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What's Yours Is Negotiable

We are now seeing how ObamaCare will pay for itself. At least, partially. At first. And it means finding places where people are making "unreasonable" profits in providing health care and coercing them to make do with less.

First up, in Massachusetts, ambulance companies. The Boston Globe has discovered that they -- gasp! -- have different rates for different passengers. They have their customary rates. Then they have their negotiated rates with selected insurance companies. And then they have their Medicare rates, which are dictated to them by the federal government. Wouldn't it be nice if they could just simplify matters and reduce their rates? Say, to just the Medicare and one other fee for insurance companies?

Yeah, it would be nice. For everyone but them. I don't know the economics of running an ambulance company, but I suspect it isn't cheap. You have a very highly-trained staff. You have very expensive vehicles stuffed to the gills with very expensive equipment and supplies. You have a very elaborate communications system to keep those vehicles connected to your base. And I suspect you have very high insurance rates to cover said above expensive people and stuff, plus liability insurance for big, heavy, clumsy vehicles that are driven at high speeds and carry very sick people.

Further, I know enough about Medicare to know that the rates set by the federal government are usually pretty crappy. I know some doctors often complain that the Medicare rates don't even cover expenses, so they end up losing money on those patients. They have to "overcharge" on non-Medicare patients just to balance things out and stay afloat. I have no problem believing a similar situation applies to ambulance fees.

Again, I'm speculating. I have nothing to back this up. I could very well be wrong.

But so what? I don't have to be an expert on the financing of an ambulance company. I don't own them.

And neither does the federal government.

Why the hell should the government get into the business of deciding what the ambulance companies charge for their services? It's one thing for them to "negotiate" those rates when the government is the customer -- even then it's questionable, as it's usually "negotiations" along the lines of what we saw between Darth Vader and Lando Calrissian ("I'm altering the deal. Pray I don't alter it further."). But for the government to decide how much is "enough" profit... that's a frigging scary thought.

And that is the crux of Obama's economic philosophy. He thinks that it's the government's role -- nay, duty -- to make certain no one makes too much profit. And, naturally, he's the decider. He decides how much is "too much."

Look at what Obama said when he was speaking with "Joe the plumber," when there was no Teleprompter in sight:

"It's not that I want to punish your success. I just want to make sure that everybody who is behind you, that they've got a chance at success, too... My attitude is that if the economy's good for folks from the bottom up, it's gonna be good for everybody. If you've got a plumbing business, you're gonna be better off [...] if you've got a whole bunch of customers who can afford to hire you, and right now everybody's so pinched that business is bad for everybody and I think when you spread the wealth around, it's good for everybody."
One wonders just how much of Obama's book royalties were "spread around" among the little people at his agent's office, his publisher's office, and so on. Or how much of Michelle Obama's salary at the University of Chicago Medical Center -- where she got her pay rate tripled after her husband secured an earmark for the hospital, and did such a vital job that they didn't bother replacing her as "Vice President for Community and External Affairs" -- was "spread around."

That's the key to doing well in Obama's America. Find a niche where you can provide a good or service that they find useful, especially politically. But be careful not to cross the line into something they consider important, because then you are setting yourself up as a target -- what you do is then too significant to be left up to the vagaries of the free market, too important to be left in the hands of the plebians and the proles. Then you have to submit to federal "guidance," in the name of the common good.

That's what's happening in the field of health care now. Insurance companies, pharmaceuticals, now ambulance companies -- they're all being told that they will be allowed to make "reasonable" profits (as defined by Obama and his minions), but not to make "unreasonable" profits.

It's something Ronald Reagan would recognize. He once described the Soviet attitude towards arms negotiations as "what's mine is mine; what's yours is negotiable."

Get used to it, folks.


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Comments (18)

First they'll take all the ... (Below threshold)

First they'll take all the profit out of health care. Then, when the doctors start leaving the field, they'll take the care out of health care. We'll be left with the same type of system they have in Canada and the UK, where the question is how many months a sick person has to wait to see a government-paid (read: "low paid") physician. The wait for an ambulance won't be quite as long but once you get to the hospital, you're likely to be "parked" for an extended period until the ER doc can finally get around to seeing you. What Barry really meant was: " I think when you spread the [misery] around, it's good for everybody."

The free market has a built... (Below threshold)

The free market has a built-in regulation: if an ambulance service provider is making an "unreasonable profit," then a competitor will step in and provide the same service at a discounted rate. It's not infallible, but it's better than government regulation, which, as has been proven time and again, does not work very well.

Isn't this curious--we've been force fed the claim that insurers are cheating patients by denying or limiting coverage, etc., but here we have a story of an insurer which somehow rolled over and paid an "unreasonable" ambulance bill. If the bill was "unreasonable," the insurer would have fought it in court and probably won. Insurers usually are not hesitant in challenging unreasonable billing. I have to guess that the insurer realized that the bill was not "unreasonable," which is why they didn't go to court over it, but instead just paid it.

That means that what was "unreasonable" was the much lower Medicare reimbursement rate. So, forcing ambulances to take unreasonably lower Medicare rates will drive them out of business. And, then, there won't be any more ambulance service (or poorly run government ambulance service).

