Update on health care systems

I agree this was a part of why no one would see me, regardless of how much I paid. Yet it still demonstrates that cash is not enough.

I made calls within 100 mile radius of where I Iive, which includes two large southwestern cities.

George: I had--and have--no debt. I was offering to pay on the spot with greenbacks, and no orthopedic doctor would see me. It was a horrible experience. I had never broken a limb in my life. I was in tears because I could not get what I think were very basic questions answered about how my arm was (or was not) healing. The (perfectly reputable, university hospital affiliated) orthopod's office that put the cast on in the first place would not see me for a consult before my scheduled date for cast removal several weeks later, either. Here I had all the money--and then some--for which any reasonable medical provider could possibly ask for a few minute consult. Yet no access, no way, no how.

. The (perfectly

I wonder if liability issues came into play here instead of the question of payment. Perhaps one physician did not want to take responsibility for treating a patient that another physician had already seen because of some senseless fear of being responsible for the first ones mistakes. I believe that sort of worry does cause a lot of inefficiency and poor care in the USA insurance=dominated, malpractice-obsessed, health care system. That is another whole important area of concern when comparing the systems of two nations.

Hi Elle,

I think legal tender must be accepted as payment. With all the guarantees of freedom we have (left), the same website tells that a restaurant has the right to refuse service to anyone - but there has to be a reason (e.g. a legal one - refusing service based on race creed color will probably not be considered legal).

As for your experience, first, I'm sorry to hear that you had such trouble. Second, "I told you so!" I said here long ago that trying to guarantee medical service to everyone creates artificial demand that cannot be supplied. Free markets handle that through higher prices until equilibrium between supply and demand is achieved. More supply is added, less is demanded, until it balances. Throw in a command economy and it will take years to unravel, instead of days, and it will fall apart at the drop of a hat.

With all the ambulance chasers here (the most lawyers per capita etc.), many 18 year olds probably think three or four times before committing to 14 some odd years of study to become doctors. For those who elect to follow their hearts, their *insurance* costs run hundreds of thousands a year - even for those who make not a single error. Those insurance rates drive up costs.

E.g. My understanding is that with the proper "insurance" and government intervention, in-home tanning salons are paid for. In a free market, those people simply could not afford them. Those tanning salons are a small example, but they do draw supply away from those with a broken arm (there are things other than tanning beds I could use for examples, but I'd get called a Nazi - which I am most emphatically NOT)..

I don't like getting pessimistic, but the underlying cause and effect as I see it is simply that we as a culture are losing our values. To analyze that would take definitions of values (citations), evidence of deterioration (statistical studies), and theses of causes (studies) - a large book. But many simply see it. We don't smile and laugh as much as we used to. I say that not as a doomsday prophecy, but as something we can do something about, wholesomely. ("First, we kill all the lawyers.")

I must retract the pessimism of my immediately prior post. Don, when you and I agree on something, it is the dawn of a New Age of Enlightenment! (I say that in good humor. Any aspersion or similarities to any aspersion real or imagined read into it are entirely fictitious and not the responsibility of the author. )

Pardon? The anecdote I gave occurred in presumably a free market system. Yet it did not matter how much money I had. I was not getting care.

On the other hand, if you want to condemn the current system as some kind of monopolistic (only those willing to work with insurance can count on care, and even then, access can be limited), then this makes sense. But in no way does our (alleged and mostly) capitalist medical care system guarantee medical service to everyone.

The vision you and others here have of a medical-care-for-all system is one that does not try to use cost controls. My vision of such a system is different: It indeed prohibits people from using procedures whose efficacy is unproven.

The New Age is on the way! People with an uncompromising "free market" orientation often advocate leaving regulation of misconduct in business to the various business and professional organizations themselves instead of imposing regulation from outside. A similar idea could be applied to medical malpractice. Why not let doctors themselves take care of disciplining misconduct by other doctors and keep lawyers out of it entirely. Some people, especially lawyers, might say that the doctors would take care of their own and ignore and downplay the instances of malpractice. But then that same argument could be applied to stock promoters, mutual fund managers, etc. You can't have your cake and eat it too. The trick would be to break up the in-house "take care of your own" mentality in some way while at the same time putting an end to all the big-money judgments from lawsuits. That may be easier said than done. Here again, it might help to look at how other nations with superior health care systems do it.

