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In Sickness And In Hell, Part I

Well, as the political season moves on, we find that once again the notion of "health care reform" is rearing its ugly head yet again.

I'm no expert, but I have a few observations and opinions.

The first is that we don't have a health care crisis in this country. We have a health care funding crisis right now, and it's threatening to bring about an actual crisis in health care, but that is a symptom of the real problem. In the Southwest right now, quite a few hospitals have had to close down their emergency rooms because far too many people (coughillegalaliens) are treating them as their primary care centers -- and don't bother to pay for services rendered.

What we have is a problem of perception -- of people conflating "health care" with "health care funding." For exhibit A, I give you one of my least favorite commenters, "nogo postal/nogo war."

"last December I woke up late at night unable to breathe..my wife called 911...as a Substitute teacher I have no medical benefits...for 18 years my wife has been in a kinder classroom...not eligible for benefits... When the Denver Fire Dpt showed up and an ambulance...we were informed there is no ambulance access to the Denver V.A which was my wife's first request as I am a service connected Vet.... ....I went to the Denver County Hospital...it turned out I had an inflamed uvula.i spent 3 days in ICU... We are paying off $15,000 in costs $275 a month..."

For those unfamiliar with nogo's particularly incomprehensible form of English, let me translate:

"Last December, I woke up late at night almost unable to breathe. My wife called 9/11. As I am a substitute teacher, I have no work-related medical benefits. For 18 years my wife has worked in a kindergarten classroom, and (she/I/we am/are) ineligible for benefits through her employment either.

When the Denver Fire Department paramedics showed up with an ambulance, we asked for me to be taken to the Denver Veterans' Administration hospital, as I am a veteran with a service-related disability. We were informed that there is no ambulance service to the Denver VA hospital, so they took me to Denvery County Hospital. There, they treated my inflamed uvula and I was released after three days in the Intensive Care Unit. We are currently paying off the $15,000 hospital bill at the rate of $275/month."

nogo wanted to use his story to show how bad the health care system is. Instead, he showed just how good it is.

He was in serious physical distress. He was taken to a hospital that was prepared to deal with his problem, treated successfully, and released. And since he didn't complain about his treatment, I feel safe presuming it was done well.

His problem is with his health coverage. He says he lacks insurance, as it is offered through neither his job or his wife's. He apparently has some coverage through the VA, but he didn't know the details in advance. He did not know that his hospital of choice was not served by ambulances in his area. He did not know that ambulance service was not covered at all.

He did not know in advance just what was covered and what was his responsibility. In short, he was woefully ignorant about the details of what was literally a matter of life and death -- his life and death -- and is unhappy that no one swooped in and saved him from the consequences of his ignorance.

nogo, as he noted, was treated for his problem. He might even have had his life saved. And there is nothing unique about his story; it happens every day across the United States. Our health care system treats everyone who seeks help, regardless of their ability to pay.

It is those who are unable or unwilling to pay that cause the problems. In that, nogo is to be lauded -- he is paying his debt, to the best of his ability.

It boils down to simple economics. Robert Heinlein encapsulated a universal truth in a simple, snappy acronym: TANSTAAFL. There Ain't No Such Thing As A Free Lunch.

Everything has costs. It might not be strictly financial, but it is inevitable. Every aspect of nogo's experience had its costs. The ambulance needed to be bought and maintained. The paramedics needed to be paid and equipped. The hospital has its own overhead, as well as the salaries of all the workers who cared for him, provided him with his bed and linens, the cost of all the instruments and drugs and supplies used, and so on.

Even "free" services have their price. The person who is declining to charge for their time is "paying" for it in lost time and opportunity.

At my day job, I'm often asked why a company should use our services instead of simply doing it in-house. I tell them to take what they would pay someone to do the work, and then double it -- because while they're doing the work we do, they're not doing the normal work they would normally perform. That doubling represents a hidden cost, one most people overlook.

So, we have a health care finance crisis. What should we do about it?

I don't have a ready solution. But I do have a few ideas about what doesn't work. I'll explore that later.

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Comments (88)

If nogo is doing substitute... (Below threshold)
jpm100:

If nogo is doing substitute work because he's between jobs or has a disability, I would have sympathy for him.

But if he does substitute work as a career choice, than I don't have sympathy for his debt. Subbing is part-time work as far as I know. And not having coverage is a consequence of that choice. He should have sought other work or found a way to pay for the coverage.

What would be dishonest is if the subbing is to supplement other income from benefits or self-employment. Then subbing is most definitely a choice. And he should have purchased at least emergency coverage to supplement his VA coverage and the griping, imho, is unjustified.

