Submitted to a Candid World


The Realities of Healthcare: the GOP Still Doesn’t Know the Price of Milk
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Ditch the logo,but keep the healthcare plan.

In the early 1990s, then-President Bush faced a firestorm of criticism for, quite simply, not knowing how much milk costs at the supermarket. It wasn’t relevant for the “truth of the matter asserted,” but rather tended to show that Bush lacked the basic awareness of reality that any policymaker should have, before presuming to speak in the public’s best interest.

The same could be said of Republicans on health care, today. GOP frontbenchers are famous for sticking to the script, and the most recent health care debate is no exception (“I thought so little, they rewarded me…”). No matter who you listen to on the right, you’re likely to hear this one talking point: government-run health care would interpose a nameless, faceless bureaucrat between the doctor and the patient.

This simple statement evinces a shocking disconnect between the Republicans’ perception of healthcare, and what healthcare actually looks like for the average “real” American. As someone with a “continuing condition” (worry not, dear reader – it’s mild and treatable!), both I and my family have spent hours upon hours dealing with the monstrous construct that is the modern insurance system. We know, as John Boehner and Karl Rove apparently do not, that what exists today in America is a system that puts “nameless, faceless bureaucrats” directly and often immovably between doctor and patient.

Tell me if any of this sounds familiar to you. I’ve waited a week for an insurance company to confirm that, yes, the medication I’ve been taking for nearly twelve years without incident really was necessary to my continued health. Meanwhile, I had to pay out of pocket for the pills – $50 for a week’s supply. I’ve been forced to retake blood tests, or produce 12-year old documents, to justify similar medicine. And this is not an uncommon or life-threatening ailment: it’s just one that requires continued treatment. Woe to another American, less well-off than me but stuck with a more dangerous or urgent condition.

I know the name of the insurance companies’ game, and you do too: loss avoidance. To the insurance companies, we’re not patients, and doctor’s aren’t caregivers. We’re liabilities, and they’re enablers. Insurance exists to make a profit, and they’re damn well going to make it, whether it’s in our best interest, or not.

Contrary to the Republican talking point, there’s every reason to think that a government-run plan would be substantially less of an impediment to care, and less of a burden on a doctor-patient relationship. Medicare spends significantly less on adminstrative costs than private insurers, precisely because the mission of private insurers is loss avoidance — not care!

This situation is one of the few cases where the “elitist” narrative makes sense. Good for Republican Senators that they enjoy a “Cadillac” insurance plan, that pays out seemingly without question. But this fortune apparently deprives them of the ability to relate to the real experience of health care on the ground. Perhaps if Republicans actually made an attempt to identify with voters on the ground (who support health care reform!), rather than using culture war issues as a proxy for real caring, they’d understand the real problems with American healthcare, and maybe win an election or two. Oh well: maybe some day.


29 Comments so far
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The House Republican plan coming out today is pretty impressive IMO. Putting purchasing power in the hands of the consumers is one of the best ways to drive innovation, cut costs, and demand better service.

Comment by Mike

I haven’t seen any mention of the republican plan, just the main one the House released today. Do you have any links?

Comment by Oneiroi

Yes, Mike, because consumers have had medical training and can tell doctors how to treat them.

Comment by Mike Haubrich, FCD

you must be one of those people who needs to be taken care of the usual dead best

Comment by fatnat

It’s not about choosing treatment. It’s about choosing services. Doctors provide a service like any other business. Some doctors are better at it than others. Some overcharge their customers. Why shouldn’t they be held accountable in the same way I hold my mechanic accountable?

Comment by Mike

Adn really, this idea is not generally incompatbile with either government-backed or private health insurance. The problem currently is that provider networks are limited and restricted, and the doctor does not always have the discretion to provide all the necessary care and instead is saddled with the HMO’s profit concerns.

I don’t know the other specifics of the GOP proposal, but I don’t see why the idea of flexibility in choosing doctors couldn’t be integrated with the Democrats’ other proposals for health care reform.

Comment by Kris

If the government is paying, why would they let the consumers pick the doctor?

Comment by Mike

Why would they not, Mike? And remember, unless you’re relatively well off and have a PPO plan (which I’m fortunate to have), you don’t choose your doctor ANYWAYS.

Comment by ACG

The problem really isn’t selecting doctors…it’s that the patients also need to be the consumers. They need to manage the money being spent and be able to press for more efficency, lower costs, etc.

Comment by Mike

(Sorry it’s so long)

I think in the end though that illustrates a main difference in the perspectives of the different parties.

I think one looks at as more of a necessity and right and the other more as a business. I think there are too many differences to look at it that way.

First, the stakes are higher. I can go in and get extra car work done or not done, and be relatively fine. If I get extraneous surgery or go without needed care, I could be maimed or die. So it’s more of an inevitable and forced cost.

Second, we hold doctors responsible for that health. We place more trust in them than any service provider. We tend to accept what a doctor tells us almost without consideration of cost. The doctor holds the power in the relationship, not the consumer.