It is exactly what happened to me in 2004. Keep in mind that this was a visit to an emergency room, not a visit to a specialist. Actually, I have heard that emergency rooms are *required* to provide treatment, even to those with no insurance or money.

Why is it you think government programs could not imitate what Safeway CEO Steve Burd has done? A sample:

Your proposal has real depth. And it is probably workable. Suggest it to your Congressmen (for real - you can do that online). You will probably get back a canned statement in the area, but that represents study by themselves and their staff, together with the current state of affairs, any pending legislation with comments, so you get quite a bit and can know your Congressman's position.

"Free markets" is understood to include effective regulation, just as a free society has police and as citizens own weapons. The ethical level of doctors is very probably much higher than that of bankers. Lawyers have proven beyond doubt IMO they're money-only (and ethical cowards). The recent settlements against banks are nothing, as even judges have noted. The "lawyers" who file suits against companies for what amounts to trivia (e.g. earnings allegedly misstated by 1%), are nowhere to be found. One Bloomberg article explained that these lawyers have banks as clients - and so are barred from filing suit against them because they may have confidential information.

That doctors and or hospitals refused you service even though you had money in hand to pay is worth a topic on its own. That certainly is not a free market. Don may have it exactly right - it's the best explanation I can think of.

Elle, while it is interesting, I did not see any evidence that their employees actually became slimmer as a result of this incentive. Do you happen to know if that was, in fact, the case, or not?

The article describes two parts to Safeway's plan, one is to essentially make their insurance plan into a high deductible plan, and another part was paying employees for becoming slimmer.

I can see that the first part is working, but is the second one working?

i

Free markets work well when buyers know what they are buying. So, for example, if you are buying writing pens, a free market could work well.

In case of medicine, it is much harder for a buyer of medical services to understand the exact value of what he or she is getting.

That's why medicine is so regulated everywhere in the world (except countries where I personally would not want to live).

i

Hospitals may be beginning to respond to individuals' pressures - some do have price lists published (estimates). Doctors I've seen usually explain what's to be done and why, then give an up front cost.

This turns into a huge topic (i.e. "I don't know"). Regulators seem to have gotten way far behind (e.g. financial crisis, globally). But the philosophy determines the practice. Imagine if hotels were required to provide rooms to the homeless? If everyone were required to purchase "hotel stay insurance?" If everyone were given the Presidential Suite (expensive procedures)? I've heard from way, way back that hospital management is a difficult business, and the emotional situation of illness is probably a very contributing factor.

Regulation is probably a very good thing. Establishing free competition between hospital chains would probably do wonders, then let patients or "consumers" handle "regulation" (who gets their dollars, or not).

The article says the following:

"[Safeway] today fully pays for an array of primary and preventive visits and tests. But beyond that, employees have skin in the game. The company deposits $1,000 each year into a "health reimbursement account," which workers can use to pay for care. The next $1,000 in expenses is the employee's responsibility. After that, employees pay

20% of costs up to a $4,000 maximum."

I do not consider the above like a high deductible plan, especially given the preventive care.

the national average."

And what if you didn't have a credit card? Thumper

There is no evidence that lawsuits have any real impact on insurance costs besides the insurers using it for an excuse to charge outrageous premiums. Thumper

Only for legitimate emergencies. They don't have to see you to remove a cast. Thumper

Other possibilities

1) The doctor had a full waiting room 2) Contractually he needs to reserve slots for patients from an HMO or other places 3) He wasn't going to do anything other than reassure you and he is not into that. 4) A person offering to pay the list price prior to the Dr providing the service is regarded as a nut case.

Note that without insurance you will be billed the list price and will be expected to pay it. Most doctors are not into negotiating with individual patients but they will negotiate with HMOs and PPOs especially if the HMO etc will fill the waiting room

medicare PPO, payments run about 30% below doctor's billing. Hospital based lab work pays about 10% of billings. Hospital outpatient and inpatient services get paid between 25% and 35% of billings.

Avrum Lapin wrote: > Other possibilities

All you're doing is confirming that having a credit card or paying cash does not ensure access to medical care. Also I resent any implication that someone is not entitled to a second opinion from anyone arguing the value of the free market when it comes to medical care.

Completely false. You are not up to date. The NY Times has been reporting nationwide for several years now on how the list price has all the meaning of monopoly money. A cornerstone of financial planning today is to negotiate medical bills, because the list fees have little rational basis. When I first went to get my cast, I was told that paying cash on the spot would give me a 10% discount, and I exercised this option, of course.