The Gospel According to Rangel, MD

Socialized Medicine = Workfare

Right now there are over 2 million people directly employed by the Federal government. A Clintonian type socialized/nationalized health care service would have the potential to add hundreds of thousands more to the government payroll as various bureaucrats and support personal.

And the truth shall set you free!

Comments

Chris Rangel
And all the people said, “Aaa-MEN!”
RoseAG
They’d be jobs with health coverage!
However they’d not likely actually be Feds. Everybody doing Fed work today is a contractor.
Anonymous
Well…If you are going to continue the free-market economic arguments against socialized medicine then I think you should support informing the public. Doctors and all healthcare providers should publish all of their billing codes on line so that patients–customers–can comparison shop based on price…yeah, I know doctors aren’t a commodity, but it would be a start if you really believe in free market economics…
DocInKY
I realize all the usual suspects here on this blog will be all over my comment hair like spray on John Edwards, but in response to:
“Well…If you are going to continue the free-market economic arguments against socialized medicine then I think you should support informing the public. Doctors and all healthcare providers should publish all of their billing codes on line so that patients–customers–can comparison shop based on price…yeah, I know doctors aren’t a commodity, but it would be a start if you really believe in free market economics…”
I have to say it really does not matter if my charge for a carotid endarterectomy is $1000.00, $2000.00, $3557.00(2007 MGMA low end ‘fee’ btw), $5000.00 or $10000.00. The national medicare allowable before modifiers is $1018.00. My private insurers pay between 110% to 125% of medicare.
My fee is immaterial unless I set it so low that M’care says ‘since your fee is now lower at xxx, we will pay 80% of that xxx’.
Posting my ‘fees’ would not help informed patient decision making.
My two cents…
DocInKY
DocInKY
I meant ‘like hair spray’
Oh well…
DocInKY
Anonymous
” realize all the usual suspects here on this blog will be all over my comment hair like spray on John Edwards, but in response to:
I have to say it really does not matter if my charge for a carotid endarterectomy is $1000.00, $2000.00, $3557.00(2007 MGMA low end ‘fee’ btw), $5000.00 or $10000.00. The national medicare allowable before modifiers is $1018.00. My private insurers pay between 110% to 125% of medicare.
My fee is immaterial unless I set it so low that M’care says ‘since your fee is now lower at xxx, we will pay 80% of that xxx’.
Posting my ‘fees’ would not help informed patient decision making.
My two cents…”
In your practice, it might not make much difference, but I think even you might agree that if patients knew and bore a percentage of the cost of treatments they might demand fancy new things less often.
I find that doctors often have only a vague idea of what tests, procedures and drugs cost. As a patient with high deductible catastrophic coverage I do comparison shop. When I as what things cost I often get answers like “don’t worry, insurance covers that,” or they don’t know at all. Doctors, just as patients, fall into the “insurance will pay for it” mentality. Well, it doesn’t. I’m the insurance company for anything non-catestrophic and I see no reason why I should have to pay more than an insurance company–especially since I pay on the spot without wasting your staff time begging for insurance approvals.
Your fee is not immaterial. If it wasn’t material then you wouldn’t charge it.
–a usual suspect.
Anonymous
“I have to say it really does not matter if my charge for a carotid endarterectomy is $1000.00, $2000.00, $3557.00(2007 MGMA low end ‘fee’ btw), $5000.00 or $10000.00. The national medicare allowable before modifiers is $1018.00. My private insurers pay between 110% to 125% of medicare.
My fee is immaterial unless I set it so low that M’care says ‘since your fee is now lower at xxx, we will pay 80% of that xxx’.”
Might be true for your practice but not necessarily true for others.
Doctors often have no idea how much procedures they refer out to cost. And how can they? Like airline tickets, the amount these procedures or tests cost varies radically by vendor and by who they are billing, whether it is Medicare, PPO, Indemnity or Self Pay.
