Ouch, I lost almost all of this post as I was writing it, so I’m re-writing it. Not the same as it was before. From now on I’ll make sure to write these on wordpad and transfer them over.
Now to the real meat of the problem: Corporate medicine. Hospitals have become little more than portals through which health insurance, medical equipment and pharmaceutical companies interact with humanity.
The practice of medicine in some form or another is as old as human kind. Hospitals (or at least places to put lots of sick people so they aren’t coughing on folks and getting their bad humors or negative chi all over the healthy) are also ancient. So when did it go bad? The same place everything else did: Nixon.
Okay, it wasn’t that great before, but still I’m going to blame Nixon. Two great President Roosevelts with five terms between them helped to build a truly amazing country and advanced the notion that the government was more than the people who took your taxes and told you what other countries to hate. Teddy Roosevelt (one of my absolute favorite presidents) first advanced the idea that the country’s ecology was both worth saving and necessary to save. FDR introduced the New Deal and with it the concept that the government would also protect the least fortunate by providing a safety net to fall back on. These would coalesce with labor laws and consumer protection laws to form the bedrock of our society. The government protecting its citizens from any threat foreign or domestic, physical or financial. Then Nixon took all our dreams and got sweat and lies all over them. Nixon started a downward slide that has continued to this very day. To me the cry for smaller government is really a cry for bigger business when it comes from politicians.
It’s not inherently wrong to benefit from another person’s suffering. Coroners would go out of business if people stopped dying. No cops without crime. No weathermen without rain. In the case of HMOs, they benefit from other people’s suffering, do nothing to alleviate it and tend to make everything worse. As I said last time, health insurance companies want you dead. Everybody knows that. HMOs want you dead as long as you die inside your coverage area.
But it doesn’t matter what style or type of corporate medicine you’re getting. The thing that ordinary insurance, government insurance, HMOs, medical equipment, pharma and hospitals have in common is raising costs. We all know the costs are going up. The debate is why they are going up and how to stop them, which is raging on all levels of our society.
The prime suspects/scapegoats are illegal aliens, malpractice suits, regulation and the uninsured.
Regulation is the favorite of the Tea Party politicians. It’s all that red tape tying up the system that prevents work from getting done and drives up the cost. Like every regulation argument these days, it’s never followed by specific regulation they would like to see struck down. I bet there’s plenty of stupid and wasteful regulations, but I can’t think of any for private sector medicine. The V.A. is a different story. Every year to keep my job I have to complete an online test to prove I won’t hand out private medical records (I already take a similar test as a civilian MT because it’s the cardinal rule of the profession – like a test for carpenters to identify pictures of hammers, nails, wood) and then sign a contract saying I won’t commit treason. The test is ridiculous. All the right answers are so obvious. “If you come across information sensitive to national security should you: A. Keep it to yourself. B. Sell it to the Russians.” Then when you click B, it makes you choose A before letting you go ahead. It’s a test which you cannot fail. Some of the tests I take have the right answers highlighted. It’s a good thing because I don’t pay attention to what it’s saying anyway.
Outside the V.A. though most of the regulations in hospitals are for real safety reasons. Instrument counts before and after surgery to prevent people from going home with a toolkit in their abdominal cavity; redundant consent forms so the patient (and doctor) has a fighting chance to know what’s getting cut off before it’s done; standardized sterilization procedures so your doctor can’t bring his lunch in with him once he’s scrubbed and drop a burrito inside you. I’m always happy to cut bad regulations, but for informed consent purposes we deserve to hear each one specifically before we slice it off.
Illegal aliens coming to America to steal our health care and our jerbs! Also, according to trusted newsman Lou Dobbs they’re bringing leprosy up here by the thousands. Leprosy! Well, first there’s 50 million uninsured Americans and only 10 million illegals, so our certified American moochers outnumber them 4 to 1. As for the leprosy thing, that’s not even a real thing. In 2005, Lou Dobbs said 7000 illegals with leprosy had entered the country over a 3-year period. That’s interesting because there have only been 250 new cases a year and 7000 existing cases total. And that’s everyone, not illegals. Considering that 95% of all humans are immune to leprosy and after a couple treatments even people with it can’t transmit it, it’s one of the least scary diseases in the world. Mexicans aren’t harbingers of disease and America’s health care system is no longer the envy of the world. Hell, I’m trying to figure out a way to get to Mexico for their medicine and churros, which I also call medicine.
Then you’ve got all those whiny, little babies suing their doctor for cutting off the wrong arm. Malpractice lawsuits are driving the entire health industry out of business and doctors are robbing you blind to pay for their insurance. So, we need the Republican answer to rising costs: Tort reform. They’ll end all those frivolous suits, which will in turn lower costs. Don’t worry that removing a patient’s ability to sue their doctor, hospital or medical product manufacturer or receive special damages will encourage further malpractice, because they’ll only cap and halt the bad lawsuits. It won’t even take that much work since while doctors on average injure 1 out of 25 patients they see, only 4% of the injured patients ever sue. If we end this stampede of lawsuits we’ll save big bucks. If you tally up all the payouts, suit costs, legal fees and even insurance costs it comes to 0.5% of health-care spending in America. So, now that 10,000 bill is only 9,950. Now you can afford a single tank of gas to drive back home. Unless your doctor accidentally paralyzed you and you can’t drive, then you can use it for the cab ride to the lawyer’s office. Well, as long as tort reform doesn’t pass you can.