$275 or less a month would ... (Below threshold)

$275 or less a month would have bought some level of coverage. It probably would not have covered all his costs, but it likely would have reduced the burden.

When you deal with the unin... (Below threshold)
WildWillie:

When you deal with the uninsured who by cigarettes and alchohol, all having cell phones and internet,etc., you will see how their priorities are out of whack. Also, all states now have the CHPS program for their children. I have questions about this 45 million uninsured figure. ww

- Doesn't have the responsi... (Below threshold)
Mark L:

- Doesn't have the responsibility to find a reasonably paying job. (Don't plead disabled vet -- Robert Heinlein was also a disabled vet, but managed to pay his own way)

- Doesn't have the interest to learn what benefits he does have and how to get them.

- Doesn't have the initiative to get himself to where he can get treated cheaply.

Then blames the world because things go badly.

His attitude seems to be one summed up by an old lightbulb joke:

Q. How many nogos does it take to change a lightbulb?

A. None. He holds the bulb and expects the world to revolve around him.

At $275 a month, he'll have... (Below threshold)
Rick13:

At $275 a month, he'll have that paid off in about 4.5 years. He received great medical care and is alive to complain about it. Between health care coverage and Aflac, my wife and I pay around the same per month. I don't see what he has to complain about.

The solution: less gover... (Below threshold)
_Mike_:

The solution: less government regulation of the medical care industry. Government, by requiring a very high level of service as the minimum, has restricted the supply of medical care. More specifically, it has restricted the supply of medical care at the lower end of spectrum. Basic economics of supply and demand states that when supply is restricted prices rise as a result.

In a free market, scarce resource with alternative uses are rationed through price. If government steps in and by fiat demands that either price be kept artificially low (price controls) or that supply be kept artificially low (through licensing and regulation), the supply will be 'inadequate' to meet the real need. The latter is what we have in the health care industry. The choice is is either (a)allocation by price (decentralized) or (b)allocation by bureaucrat (centralized). There is no other.

I also think that perhaps a... (Below threshold)
_Mike_:

I also think that perhaps a pre-negotiated 'limitation of liability' with the patient would help reduce the cost of malpractice insurance significantly. That is, prior to whatever procedure your physician is going to perform, the two of you negotiate a limit to what his financial risk is for the procedure. This would state, that in the case of malpractice, you agree to only hold him liable for up to some agreed upon dollar amount. This should have the effect of reducing the number of 'defensive' (read:potentially unnecessary) tests run. The fewer 'defensive' tests, combined with lower malpractice insurance cost, should help create conditions whereby it would be feasible to offer service at a lower price/performance point.

James Bond: "Do you expect ... (Below threshold)

James Bond: "Do you expect me to pay for my own health care?"
Goldfinger: "No Mr. Bond, I expect you to die."

I'd say problem number one ... (Below threshold)
Jay:

I'd say problem number one is that the 3 days and what sounds like a pretty modest problem cost $15,000. That's absurd.

Or is problem number one that insurance is expected to be provided through employers, which has contributed to the expectation that everyone have insurance and the massive overpricing of both insurance and medical care?

Or is problem number one that there isn't insurance so cost effective that people on that kind of income are able to afford it and encouraged to buy it with a barrage of marketing from all those competetive companies who want to pick up every last customer?

Of course there's nothing wrong with health care services, unless you mean arificial restriction of supply by the AMA, doing what any union wants to do. They've been wallowing in cash since FDR fucked with the economy. Turning it into a huge, lucrative industry made it worth curing, even inventing, lots of ills and becoming really good at what they do. Even LBJ has taken decades to threaten that at all.

For the no big dealers, $27... (Below threshold)
Jay:

For the no big dealers, $275 extra a month would shove me over into bankruptcy. Not that the $766 a month I pay for insurance hasn't already come close, and now I'm not allowed to risk dropping it for a while to become more stable because this is Massachusetts, and we can fix health funding if only we outlaw being poor.

Let me translate nogo idio ... (Below threshold)
Paul:

Let me translate nogo idio again....

I made irresponsible life choices and I did not buy heath insurance. When I got sick, that decision bit me on the ass so now I want YOU PEOPLE to pay my bills.

THAT'S WHAT HE IS SAYING!

1. If he could have been c... (Below threshold)
Mycroft:

1. If he could have been cared for at the VA hospital, it would have been free to him there. So his BAD choice to go to a different hosptial cost him $15K. Why is he even a story?