I do comparison shop for some things including medical services. It is hard because when you ask how much something will cost you get answers like “insurance will cover that.” It is hard to control costs when you have no idea what the patient is being charged.
Anonymous
It is the attitude that the fee is immaterial that has some doctors posting unconsciouseably large fees on the rationale that no one is paying them anyway, with the result that people who can self-insure buy insurance just to get a reasonable fee from doctors and hospitals. I think it is an immoral way to charge and providers should set one fare fee for everyone and collect that from all, except where they personally elect to extend charity or courtesy.
Anonymous
providers should set one fare fee for everyone and collect that from all, except where they personally elect to extend charity or courtesy.
The fast-track to bankruptcy.
I think my car dealer should set one fee, and charge only that fee, to everyone for the car. Why should I pay more than the next guy? Why do we negotiate at all? It should be one set fee! If his costs go up, or the manufacturer raises the rpcies, why should that be my problem?
Same for my plumber, lawyer, dentist.
I want the electrician to tell me how much the repairs will cost BEFORE he comes to the house, so I can comparison shop. He should be able to PREDICT exactly what the problem is and how much it will take to fix it. Why is it my problem if he can’t do that? If he won’t tell me, I’ll go somewhere else. After all, HE chose to work that way. I don’t have to play along. Same goes for the auto mechanic.
While w’re at it, I want my stock broker to tell me exactly what the return on my investments will be, and I don;t want low yielding ones either. Why shouldn’t I have the benefit of high returns as much as anyone else? Stock brokers should be required to guarantee that all new clients will earn at least as much return as their best performing client the prior year.
I bet I paid more for my computer than you did. You owe me $250 to make it fair. Pay up – or I’ll force the government to take it out of you in taxes.
Rich, MD
There is a lot of talk about disparity in doctor’s fees, so I thought I would present a different take on this.
It is true that we negotiate fees for large groups of patients with insurers. We call this “negotiated fee for service.” It is usually substantially less than the usual fee. Let’s say, for example, that my standard charge for 99213 (low level office visit) may be $120, and I can expect to collect, say, $70 in total from a commercial insurer, and perhaps $54 from Medicare. For cash paying people, I charge $120, but I might discount it for prompt payment to $100 (meaning paid at the time of the visit).
So yes, I collect less from those with certain insurance plans. As for plans I don’t accept, those patients pay the cash rate.
Now, some here are saying (writing) that this is not fair. There should be one rate for all. But I will tell you that it is fair, and there is one rate for all, $100.
The difference between what I collect from an insurer (negotiated fee for service) and what I collect from a cash paying payment is not a discount. It is an expense. My view is that I pay $30 (100 – 70) for each commercial insurance patient for advertising and promotion. That’s right – for that $30 per patient, I get my name in print in a book, where a large pool of potential patients look to find a doctor. I also get listed on the insurance company web site, and in the physician directory distributed to other physicians.
Since I am getting something for my money, it is not just a discount, and I am not taking advantage of the cash paying customer. It costs more in advertising to attract the cash paying customer, because they are not perusing insurance company directories or web sites. I place newspaper ads, radio ads, and so forth to attract those patients, each of which has an associated cost.
The same is true in nearly all businesses – attracting customers (or patients or clients, etc) costs money. Why should it not be true in medicine as well? When the cost is too high, I look elsewhere (i.e. drop the plan).
Medicare is a bit of an exception in that the rates are NOT negotiated, but mandated by law. Many patients have secondary or co-insurance, which might help. But when the difference betrween my charge and what they pay (the ‘cost’ of accepting Medicare) becomes too great, relative to the portion of my practice that has Medicare, it will go, too.
Anonymous
“I want the electrician to tell me how much the repairs will cost BEFORE he comes to the house, so I can comparison shop. He should be able to PREDICT exactly what the problem is and how much it will take to fix “
At least the plumber gives estimates. And your comparison is BS. You **do** know what you charge for certain **procedures.** You’ve got a whole chart of contract rates.