So the reason I think a national healthcare plan is important is that it leverages more people which can lower cost (while at the same time, can offer more sources of income), works on finding a base cost of services through research (without the for-profit insurance middle man), and hopefully will work to remove some of those profit incentives that are hurtful.

(Good read for anyone interested in the cost/incentive issues)

I think that Republican plan is to basically throw more money at the problem, I feel like it misses the systematic issues. It’s great that you let me choose from private insurance, but that doesn’t address the rising cost of health care or inefficiencies in the system. I don’t really have a leveraged buying power, I don’t have cost analysis, I have an insurance company still trying to find reasons to not cover me and me being unable to do anything about it when the time comes.

The thing about the House plan today is that it provides oversight, it provides research. I didn’t hear anything similar coming from the Republican plan? But maybe I’ll see later.

I personally think a public insurance option will be the competition to put private insurance back in the game. Right now they’re not meeting our needs.

Comment by Oneiroi

How are they not meeting your needs? My insurance covers me completely. I don’t the debate is really about what it is covered, it’s about coverage verses no coverage.

The best way to hold a business, any business, accountable is to give the consumers the ability to take their business elsewhere. That’s not present under the current system and will actually get worse under the Democrat’s proposal. When has government involvement ever made an industry more efficent?

As for doctors’ roles in our lives, it is that fear of death which gives both them and the insurance copanies so much power.

Comment by Mike

The best way to hold a business, any business, accountable is to give the consumers the ability to take their business elsewhere.

But I thought the Democrats’ plan was exactly that – give people the option of taking the government plan. And haven’t the private health insurers been screaming that think they’ll be driven out of business if consumers have that choice?

Comment by Kris

The government plan is being designed in a way that Democrats hope most Americans will choose it. It’s a subsidy program. No one can compete with that.

Comment by Mike

But what would consumers be basing their decisions on? I suppose if your aunt dies in a doctor’s care, you stop getting checkups from him in the future, but what else can a consumer do? The problem is that consumers have next to no ability to accurately evaluate the quality of medical care. In fact, we know that consumers systematically make certain errors in evaluating the quality of medical care. Markets only work when there’s information to be evaluated, but health care consumers don’t really have any and can’t really have any without a great deal of education. They only have access to a very small sample of a limited set of outcomes – statistical noise alone is going to guarantee that most consumers will have no clue how their doctor stacks up to other doctors.

Look at homeopathy. This seems to be a model of what you’d like the health care industry to be. All that matters for the success of the makers of homeopathic drugs and for homeopaths themselves is customer satisfaction. Consumers have decided that traditional medicine isn’t for them and have shopped around for an alternative. Many will report being quite happy with this alternative. Of course, it’s all bunk, but many consumers simply aren’t equipped to understand that. Making health care “accountable” to the consumer would be like making the sixth grade “accountable” to the students – it’d become useless and massively inefficient. The only reason that our health care system works as well as it does is that it’s heavily regulated – not just anyone can put an MD after their name and open up a clinic, and I can’t just go to the pharmacy and obtain any medication I think I need. If you’re right, then don’t the same arguments imply that the medications I have access to shouldn’t be held hostage to a doctor’s opinion? Does anyone believe that this would really promote health?

Also, in what sense do you mean ‘efficient’ when you ask when the government has ever made an industry more efficient? The FDA seems like an obvious example of the health care industry being made more efficient, where efficient is understood to mean maximizing good outcomes and minimizing bad outcomes. Laws against fraud are enormously useful in promoting quality products. Although this has been the subject of some controversy lately, laws regarding intellectual property are plausibly efficiency-producing. The government also seems best able to maintain the very useful interstate road system. Government action can be more efficient than private action when there are collective action issues or when consumers lack the information to make qualified decisions. Both obtain when we’re talking about health care, with uneducated consumers and an insurance-dominated payment scheme.

Comment by Gotchaye

So your position is that because medicine requires a high level of learning, consumers cannot make any intelligent choices for themselves and therefore the best approach is to remove that choice by having someone much smarter make it for them?

Comment by Mike

Like that mother of three your clip mentioned will have the time to research health care?

C’mon, be realistic, it will just end up in the first insurance providers/hospitals pocket she can get to.

Having a public option for health care doesn’t remove the choice for those that want to do the research.

Comment by Oneiroi

You’re missing my point. Putting the purchasing power in the hands of the consumers instead of a large corporate HR dept means the consumers will demand more competitive rates. It might also cut down on excessive use of health services, which drives up costs as well.

All we’re talking about it bringing coverage to everyone by making people, not the government, responsible for purchasing their healthcare.

Comment by Mike

Basically. I’d use ‘knowledgeable’ instead of ’smart’, but that’s what I’m saying. How does the massive market for alternative medicine not prove this point? Similarly, I wouldn’t want to let consumers of education, even understanding the consumers as the parents of children instead of as the children themselves, determine curricula. That’s a good way to get unpopular but well-established material (evolution, say) tossed out. There’s a reason that we require home-schooling parents to meet certain curricular requirements.

