Earlier this week, we ran a Q&A with Julie Salamon, author of the new book Hospital: Man, Woman, Birth, Death, Infinity, Plus Red Tape, Bad Behavior, Money, God, and Diversity on Steroids. Given the richness of her book and the primacy of healthcare as a topic of interest, we’ve asked Julie to guest post here, and she has obliged.
(Disclosure: Julie once reviewed a book of mine; and yes, if it had been a bad review I would have remembered …)
Photo: Julie SalamonCommon Sense Health Care
A guest post by Julie Salamon
Last week a young friend, an international student at N.Y.U., received an upsetting call from a bill collection agency. She was told she owed a $1,089.50 balance on an emergency room visit, the part her insurance didn’t cover.
She had a high fever at night. The resident advisor in her dorm took her to the N.Y.U. emergency room, which accepts her student insurance. After a long wait, a doctor saw her, gave her Tylenol, and sent her home.
I called the insurance company, which had no record of any claim being filed or turned over to the collection company. On hearing this, the collection company told us “to sit tight” while the two companies deal with it.
“What does it mean, to sit tight?” the foreign student asked. “To do nothing,” I said. “To wait.”
“Crazy system,” she said.
As problems go, the $1089.50-plus tab for a quick fix was microscopic in the face of the $2.3 trillion spent on health care in the U.S. last year — about 16 percent of the GDP compared with 7 percent in 1965. But it was a big bill for my young friend.
Sitting tight in our crazy health care system doesn’t cut it anymore. A useful June election tracking poll from the Henry J. Kaiser Foundation reports that 25 percent of Americans see paying for health care costs as a serious problem — for them.
Our market economy approach to medicine has to change. There is “a fundamental illogic to trying to contain costs in a market-based system,” writes Dr. Marcia Angell in a thoughtful article about health reform in the April 21 issue of The American Prospect.
Dr. Angell, a senior lecturer at Harvard Medical School and a former editor-in-chief of The New England Journal of Medicine, was called “an unlikely muckraker” by The New York Times in 2004, when she published a powerful expose of the drug companies.
Her position on health reform appeals not to corporate interests but to common sense and the desire for good medical care, making it appear radical:
“The only workable solution is a single-payer system (there, I said it), in which everyone is provided with whatever care he or she needs regardless of age and medical condition,” she writes. “There would no longer be a private insurance industry, which adds little of value yet skims a substantial fraction of the health-care dollar right off the top.
“Employers, too, would no longer be involved in health care,” she continues. “Care would be provided in nonprofit facilities. The most progressive way to fund such a system would be through an earmarked income tax, which would be more than offset by eliminating premiums and out-of-pocket expenses.”
Until then, will state and federal lawmakers be willing to rein in a system that dishes out Tylenol at $1,089.50 a pop?
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I’m not sure I understand how government insurance solves the problem of what an emergency room charges for services. All government insurance does is pay the bills. If they are the only game in town (single payer) they have a lot of leverage, but does this mean the government is going to decide how much things cost and how much doctors are paid. I think it is about time that doctors start making as much as a public school teacher. That should really improve the quality of health care.
Unlike healthcare, everyone needs food every day to survive. The price of agricultural commodities have gone thorugh the roof and we are seeing this passed on to consumers. There are families with children that can no longer afford the basic food neccessities of life. So, lets try these arguments substituting the word food for healthcare.
Our market economy approach to food has to change. There is a fundamental illogic to trying to contain costs in a market-based system. The only workable solution is a single-payer system, in which everyone is provided with whatever food he or she needs regardless of age and nutritional condition. There would no longer be a private food industry, which adds little of value yet skims a substantial fraction of the food dollar right off the top.
Food would be provided in nonprofit facilities. The most progressive way to fund such a system would be through an earmarked income tax, which would be more than offset by eliminating premiums and out-of-pocket expenses.
Sound like a good system for food distribution or does it sound like the system that collapsed in the former Soviet Union?
Health care is rationed now: by wealth. Rich people get all the care they want. Everyone else gets to fight it out with insurance companies whose profits depend on NOT giving care, or underfunded government agencies. It’s irrational, but that’s our system, where you can pay into health insurance for years and get denied when you actually need care, denied prenatal and pediatric care (the best ROI by far), denied ongoing disease management so you end up in the emergency room. Social Darwinism shows its ugly head.
There’s a big difference between the market for “health” and the market for pork bellies. Simply put, most of the destroyers of our health are contagious. If we make the general populace more healthy, we reduce the need for health-care. There is a demonstrable payoff to the individual for the health of the society. True, many of our biggest health risks are self-inflicted, and any single-payer scheme has to charge people based on their own health maintenance, but that’s a much better feedback mechanism than charging based on their employment.
The current medical system in the US is not a “free market.” In a free market, the patient would ask what the price would be before the service is provided. In most cases, patients and doctors do not bother to address the price of the service, because a third party (employer, insurance company, gov’t) is paying the majority of the bill.
What this country needs is a “catastrophic insurance” system that would pay for out of the ordinary bills. The patient would pay for routine treatments, and the insurance bill would be much lower. Under such a system, the doctor, the patient, the medical laboratory and the pharmacy would all be considered before a medical treatment is undertaken. In a true “free market” system, many 24-hour urgi-care type facilities would be available, and ER would be used only for true emergencies. The urgi-care facilities would charge a reasonable fee for the service. If they didn’t, other facilities would take their place.
With respect to the proposed “one payer” system “in which everyone is provided with whatever care he or she needs regardless of age and medical condition,” who will make the decisions? I certainly wouldn’t want the government making the decision, any more than I like my insurance company making it.
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DJH hit the nail right on the head.
Free markets only work when people have access to pricing information the the ability to make choices.
Neither of these are true when it comes to health care, especially when it comes to acute care.
That’s how you get hospitals charging $1100 for something whose true cost is probably less than $100 (i.e. 5 minutes of a doctor’s time and some Tylenol), and $2000-$3000 a night for a hosptial bed when a private nurse at home generally costs roughly $500 a day.
“Until then, will state and federal lawmakers be willing to rein in a system that dishes out Tylenol at $1,089.50 a pop?”
You know, last month I got the timing belt on my wife’s car changed, and it cost me about $600. So you can imagine my outrage when I found out that a timing belt ONLY COSTS $31! That greedy, for profit garage padded my bill by $569 bucks. I mean, sure, they had to spend a couple of hours disassembling engine components, pay rent on the garage they were using, and they did have free Wi-Fi. But my wife needs that car, and she (and I) shouldn’t have to be victimized by that kind of corporate greed.
“Crazy system”, I said.
Our market based system to vehicle maintenance has to change. The only workable solution is a single-payer system (there, I said it), in which everyone is provided with whatever vehicle maintenance he or she needs regardless of vehicle condition.
Until then, will state and federal lawmakers be willing to rein in a system that dishes out timing belts at $600 a pop?
“bureaucrats deciding whimsically who lives, who dies, who gets treatment for something and who must live with a painful condition ’cause we won’t pay for that.”
Umm, right, because HMOs aren’t run by bureaucrats now…
You’re worried about care being rationed. Well, right now it already IS being rationed, but solely on the basis of money.