While it may not be able to predict the cost of the course of treatment for a disease, you could tell me how much you charge–except you can’t because you have a sliding scale that is nothing like the sliding scale in retail. In retail, regular customers might pay more for products than prefered customers, but not 3 to 5 **times more.**
I doctor suggested I get a certain test. I called around. Places wanted $3,500-5,000. The contract rate is $1,200.
“I bet I paid more for my computer than you did. You owe me $250 to make it fair. Pay up – or I’ll force the government to take it out of you in taxes.”
Here’s what doesn’t happen:
Customer, “I’d like to buy a MacBook. How much is it?”
Retailer, “Don’t worry. Insurance covers it.”
Customer, “No, how much is it.”
Retailer, “I really couldn’t tell you in advance.”
Customer, “How bout and estimate?”
Retailer, “Not really.”
–when what the “retailer” in this analogy is really doing is hiding the price because the price depends entirely on who’s paying even if the **patient** is the same.
Reimbursement rates are sooo messed up that the co-pay under an indemnity plan can be larger than the full reimbursement to a doctor under a PPO.
That’s just nuts.
Cash patients save doctors serious staff time. No dickering around with the codes to get billing to go through. No arguing for approvals. No low balling the bill. No 6 month delays knowing you can’t sent an insurance company to a collections agency. And what do you you do to cash customers? You charge us EXTRA! It’s like the youngest brother kicking the puppy because he knows he can’t get back at his older brother.
Anonymous
“My view is that I pay $30 (100 – 70) for each commercial insurance patient for advertising and promotion. That’s right – for that $30 per patient, I get my name in print in a book, where a large pool of potential patients look to find a doctor. I also get listed on the insurance company web site, and in the physician directory distributed to other physicians.”
What you are leaving out is the **extra** cost of:
-having your staff do insurance billing
-the extra time you spend doing things to prove to the insurance company that certain treatments should be covered
-time spent consulting on how to game the billing codes to try and get properly reimbursed
-and the long float while you wait for the insurance company to pay you, if they do.
You’ve given a low-ball estimate of how much you pay the insurance companies for patients. It is more than the $30 you posit.
And your justification–albeit a real world one that I appreciate your explanation of–is off. You say:
“Since I am getting something for my money, it is not just a discount, and I am not taking advantage of the cash paying customer. It costs more in advertising to attract the cash paying customer, because they are not perusing insurance company directories or web sites. “
I don’t have your figures so I can’t say whether this is true for you or not, but you call the $30 you lose on every insurance patient “advertising” rather than calling it the cost of acquiring the insured patient. Since you probably lose more than that per patient your customer acquisition fee for insured patients is high. With cash patients you consider the advertising you spend on them waste and charge them more. But what if you didn’t advertise, other than a phone book listing, would you still charge cash patients more? I’m guessing you would and that your justification is one that is after the fact.
–a usual suspect
Rich, MD
You are not correct that I left those items out. I did not.
I already discount cash patients who pay at the time of service. I recognize the cost of collections, and therefore, as I stated, discount about 17% from the charge for an office visit for those who pay up front.
Second, insurance billing is not as bad as you make it seem, at least not for primary care. I do it electronically, and the turn-around, or float, is actually very short, in most cases. Medicare actually pays relatively quickly. You have not seen me complain about floats or timely payment. In fact, for those plans that cannot do so in a timely fashion, or introduce hassles in order to get paid, they get dropped. With the right software, the staff does the insurance billing without too much difficulty.
As for “the extra time you spend doing things to prove to the insurance company that certain treatments should be covered” – well, in primary care, this is not a big problem. I do a few treatments or tests in office, spirometry, holter monitor, ecg, u/a. I know which plans will pay and which will not. I know which ones require pre-cert and which do not, and we act accordingly. Where it is too costly to do the test (because of insurance hassles) we send them out. Otherwise we make a decision if the hassles are worth the reimbursement for that particular procedure. In some cases (like u/a) we eat the cost because the value in convenience exceeds the cost.