You want to talk about health care costs? I'll tell you about costs. In 1994, after 60 days of testing, I was diagnosed with Cancer. I spent 6 months in Chemo, and was cured. I had medical insurance, but thanks to the way that company did business, I had a hospital dunning me for $20K while the insurance comapny was STILL PROCESSING the payments.

When all was said and done I paid $1700 for the health care I recieved. I had to watch everything the insuance company did, because they WANTED me to pay for $32K of the $97K bill, by doing the paperwork wrong.

What drove me into debt was the "disability insurance" I had from my employer. And for those that say I should have gone on Social Security? Social Security still had a year to go to kick in before I was eligibile for it, by the time I went back to work.

10 YEARS later, I paid off all the debts associated with the whole thing.

I am authorized medical car... (Below threshold)
scrapiron[TypeKey Profile Page]:

I am authorized medical care at the VA hospital (never used it), but I know which ambulance services will take me to the VA if I request it. If it's an emergency they will take you to the nearest ER and after you are stabilized you can request and be transfered to the VA. I've always suspected that NoGo wasn't wrapped too tight, so from now on you can ignore his 'ignorant' comments. Did he say he taught kindergarden or was in kindergarden. I pity the parents of an child in this school, brainwashed by the brainless. This is actually normal for any left wing democrat, it's the governments responsiblity to take care of them, including what is the normal persons personal responsibility. That's what you'll get under a Shrillary/Obama socialist/communist administration. No brain will be required, they'll do your thinking for you. I love it when a plan comes togather.

"For those unfamiliar wi... (Below threshold)
FreedomFries:

"For those unfamiliar with nogo's particularly incomprehensible form of English, let me translate:" snark from Jay Tea

and then Jay Tea writes...

"He says he lacks insurance, as it is offered through neither his job or his wife's"

and, from American Heritage Book of English usage

"neither ... (n)or. As a conjunction neither is properly followed by nor, not or, in formal style: Neither prayers nor curses (not or curses) did any good"

So who lives in a glass house?

Another often overlooked fa... (Below threshold)
scrapiron[TypeKey Profile Page]:

Another often overlooked fact. NoGo is not only paying his medical bills. He is paying for the thousands/millions of criminal aliens that the hospital must treat, free. Go ahead, support the open border crowd. In the end it will be 'you' that pays the bill. 1/2 + of every medical bill, and medical insurance, is a result of treatment of criminal aliens and insurance driven up by the likes of The Breck girl (Edwards) and his phony multi million dollar lawsuits.

yes FreedomFries you caught... (Below threshold)
Paul:

yes FreedomFries you caught Jay Tea in a typo... yippie for you.

Moron.

BW, who's to say it's a typ... (Below threshold)
FreedomFries:

BW, who's to say it's a typo rather than untutored usage? Or is Jay a legal immigrant still struggling w/ ESL?

If one is going to cast stones regarding English usage, one ought to proof read so as not to appear foolish.

I smell a red herring.... (Below threshold)

I smell a red herring.

Oh, FreedomFries is in here.

"Well, there's your problem."

Uhhh, I don't believe that ... (Below threshold)
D-Hoggs:

Uhhh, I don't believe that that "Jay" is even Jay Tea freedomfries.

Nogo's wife should have dri... (Below threshold)
BillyBob:

Nogo's wife should have driven him to the VA hospital. Another solution is Nogo should have claimed to be an undocumented worker, you know, like from Ukraine. He'd have his free lunch then and the hospital would have taken it in the shorts like it does for all the other illegal aliens. Eventually taxes go up to subsidize the freeloaders or the hospital closes from lack of payment for services rendered. (doctors & nurses don't work for free ya know).

Ahh, thought you were talki... (Below threshold)
D-Hoggs:

Ahh, thought you were talking about the Jay in the comments. Proceed.

Yeah, I am not Jay Tea. Hi... (Below threshold)
Jay:

Yeah, I am not Jay Tea. His is even more of a pseudonym than "Jay Solo," blogging since early 2003, before Jay Tea. and more or less concurrently with Kevin.

Back when I was famous for "The Great Rat Race" in the Ecosystem, Kevin was still at the point where it made a difference whether he supported me or my competitor, depending whose links and traffic he thought would help him more.

The blogosphere has gone all to hell since the halcyon days of 2003.

freedomfries:"Or i... (Below threshold)
D-Hoggs:

freedomfries:

"Or is Jay a legal immigrant still struggling w/ ESL?"

Speaking of glass houses, I believe that is what is called a sentence fragment.

Let's rewrite it from a Fre... (Below threshold)
BarneyG2000:

Let's rewrite it from a French perspective (or any other country that has universal coverage/care):

I had a medical emergency. The ambulance picked me up, and took me to the nearest hospital. I was treated and released.

