilege.

This is harsh, I agree. People who cannot pay enough (directly or through an insurance fund that they pay into) to get a doctor to divert his time and attention from people who can pay enough, will not live as long as the latter, all else being equal.

Waa, Waa, Waa! You poor thing. Both of us are Liberal Democrats, even if you will not admit to it.

I cannot support your efforts to force physicians not to avail themselves of the freedom of the marketplace that I would want as an agent.

You were just not savvy enough as a consumer to go on the record with the facility and demand all network providers, or if they did not have network providers for that service, that they agree upfront to accept the usual and customary fee of the insurer.

What is the surprise with seeking medical care out of the country? We have shipped all our jobs out of the country, and we accept the products made by those workers as equal to our workers, so why not medical care?

Just so you know, my brother is a surgeon and dinners can have exciting conversations. You should hear the stories of what patients do to their doctors. You would be amazed.

SAM RESPONDS:

For the record, I am a Liberal Democrat and proud of the fact. I am also a Patriot and a firm believer in the free market--within limits.

I don't believe you would want your food and drugs distributed through the free market with no regulatory oversight whatsoever from the government, and neither should a service so critical to the life of the nation be left to the not-always-tender-mercies of the free market, either.

As for my own personal experience, the hospital never even told us some of their providers did not accept insurance--ours or anyone else's. You can't protest what you don't know about--one reason why President George W. Bush insists on keeping so many of his programs secret.

I also believe there is a huge difference between outsourcing customer service jobs or buying foreign-made products and getting medical treatment. What about the people who cannot afford to leave the country for such treatment?

The free market doesn't mean total social Darwinism, in which good people are allowed to be bankrupted, disabled or killed just because under the theory of Survival of the Fittest, those who cannot afford proper health care are just out of luck.

We have a very different vision of the type of country we wish to live in.

Citing as a doctor's obligation to make "society well" is ignoring what I consider the most basic economic truth--that, admit it or not, we all act in our own best interest and doctors are no different.

Carriers are now trying to hold down the inflationary effect insurance has had on our medical industry. Once one has health insurance, his perception is that coverage is there, so demand goes up for more services with the carrier's wallet in hand--hence too much money chasing too few goods or inflation.

Carriers are now chastised for trying to close the wallet, which is not an endless source of funds.

The answer is to address the problem, which is to make the system more market-oriented--let the individual bear the decision-making. Increase the use of high-deductible, excess major medical and let people choose and pay for the basic services they want.

You think control of your health care by insurance companies is bad, wait until the bureaucrats step in.

SAM RESPONDS:

You raise some interesting issues. Indeed, we all act in our own best interests, and while I believe in the free market, just like in any game, you need referees to make sure the playing field is level and everyone is playing fair. That's the crux of my argument to require state-licensed doctors to accept insurance.

Making the system more market-oriented, I believe, will leave even more people broke and/or uninsured. What if you have a pre-existing condition? Good luck trying to buy insurance on your own.

The whole point of insurance is to spread risk, is it not? That's why group coverage is so valuable. We never know which one of us will become seriously ill or when. But we need to know we'll be able to afford the care we need if we do become ill.

That's what insurance is all about, is it not?

As for the bureaucrats, they are already in control of the process, only they work for health insurers. You have doctors having to justify their medical decisions to insurance company and HMO bureaucrats.

I strongly disagree that doctors should be required to accept insurance. If that were the case, they would have zero bargaining power when dealing with insurance companies.

Right now their only credible bargaining chip with insurance companies is to stop accepting insurance. Take that away and the insurance companies would have far too strong of a bargaining position. It would discourage entry into the medical field, which would only further damage our health care situation.

Now, I do think it is reasonable that a patient should be informed (with reasonable advance notice) that a doctor who will be performing their procedure is not covered under their insurance plan.

I understand there might be emergency situations where this isn't practical that would be exceptions.

SAM RESPONDS:

I understand your view, but am not yet prepared to concede your point that regulating fees and mandating that doctors accept them would discourage doctors from entering the field. Is that the case in Canada, England and France? That's one complaint about single-payer I haven't heard.

And so rests the case for nationalized health care, also known by the name of socialized medicine.

In those countries who have it, some think it's wonderful and fills their every need. Others complain bitterly about extended waits for critical operations and procedures.

Others simply die, as MH seems to postulate will happen, when those who can't afford to pay more end up depending on the national system.

So it comes in a complete circle. Socialized medicine, somewhat akin to Medi-Cal and the give-away programs that benefit certain classes, and paid plans that have huge loopholes that don't cover you no matter what premium you pay.

Can we say Catch 22?