I don’t game the billing codes. I bill what I do. E&M codes are complicated, but few in number, so it can be easily mastered. (And I resent the implication that I might be doing something unethical).
It may cost more than $30, and for the more costly procedures, it certainly does. I was providing an example using hypothetical numbers for a single code. The point is that this difference is the cost of acquiring those patients, whether it is advertising, clerical costs, or whatever. It is a cost I choose to pay, and if the cost were too high, I would be a poor businessman to accept it. So when it is too high, I do not accept it.
I never wrote that the cost of acquiring cash patients was a waste; I said that I do it by placing newspaper ads, radio spots and the like. If I thought it was a waste, I would not do it. Quite to the contrary, I LIKE cash paying patients. But I spend about A LOT of money on traditional advertising, and while I acknowledge that insured patients see these ads, too, I still get very few new cash patients. So the cost of acquisition for them is VERY high. But it’s not a waste, at all. I charge more because a) the cost of acquisition is high, b) the cost of collections is high (but I discount for prompt payment), and finally, because, being a free market type, that’s what the market will bear. I have a healthy mix of cash and insured patients, and some Medicare, and my patients, including the cash paying ones, are not complaining. They get good value for their dollar (I do satisfaction surveys). And no one is paying me any extra for the extra things I do in my practice to improve the patient’s experience – like online access to their records, online communication with the office and the doctor, email appointment reminders, online refill service, and so forth. But these value-added services receive consistently high marks from my patients.
And would I still charge more if I didn’t advertise? I don’t know. I have not done that. But I think it is unlikely that there would be anyone to charge if I did not advertise. I have had ads running from the day I opened my practice, and I see no reason to stop.
It is disappointing that when you finally see an honest, reasoned, business-oriented explanation (IMHO), you dismiss it as after-the fact justification, which tells me that you are not interested in any explanation at all. The fact is that I set my price, and then decide if I will accept any discounts against that price in exchange for volume. It is my business, after all.
Rich, MD
Anon 7:28 –
I addressed many of your points in my last post. Your premises are flawed, at least as regards internal medicine/primary care. For primary care, the items that you perceive to be so much more costly to the doctor for an insured patient (billing, coding, collections) just aren’t that much more costly. It may be true for procedurists or some sub-specialists, but not in primary care/internal medicine. I know I am not alone in discounting cash patients for payment at the time of service.
As for the “messed-up” disparity between indemnity plans and PPOs: it is not the doctor who chose your plan. In fact, it is likely that your physicians had NO input into which plan you should sign up with. Don’t you comparison-shop for insurance plans? I do. See above for reasons why a physician would agree to accept a discounted plan.
Regarding knowing charges in advance, I can tell you that for low level visit, code 99213, this is my charge. For 99214, that is my charge. This is what I charge for an ECG, that is what I charge for a hospital visit. It is much more difficult to tell you what an insurer will pay. It varies, not by insurance company, but by employer, and contract. It is actually very difficult to get a rate sheet from an insurance company that is anything more than an “example.”
What I cannot tell you, in advance, is what procedure(s) I will recommend, or the complexity of the assessment. You can assume, though, that the cost of assessment of a patient with multiple complicating issues and complicated complaints will be higher (this is addressed by E&M codes). And FYI, we do coding for cash paying patients also. And we don’t charge (in internal medicine) 3-5x for cash paying patients. Some of us also help find low-cost pharmacy plans to save our cash patients some money. I keep the Wal-Mart list of $4 meds handy at all times.
