No one seems to be adressing the cost issue of medical care…

With Republicans threatening to hold funding for Obamacare hostage in the upcoming federal debt ceiling debate with a threat to shut down the government, I got to feeling guilty that I wrote a long time ago that I would be studying Obamacare to see what it really offers. I began to do it but then it seemed what I would read would either be too complex or even too general and vague. That’s my excuse.

But meanwhile, my sister gave me a copy of a special edition of Time Magazine with the theme or story of “Why Medical Bills Are Killing Us”, by Steven Brill (March 4, 2013 issue). Everyone should read this (I give you a link at the end of this post). A lot of it you kind of already knew to some extent. Some of it is so outrageous and absurd that you just feel like throwing up your hands and giving up. I have not read all of it yet.

But really it reinforces the notion that our main problem in health care is it costs too much. We are being ripped off. You can read the article for specifics on costs, but there are things like marking things up 400 percent and more even when the health care providers get a price break by buying in volume. And it seems that although they more than get their money back on expensive equipment, you the patient end up paying for the equipment as if they had to buy it each time they used it. Sometimes the excuse is that they have to charge a lot in order to pay for all the charity cases they (hospitals) do. So that’s an excuse to misrepresent things? And how is it charity on the provider’s part if patients are actually paying for it all?

I think heretofore people have not worried so much, unless they were specific victims of the system, because, well, the insurance paid for it. If you were lucky enough to work at a place that provided you good insurance, generally speaking, no problem. And for those who are professional non-workers, well the government picks up the tab. It’s those good people caught in between who may have had the most problems.

And as I have always added, and will again, when I write on this subject, I thought that Medicare should have been expanded, extending coverage to those who have not qualified for it but whose economic position puts them in need of it, realizing that it is hard to make rules to fit that because everyone has his or her own story, and some people might just maneuver themselves into it to get free or cheaper coverage. Now I have really thought that a better system would be single-payer for all, the bill being paid collectively by us all as taxpayers. But the latter does not seem politically feasible in the United States, so never mind. Actually, if nothing works out, the time may come to pass when single-payer might seem more appealing to more people.

I’m not sure that Obamacare attacks the problem of cost. Maybe indirectly. But cost is the problem.

You see health care services are not set in a normal marketplace. Health care for the most part is a monopoly. It almost has to be. It is not practical to have competing services side by side. Oh, yes, cities sometimes have more than one hospital, but there is no real competition in price. And consumers, it is said, are not particularly “price sensitive” to costs. I mean in questions of life and death or at least health, people are not in a position or mood to haggle or bargain.  The Time article says you or your loved ones should be though. It can pay off.

The deal is that health care providers, especially hospitals, basically just make up the prices without any relationship to an actual market-driven price or true cost of delivering service (naturally with a reasonable return figured in). The sky is the limit. The article says they use something called the “chargemaster” as a beginning point and go down from there when forced to.

No one seems to know where this chargemaster came from or at least no one seems willing to admit it or explain it.

And I don’t think I will write much more about this now. I need to read more. However, I will note that the medical industry (and that is what it is, an industry) never seems to be held to account for its shenanigans.

That may because it has so much money and can pay for a lot of influence in government. I think I am correct in saying President Obama depended upon the medical establishment for getting his Obamacare through. To the extent the medical establishment helped him, they did so to head off single-payer, which Obama rejected.

And added to that — well who wants to insult doctors (and others in the field)? I mean I have a form of incurable cancer, although I am essentially in remission at this time. But I depended on and continue to depend upon the medical establishment. I try to tread lightly or at least not too heavily.

And I think medical professionals should be paid handsomely. And I think they could even in a system where there was some reality in the marketplace.

It is said that we in the United States pay more for our medical care than anywhere else in the world and get less for it.

I would like to see that money go for actual services, rather than bloated salaries for administrators and the private bureaucracy of insurance, and corporate profits (realizing that if care is to be served up through corporations, they do have to be profitable nonetheless).

That was also in the article, by the way, that is those bloated salaries of administrators, not to mention the kickbacks some doctors get for promoting some medicines and costly procedures.

And I want to note that the thoughts expressed here were not totally in or from the aforementioned article. Just my thinking on the subject. I need to read more and write more on this.

There are interests of the status quo who would like to do away with Obamacare. They attack it as a government takeover of health care and say people will be forced into essentially a stifling government system, with personal decisions taken out of the hands of patients and their health care professionals. To some extent that already exists, what with health care professionals having to adhere to requirements from insurers and the government.

Also, I think we all know, at least all thinking people know, that the attack on Obamacare is basically a straw man routine of sorts. It is a rallying cry to appeal to the masses in order to promote a wide range of special interest so-called conservative causes. Obamacare is always represented by the far right as socialism and a power grab by the all powerful state (as in the old communist nations).

(Now this may not fit in here, but this is, after all, a blog. But I do think to some extent Obamacare was misrepresented slightly when it was sold. Obama said time after time that it would not change coverage for those who already are covered and like their own insurance. But he failed to note that changing the law and dynamics of the system tends to make private providers want or have to change their offerings or their rate schedules. In other words, your old plan may no longer be available).

What Obamacare foes don’t say is how they could actually make sure everyone has health care (and indeed they may not think everyone should) and how they would get a handle on prices. Oh, I know. The market takes care of everything. Well I already addressed the fact that health care is not in a true marketplace (and maybe can’t be).

Finally, I think a lot of people just figure they will either have insurance through their job or if nothing else if they get sick or hurt they’ll get free care because the law already says you can’t be just left to die — well actually I think you can after fashion — but health care providers, particularly hospitals, are forced to provide emergency care to everyone, and then they pass the costs on to everyone.

But don’t feel too sorry for the hospitals. Even the non-profits are making huge profits (read the article).

The Time article I am reading is in a hard copy of the magazine. I first tried to find it on the computer but only got a teaser, but then I got the one I give you here. It at first glance seems like it might be a longer version of the one I am reading (not sure). But, whatever, you ought to read it. Information is power.


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