Comment by Gotchaye

So why allow people to make choices about any number of other things? Education, their auto mechanic, the car insurer? It seems that if we’re going to require an MD before you can manage your own healthcare, why not an economics degree before you manage your IRA?

Comment by Mike

I’m saying, the problem now isn’t that people don’t have enough money.

It’s that health care costs are too high in general.

Giving people more money doesn’t address that the costs are too high.

There’s already plenty of money in the healthcare system. We’re at a point with high cost, no benefit.

Reform will change it, not more money.

Comment by Oneiroi

How do you see it as ‘throwing more money at it’ ? We’re simply talking about changing who the consumer is.

Comment by Mike

Oh, there’s also the obvious point that virtually every country which has more government involvement in health care than we do enjoys competitive health outcomes or better while spending far less on health care. It’s hard not to conclude that, whatever they’re doing, they’re doing it efficiently.

Comment by Gotchaye

I’m saying, that unlike other businesses, your ability to take your business else where when you’re dealing with health, is very very low.

I can’t go around doctor to doctor every time I get sick or end up in the emergency room.

I used examples how it’s different than any other industry.

Second, problems with insurance coverage are explained by Ames post above unless you’re disagreeing with that problem.

In the end, throwing more money at the problem, won’t make the high costs go away, it’ll just put more money in the health care system.

Suddenly, yay, Republicans gave me more money to pay for insurance, that doesn’t mean that the insurance company won’t rip me off, or that I won’t be stuck with a unreasonable bill or a myriad of the other existing problems.

Comment by Oneiroi

Ah yes, the good old “the market makes everything better, no matter what it is” argument. I wonder when privatization of police and national defense will rear its ugly head in western civilization, if this ideology continues to rule unchecked. Not that this would be without precedent in history, but I digress…

More to the point: I have never lived in the USA, but I am quite happy with the two health care systems I have experience with (German and Swiss). While we Germans are always complaining about the high costs and bureaucratism of our heavily regulated system, it actually seems to be more cost-efficient than the American one from the figures I have read, and it covers virtually everything. The Swiss system has a lot of private insurers but they are all forbidden by law to reject basic coverage to anybody, and everybody is required by law to be insured. You pay extra for and are not required to have anything above basic coverage, including, much to my annoyance, dental, but apart from that it seems like a decent compromise between “freedom of the market”-mania and the fundamentally civilized idea that everybody should have access to medical services in case of accident or illness regardless of their income.

Comment by Mintman

I can only agree with Mintman. As someone fortunate enough to live in two countries that enjoy government-run health care systems (Denmark and most recently the UK), this “faceless bureaucrat” idea that the GOP keeps bringing up is completely unrecognizable to me, and strongly suggests that they have not looked very closely at how such systems actually work in other countries.

Like our esteemed columnist, I too have a “continuing condition” which has given me a fair amount of experience with the health care systems of both countries, and I have never once experienced any sort of “rationing” or anything like that. Certainly, departments have budgets that they need to stick to, and the system is not perfect by any means – there are inefficiencies, and there are queues and waiting lists. But fundamentally, a universal health care system means that when you get in a situation where you require medical care, you can go to the hospital or to a specialist and get the treatment you need without the question of money ever being raised at all. When faced with the sort of stressful situation that a medical problem usually is, that sort of security is simply, in every sense of that word, invaluable.

Comment by lanfranc

This is in reply to Mike @ 4:30 (the comment window is narrowing too much):

I didn’t say that people weren’t qualified to make informed decisions about anything at all. Various services that we enjoy exist on a spectrum of rational understandability. Health care is way over on one extreme – people are absolutely terrible at gauging the quality and value of the medical care that they’re receiving. Ice cream is at the other extreme – people are very well-equipped to figure out for themselves what amounts of which flavors of ice cream are optimal for them. There’s a certain amount of inefficiency introduced by top-down decision-making, and the government should only interfere in markets when their natural state is so ridiculously inefficient (health care, education, policing, highways, etc) that it’s justified. But it is worth noting that aspects of almost every market are in fact this inefficient – there’s a reason that anti-fraud law pervades just about every industry out there. We do believe that the government has a role in the ice cream business, at least insofar as it ought to make sure that the people making ice cream are using safe ingredients and clean equipment.

Also, some differences between industries are cultural. Most people don’t want to manage their own IRAs, and so it isn’t an issue. Regardless, that’s kind of what Social Security is for – it’s a government-managed retirement fund. And we do mandate that people get car insurance. And we do mandate quite a bit about how much and what kind of education people get.

Comment by Gotchaye

Kinda makes you wish somebody in Congress would oppose it on the grounds that healthcare’s bad because it keeps people from dying, so we need less healthcare, not more.

Comment by Steve

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