Alex in OKC
If you look at the following information from the AAFP (http://www.aafp.org/online/etc/medialib/aafp_org/documents/policy/state/medicaid-adm-costs.Par.0001.File.tmp/stateadvocacy_MedicaidAdministrativeCosts.pdf)
you would find that Medicaid administrative costs are usually less then four percent of claims paid. Private health insurance plans are 4-6%. HMOs are 8-12%. Commercial Health Plans are 15-20%. Looks like government funded healthcare might not be such a bad thing.
Facts are so silly.
Anonymous
“Looks like government funded healthcare might not be such a bad thing.”
At the current rate of Medicaid reimbursement, there won’t be any healthcare. Docs will be bankrupt.
DocInKY
To comment on the administrative cost ratios, I remember recently seeing a discussion on that (and cannot get the link yet.) M’Care and M’caid in many state are through 3rd party adminstrators, adding a layer of costs that are not counted in the “less than 4% costs”. Many of those admin expenses are effectively cost shifted to other agencies and other layers of management.
When an accounting of all costs at all layers is fairly compared, M’Care and M’caid cost more than “4%” I will try to find that link…
DocInKY
DocInKY
Found the link:
http://www.healthcarebs.com/2007/08/08/medicare-and-the-myth-of-lower-admin-costs/
I realize some will attack the messenger (the blog author), but it is real. I see the layer over my M’Care and my Tricare activities on a daily basis.
DocInKY
Anonymous
“I realize some will attack the messenger (the blog author), but it is real. I see the layer over my M’Care and my Tricare activities on a daily basis.
DocInKY”
No need to attack the messenger. healthcarebs.com and Kevin MD are birds of a feather. Heck, Health Care BS quoted Kevin MDs anti-socialized medicine Op Ed just 4 days ago.
http://www.healthcarebs.com/2007/08/06/medicare-cuts-foreshadow-single-payer-health-care/
http://www.unionleader.com/article.aspx?headline=Kevin+Pho%3a+Cut+Medicare+payments+for+doctors%2c+you%27ll+have+fewer+doctors&articleId=a63edbd0-0431-489d-9bba-16d8872bd609
I do agree with Kevin that we shouldn’t keep reducing medicare reimbursements, but Kevin likes to use medicare as proof that socialized medicine is a bad idea. However, I’ve yet to see Kevin explain how the US can move from its pathetically low ranking vs. other industrialized nations.
Anonymous
…pathetically low ranking vs. other industrialized nations.
Please provide an example of a metric which is measured objectively by reliable observers, using standardized methodologies, to compare healthcare across nations.
Anonymous
“Please provide an example of a metric which is measured objectively by reliable observers, using standardized methodologies, to compare healthcare across nations.”
Sure, right after you prove the US ranks **highest** in healthcare among industrialized countries (it doesn’t, of course, unless you can prove otherwise…)
Anonymous
Why should I have to prove it’s the highest? I never made that or any other claim.
YOU made the claim that the US ranks “pathetically low” compared to other industrialized nations, and I am asking you to support that assertion with reliable, confirmable, and reproducible data.
Nice straw-man, though.
Anonymous
Why should I have to prove it’s the highest? I never made that or any other claim.
YOU made the claim that the US ranks “pathetically low” compared to other industrialized nations, and I am asking you to support that assertion with reliable, confirmable, and reproducible data.
Nice straw-man, though.
Anonymous
“Why should I have to prove it’s the highest? I never made that or any other claim.
YOU made the claim that the US ranks “pathetically low” compared to other industrialized nations, and I am asking you to support that assertion with reliable, confirmable, and reproducible data.
Nice straw-man, though”
Why should you prove US healthcare is the highest ranking? Because that is your implication.
I suspect you know full well that the WHO report puts the US at number 37.
Implicit in the earlier post I was responding to:
“Please provide an example of a metric which is measured objectively by reliable observers, using standardized methodologies, to compare healthcare across nat”
…was that the poster was baiting me to cite the WHO report to which the would claim methodological imperfections.