Actually, this may cut down on overall medical expenses, because people would be dying in their homes instead of getting prompt, competent medical care.

As a faithful party organ d... (Below threshold)
jim m:

As a faithful party organ don't expect the globe to explain that businesses cannot remain in business with the reimbursement the government gives them.

I do find it striking that when a business charges different rates based on who can afford to pay what it is evil capitalism preying on the unsuspecting public, but when the government redistributes wealth in the same manner it's "social justice" and "fair play".

Central Planning was such a... (Below threshold)

Central Planning was such a big hit under Josef Stalin we should try it here.

John Edwards was right about one thing: there ARE "two Americas". One that wants freedom to live their lives as they see fit...and the other that wants the Government to dictate every aspect of that life. I pray the "two Americas" can have a peaceful seperation...soon.

Mr Obama said "I will pay f... (Below threshold)

Mr Obama said "I will pay for medical care....just not the most expensive medical care." True to his word, these are the steps toward mediocrity.

As a Physician that had to leave a practice due to non-payment, I see this trend coming to a "health care provider" near you, too.

Those whom the gods would d... (Below threshold)

Those whom the gods would destroy, they first have the government "improve."

I wonder how Indonesia has ... (Below threshold)

I wonder how Indonesia has ever survived without Barry?

Somewhat related:I... (Below threshold)

Somewhat related:

I buy my Thanksgiving and Christmas turkeys from a local, family-owned turkey farm. I asked if they sold other poultry, and they told me they used to, but government regs now forbid it.

This is the essense of encroachment. By all means, warn me of risks, but let the decision to buy (or not) be mine.

Jay, let me end your specul... (Below threshold)
jim m:

Jay, let me end your speculation. Medicare pays about 50 cents on the dollar.

The government views the cost of healthcare to be what they pay through medicare. This has nothing to do with the actual cost of delivering health care to patients. Imagine if you went to your doctor and asked him if he wanted to reduce the cost of delivering health care and when he said "yes" you offered to reduce what you paid him by 10%. That is what obama thinks cutting costs is.

I dare the lefties to go to their doctor and try the same. Or perhaps they would like to try it with the grocer or the gas station. Better yet they could go to their neighbor and demand money from them saying that they should do their share to spread their success to others.

Parasites all.

It seems the only ... (Below threshold)

It seems the only solution to what is in store is to "go Galt" as far as practical. That will differ among the parties involved, but it's merely a matter of degree.

I yet hold hope for the upcoming Congress to commence dismantling Obamacare, and the plethora of stifling regulations that have hamstrung us, but until things turn round, Galt is more and more appealing.

Either the upcoming year will see the rebirth of the America once celebrated, or the continuing slide into decline.

At least the choice is clear.

I pray the "two Americas... (Below threshold)

I pray the "two Americas" can have a peaceful separation...soon.

I doubt it will be soon, and when it does, I doubt it will be peaceful.

It seems the only soluti... (Below threshold)
jim m:

It seems the only solution to what is in store is to "go Galt" as far as practical.

Absolutely. I will W2 $30K less this year most comfortably. I have greater job satisfaction and security. Of course part of that is going from a sales position with a substantial bonusto a non sales position, but since I have moved to a job with a more substantial base salary my cash flow is consistant and that was more than worth the difference.

So not only will I pay taxes on less income but what I do pay I will pay at a lower rate.

There was a time when every... (Below threshold)
Jim Addison:

There was a time when every school child above eighth grade would recognize the signs of collectivization, and that it was against the grain of American history and freedom.

But nearly half a century of federal domination of the public school system has led us to the point where our children have learned nothing - but feel really good about themselves.

Goodness, Mr. Tea! What an ... (Below threshold)
Quaker in a Basement:

Goodness, Mr. Tea! What an incomprehensible hash you've created here.

You're railing against Obamacare and the feds but link to a Globe editorial in support of a state level proposal in Massachusetts.

You haven't cited a single thing to back up your central assertion.

Quacker in grandma's baseme... (Below threshold)

Quacker in grandma's basement-

"You haven't cited a single thing to back up your central assertion."

Sorry to inform you that Barney has been canceled for this evening.

Quaker, if you're not famil... (Below threshold)

Quaker, if you're not familiar with Massachusetts' health care system as a model for ObamaCare, or the thematic union of "controlling health care costs" as a unifying theme behind the advocates of both, then I don't particularly feel like enlightening you.


Don't sweat it, Quaker. As ... (Below threshold)

Don't sweat it, Quaker. As usual Jay Tea has no idea what he's talking about Because he didn't understand what he read. Not only does this have nothing to do with federal health care reform, this is a case of the government stepping at the request of a privte industry. In this case, the ambulance companies which originally supported a measure requiring insurancecompanies to py them directly. The insurance companies protested and demanded compromise legislation in which they would py the bulnce companies directly as long as they had guarantees that the price s would be controlled. This is entirely a dispute between two private industries whose linguists turned to the government for a solution. It has nothing to do with the government injecting itself into the "free market" uninvited. The industries themselves are seeking a giveremt remedy to a problem.

That's "lobbyists" not "lin... (Below threshold)

That's "lobbyists" not "linguists."






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