I did not have worry about what was or wasn't covered, or which ambulance service is contracted with which hospital. I did not need a referral or fill out a lot of paperwork.

Best of all I am not paying off a $15K bill plus double digit interest.

As a side note: Bush wants to veto the medical coverage for kids bill because it works too well and people might start asking for coverage for all.

Two things to thank God for... (Below threshold)
Peter F.:

Two things to thank God for:

1.) That nogo survived his ordeal;

2.) That he's only a substitute teacher and his influence on our children is limited when it comes to the wholesale abuse of ellipses.

"As a side note: Bush wants... (Below threshold)
D-Hoggs:

"As a side note: Bush wants to veto the medical coverage for kids bill because it works too well and people might start asking for coverage for all."

He wants to veto it because it is already being spread to cover families of those children, and thensome barney. Glad to know you are going to be moving to France soon.

d-hogg, this is what the pr... (Below threshold)
BarneyG2000:

d-hogg, this is what the president said:

"I strongly object to the government providing incentives for people to leave private medicine, private health care to the public sector. "

http://www.whitehouse.gov/news/releases/2007/07/20070710-6.html

The president is more concerned with how much money the insurance, doctors and hospitals will make and not about covering kids.

Thats because he's pure evi... (Below threshold)
D-Hoggs:

Thats because he's pure evil barney, he wants all kids to either sign up for his imperial army or die. But you already knew that. (Coo-coo, coo-coo)

Bye barneygoogle. Hope Fran... (Below threshold)
jhow66:

Bye barneygoogle. Hope France likes you better then we do.

jhow,I'm sorry. I'... (Below threshold)
BarneyG2000:

jhow,

I'm sorry. I'm a great big doodyhead and a pottymouth, especially when I speak the language of the cheese-eating surrender monkeys. I abjectly apologize for both my words and my very existence. In fact, I need to be spanked. By a very large man named Bubba, preferably, while wearing a chicken suit and yodeling.

BarneyGump:Let's ... (Below threshold)
_Mike_:

BarneyGump:
Let's rewrite it from a French perspective (or any other country that has universal coverage/care):

How very poorly informed you demonstrate yourself to be, again.

A study performed by the Canadian government on the Canadian government's health care system found:


While people in rural areas seem to fare better, Toronto patients receive care in four hours on average; one in 10 patients waits more than a dozen hours.

So, the good news is that nogo might not have had to pay for but 2.5 days after spending the first 12 hours waiting for emergency service...

This was an interesting editorial written by a Canadian doctor:

Although, Canada does have this cool website that shows how many MONTHS you'll have to wait for a procedure. My wife recently had to have an MRI. The wait time - 1 day. Checking the awesome shows that wait times for MRI's in the Ontario province are typicall 110 days, but hey, they're targeting 28 days.

Moron.

Oh and Barney:Here... (Below threshold)
_Mike_:

Oh and Barney:

Here's the link for the quote and another excerpt about the tremendous socialist health care systems of which you seem to be fond:

Her client, Lindsay McCreith, would have had to wait for four months just to get an MRI, and then months more to see a neurologist for his malignant brain tumor. Instead, frustrated and ill, the retired auto-body shop owner traveled to Buffalo, N.Y., for a lifesaving surgery.

www.opinionjournal.com/editorial/feature.html?id=110010266

Barney is moving to France?... (Below threshold)
Jo:

Barney is moving to France?!! Good luck finding a job! Oh and they have a rightwing president there now too. You know, to clean up the leftwingers usual messes.

Bwhahahahahahah.....too funny.

Oh BarneyGoogle poo flinger... (Below threshold)
BillyBob:

Oh BarneyGoogle poo flinger, here's your French perspective.

Barney lives and works in Fwance. Fwance takes a huge chunk of Barney's earnings each month to pay premiums for his "free" health care.

Barney gets sick and calls an ambulance for an inflamed labia. Barney waits 12 hours in the ER to be seen and suffocates in the process. Fwances's health care system just got healthier.

There's no such thing as "free" health care unless you are an illegal alien or lazy ass scumbag liberal leech on society.

In 1994 the medical coverag... (Below threshold)
WildWillie:

In 1994 the medical coverage was catching up with available treatments. NOW, doctors and hospitals has staff that their sole job is to get pre-approval for all tests and treatments. That way, when the billing takes place, all charges are relevent.

The new CHPS bill will take care of whole families and is the liberals sneaky way of starting universal healthcare without the debate. ww