My post to anon 1:52 was to ask them to prove their contention that the US ranks high (implicit in their implied criticism of the WHO report), for even if they could cast doubt on the WHO report that wouldn’t mean that the US ranks high by any overall standard of health for the nation as a whole.
Thus…in light of the WHO report putting the US at 37 it is up to anon 1:52 to prove that the US should rank higher.
BTW, the point you are arguing is not against a “straw man” but against “burden of proof.” If you are going to try and point out logical fallacies you should at least take the trouble to know which is which.
Anonymous
“A straw man argument is an informal fallacy based on misrepresentation of an opponent’s position.”
By requiring me to “prove that the US ranks highest” you attribute me with the claim that the US ranks highest, and then argue against that claim, which I did not make. Hence, a straw-man argument, which I was accusing YOU of making.
I was, in fact, arguing the burden of proof regarding YOUR claim that the US ranks poorly. It is your claim, you should be prepared to support it.
The burden of proof is only a logical fallacy if the burden is inappropriately high. I do not believe that weighty policy decisions should be made based on poorly measured, non-reproducible metrics which are not gathered from a reliable source. Doctors on this blog are frequently criticized for not applying the same critical analysis to socio-political issues that they do to medical issues – well, I am doing so right now.
So which is it, emotional responses to bad statistics tainted by self-serving reporting, or critical analysis of observable facts?
Anonymous
“By requiring me to “prove that the US ranks highest” you attribute me with the claim that the US ranks highest, and then argue against that claim, which I did not make. Hence, a straw-man argument, which I was accusing YOU of making.”
Actually, said it was implied. You claim that my citation that the US ranks low in healthcare among industrialized nations is unsupported, with the clear implication that you think the US does not rank low.
I have now cited the WHO report, which you are no doubt familiar with, but you have failed to cite proof that the report is wrong or that the US ranks higher than #37 by **any** metric.
Ball is in your court. Burden of Proof: you.
Anonymous
You’ve cvlearly missed the point entirely, but I am partly at fault for taking your bait.
To review, I asked for a reliable measure of “healthcare” in comparison to other nations, because it was brought into this discussion. The point of my asking was to illustrate that no such measure exists.
Even if I provide examples where the US fairs better than the WHO reports, I still believe it is largely irrelevant to a discussion of the US healthcare system because the measures still do not meet the criteria they should for their inclusion in such a discussion.
The goal should be to improve healthcare (access and quality), not beat France. Your statement is one of national pride rather than concern for access to quality healthcare (“…explain how the US can move from its pathetically low ranking vs. other industrialized nations.”)
Some argue that we should look at systems in other nations that “beat” the US in these rankings to find ways to improve. To this I say a) The rankings are not reliable, even those that favor the US, and b) emulating systems employed elsewhere is a non-starter unless we also embrace their system of laws, tax system, and culture. Which isn’t going to happen.
Instead, any “reform” (we can argue separately whether or not we really need reform) in the US will be uniquely American. The metric that should be applied should be one which compares American systems to American systems. Comparisons among systems that work in the same culture, with the same cultural expectations and obligations, and against the same set of rules we must live with.
For example, do large, consolidated multi-specialty health systems (i.e. Mayo Clinic or Kaiser Permanente) provide better long term outcomes than traditional small practices and community hospitals? Do “all-inclusive” programs (VA, Kaiser) provide better outcomes than employer based or government based programs?
If international rankings were really that valuable, where is the mass exodus to France?
Anonymous
“Even if I provide examples where the US fairs better than the WHO reports, I still believe it is largely irrelevant to a discussion of the US healthcare system because the measures still do not meet the criteria they should for their inclusion in such a discussion.”
Trying to figure out how to improve healthcare without comparing yourself to countries that do a better job overall is foolish and willful ignorance. It is somewhat like saying that we shouldn’t learn from history.