The final parasite on the soft underbelly of American medicine is the uninsured. Colloquially known as poor people, this ever endangered creature is the source of a great deal of frustration from Congress. What to do about it? Democrats want to put them in a zoo to keep them safe and healthy. Republicans want to heap criticism on them until they are shamed into buying insurance they can’t afford. The Republican Party eats its own tail when it comes to the uninsured. Premiums are too high because there aren’t enough people on the system to distribute the risk, but too many people with insurance would lead to overcrowding in the system. People can’t afford higher taxes for government run health care, so they should pay outrageous premiums instead. We can’t afford universal health care because national debt devalues the dollar and hurts the economy while tens of millions of private citizens with a massive personal debt burden from health care and thus can’t spend money in the private sector or pay taxes (or hold down a job if they’re sick) miraculously doesn’t effect the economy.
To solve this problem, ObamaCare was forged in fetid swamp of D.C. Created from the failure of Democrats, the sabotage of the Republicans and both parties selling out (the only thing that brings donkeys and elephants to the same watering hole is corporate contributions), the bill is decidedly middle of the road, so no one likes it. The Right argues that it’s socialism. I hate it because it’s too corporatist. They are making me buy a product I don’t believe in. Or at least a product sold by companies I don’t believe in. Thanks Congress, as usual the only thing all Americans can agree on is how terrible you guys are at your job. Still, I’m withholding further judgment until it is enacted. It’s a complicated bill on top of a complicated system designed to handle a complicated problem, so the results are… well, complicated. I will always fight for the public option and true universal health care. No American should go to bed hungry, sick, cold or abused. We’ve got far too many people in all four categories.
So, if poor people, Mexican lepers, bitter medical incompetence victims and regulations aren’t choking the life out of the system, the real moocher is still on the loose. It should be pointed out that medicine is more advanced than ever. Medicine was a lot cheaper when it was just a guy coming over to your hut, slapping you around with a dead chicken and invoking the gods to fix you. It got more expensive when doctors started needing fancy black cases to carry all their tools. Each new tool or drug raised the cost. The splitting of the atom led to an exponential increase. Now we can blast you with radiation to see which parts of you are glowing that shouldn’t and which ones should that aren’t. Admittedly, for followers of Benny Hinn or other faith healers nothing has changed since the dead chicken to the face days of mankind.
The price of medicine is naturally going up. No greedy financial sector maneuvering needed. You pay for what you get and we get an awful lot these days. Three decades ago HIV was a short death sentence. Cancers that once stood as premonitions of death are now survivable. Smallpox is gone and polio can be prevented. Higher resolution scans, genomic prediction, stem cell treatment, genetically tailored medicine, nanobiotics, manufactured organs, the DRACO vaccine and more are coming down the pipeline.
Not the answer we all want, but a piece of the puzzle. Still, the more advanced technology gets, the cheaper it gets, so why isn’t any sector of medicine getting cheaper? We should be paying out the ear for PET scans and getting x-rays for cheap.
Either that or corporate avarice, ineptitude and immorality is the source of all our woes. Health insurance companies saying they have no choice while their profits continue to grow even in the face of rising costs from ObamaCare. Going cheap on their patients, while putting their money into the architecture and decorating of their buildings. Executive wages rising annually and bonuses to all who show up. Corporate jets to travel to Washington to ask for more money and benefits on the side. Intentionally denying good claims in the hopes they’ll give up or die first. Cancelling insurance for pre-existing conditions. Cancelling insurance for no decent reason. Not paying out when they should. Paying people to go over your entire medical history to find a single contradiction.
The insurance my former company offered me was $300-400 a month premiums for 50% coverage after a 2,500 deductible. The staggering amount of disease I would have to get to make that plan pay for itself is astounding. Anything costing over 2,500 and it won’t matter if it’s 50% off, I would be hard pressed to pay that in time before they would send me to collections. And, of course, it didn’t include dental. Nobody seems to be able to get dental. I have no idea how my teeth and jaw aren’t part of my body. If you hurt your tongue, that’s medical. If you get an infection in your tooth that could spread to your brain, that’s not medical. Yet try telling your dentist he’s nothing more than a glorified enamel mechanic.
Behind it all was the greed of the insurance companies. No, wait, that’s the tip of the iceberg. The hospitals themselves might well be ripping you off even worse. The insurance companies are designed to be profitable and they aren’t even the ones giving you the giant bill in the first place, only the person who promised to pay the bill and then remembers they forgot their wallet every time they go out. The hospital is supposed to be there to save your life and make you well. Ever since the article Bitter Pill in Time Magazine the hospital billing system has been cracked wide open. One of the biggest revelations was that of the “charge masters.” These documents/people who make the documents/Lovecraftian-horrors-risen-from-the-depths determine what we all pay. If asked before how hospitals determine prices, I would say based on shady internal math where they jack up the price to screw us. And I was wrong. Because the real way is slapping a random number on each treatment.
Let’s pretend I’m a charge master. A kidney transplant is going to cost 250,000. Wait, that’s too high. 40 bucks. No, too low. 57,936.99 except on secret double kidney Tuesdays where you get two for the price of one. That’s the system.
Look at that map of New York. Anybody who sees this and thinks that makes sense is obviously a charge master. Three guesses which hospital in the Bronx is now the most popular for COPD treatment after this article. I have a hard time imagining how insane someone would have to be to pick the high end or low end of that spectrum.
By the above standards the corruption of the other corporate facets of this problem seem so benign. The problem with pharmaceutical companies is simply that they go cheap in the research, steal other people’s ideas, re-formulate the same worthless chemicals to patent a new drug, ignore and hide side effects, carefully word reports and studies, and then over charge the buyer. That’s a classic con. It makes sense. It’s wrong, but we get it.
We’ve got people coming out of the hospital sicker than they went in, an epidemic of imaginary immigrant lepers, millions suffering with no insurance, hundreds of millions suffering with insurance, companies that don’t care, pills that don’t work, and now drastically insane charge masters.
What this all means in the end is that before we can even figure out how to lower the costs, we better find out what the cost is now.