Many advances in medical research depend on international cooperation. Why? Because we don’t have all the answers. Would you really suggest that the best way to improve US medical research would be to cut off communication with the rest of the world? That is what you are suggesting the US do in terms of researching how to improve the US healthcare industry. Such an idea is completely insular and unreasonable. Why you would advocate willful ignorance is rather beyond me.
“If international rankings were really that valuable, where is the mass exodus to France?”
It is hard to give you a reasonable response when you post such specious arguments. Where is the mass exodus to **anywhere** from one industrialized country to another based on healthcare? Oh, sure 3d worlders flock the US. That is primarily for jobs, though, and Mexico does rank 61st to the US’s 37 so that is quite a step up. However, it is a shame that the US is only better than **the 3d world** in overall health care.
“Instead, any “reform” (we can argue separately whether or not we really need reform) in the US will be uniquely American.”
Pardon my French, but F’ that. We wouldn’t even measure the quality cars with that kind of insular ignorance. Instead, we compare our domestic cars to the best the rest of the world has to offer and make our cars based on international standards of quality.
The kind of isolated quality standard you are proposing is, ironically, the kind perpetrated by totalitarian states with sub-par products, like a Volga or Soviet health-care, where they deliberately protect the populace from any facts about the outside world which would make the domestic situation seem less than ideal.
(I know you’ll be tempted to try to bring up Cuba some how, I don’t think bringing up a country that is ranked worse than the US is going to help your argument, especially since all other industrialized nations have government sponsored healthcare.)
Anyways, you are just trying to change the subject by saying it doesn’t matter how badly the US performs relative to other countries. I call bunk on such low standards. If 36 other countries can do better than the US then the US should try and take some “best practices” from those examples.
Anonymous
Circular.
Anonymous
Two quick points:
1: What is considered a viable birth in the US is NOT considered a viable birth in Europe and much the rest of the world skewing results.
2: The level of morbid obesity in the US is much higher in the US than in Europe. This brings associated comorbidities such as CAD, DM, HTH, and others.
That is off the top of my head. Yes we can do better, using WHO numbers as gospel shows you don’t know the limitations of the study.
Anonymous
Once you start discussing health care as a societal issue, rather than an individual one, you’ve already made the largest step toward nationalizing it.
Don’t talk about the overall cost of healthcare. It’s irrelevant, unless you want all of society to fix it. And you don’t. You really want to deal with people as individuals.
The issue comes down to what is the minimum level of healthcare a person should be entitled to. Beyond that, it ought to be out of pocket. But when you have broad discussions about the overall “cost”, you move away from that.
Anonymous
“Don’t talk about the overall cost of healthcare. It’s irrelevant, unless you want all of society to fix it. And you don’t. You really want to deal with people as individuals. “
That is just silly. That’s like saying we shouldn’t talk about GDP to evaluate the economy. Of course you have to talk about overall heathcare costs.
Anonymous
You will never convince the socialists that non-socialist solutions might work. Don’t waste your breath.
Anonymous
“That is just silly. That’s like saying we shouldn’t talk about GDP to evaluate the economy. Of course you have to talk about overall heathcare costs.”
No, you really don’t. Because it doesn’t matter what overall healthcare costs are – it matters what they cost ME, or the next guy. What does MY medical care cost.
The way it has been set up, thanks in no small part to physicians themselves as well as the tax code, I never think about what it costs ME, I think about my deductible and that’s it.
As long as you continue to talk about healthcare as a behemoth which must be dealt with from a societal standpoint, and by societal I mean government, you’re going to get government solutions. And that isn’t going to mean MORE free market.
Anonymous
“The issue comes down to what is the minimum level of healthcare a person should be entitled to.”
Just for being alive? for breathing? None. You are entitled to get what you pay for, and nothing more, whether food, shelter, healthcare, or tickets to the Rose Bowl. Any additional goods and services you receive are either freely given gifts are stolen goods.
Anonymous
So then why are we talking about the overall cost of medical care. Because it only matters what the individual is paying.