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Healthcare Access - How Do We Improve It?

Posted by WhiteCoat on October 10, 2007

In all my “busyness,” I haven’t really scanned my favorite blogs lately - until today.

Scalpel is doing one hell of a job bringing issues about healthcare access to light. Whether you agree with his opinions or not, these are issues that MUST be discussed before the decision is taken out of our hands.

And Nurse K is promoting ways people can empower themselves to better afford medications. Good work!

If you read some of the comments to Scalpel’s posts, healthcare access just isn’t an issue for the indigent population anymore. One person posted that he was in the hospital for less than 24 hours and walked out with a $17,000 bill. That’s more than a lot of people make in a whole year. A friend of mine showed me a bill where her father was in a cardiac cath lab and outpatient recovery for a total of six hours. The bill? $32,000!

I’m a very apolitical person. I don’t follow party lines. I look at the person and their ideology, not their political party. I don’t consider myself liberal or conservative. With that in mind, after reading Scalpel’s posts, I recalled an article on my computer from the mid-90’s that discusses one of the biggest issues that we are having right now in health care. I agree with a lot of the sentiment in the article, but don’t have feelings one way or another for the organization or the authors - just have to credit them for a thought-provoking article.

Hats: A “right” for every American!

Dianne L. Durante and Salvator J. Durante

Let’s say we all agree that hats are worth having, or even a necessity, and that all Americans have a right to them. We pass a law stating that the government will pay for everyone’s hats, through taxpayer dollars.
What happens? First of all, hat sales skyrocket. I’m not particularly fond of hats, but if I can get them for free or below cost, why not?
Lesson One: there is no limit to demand, if those who get the product or use it, are not paying directly, or in some way they can see. This is unavoidable. The freeloaders will try to get all they can, and most of the rest of us will want something to show for our tax dollars.

If such a law passed, most hatmakers would be delirious with joy. Everyone wants hats! They expand their shops and produce as many hats as they can.
What happens next? The average price of hats shoots through the roof. . . Why?
There are two reasons. First, of the hats now being sold, the more expensive ones — the ones only a few people could afford before — will now be in much greater demand, since the individual hat-buyer no longer has to pay from his own limited resources. If the latest style is a platinum-plated beret, anyone who wants one will now get it. The other reason for the rising prices is competition: specifically, lack of it. New products, such as the first camcorders or the first compact disc players, are usually expensive. Prices drop because more people want to make money from a product: they try to come up with cheaper and more efficient ways of producing it, so they can sell the product more cheaply and grab some of the market. Our unlimited government funding of hats has completely cut out the need for competition. Any hat maker can stay in the business, no matter how high his prices.
Lesson Two: prices will skyrocket if there’s no limit to how much people can spend on a product. If anyone who wants the product can buy it, price no object, there is absolutely no reason for the manufacturer to try to cut his prices, and no reason for the buyer to control how much he spends. The government, and only the government, can give people virtually unlimited amounts to spend on a product. In short, it is not the greed of the manufacturer or the consumer, but the mere fact of the government funding of hats that is making hat prices exorbitant.

Next step: the government, and hence the taxpayers, are faced with enormous hat bills. Mrs. Smith may have confined herself to one hat, but Mr. Jones wanted five, and Mrs. Imelda wanted 52 Paris originals. The government knows it can’t continually raise taxes to pay for hats. Assuming it wants to keep the hat program intact, it has two choices: restrict the number of hats any one person can buy, or restrict the price of hats. In political jargon, that means rationing or price controls.
From a politician’s point of view, stating limits on the price of hats is the obvious way to go. There are fewer hatmakers who vote than there are hat wearers, and it’s easy enough to paint the hatmakers as greedy exploiters of the hatless. So a new law is passed no hats may be sold for more than $15, even if the buyer is willing to use his own money. The immediate result will be that the best quality, most expensive hats become unavailable. No more Paris originals.
Lesson Three: You can’t make a silk purse out of a sow’s ear. Good materials and good workmanship cost money. Yes, competition among manufacturers in a free market will cut prices in the long run. However, legislating a lower price for a product is not a shortcut to cheapness. It merely makes those who were selling more expensive goods go bankrupt, before anyone has time to work on price reduction.

We could try some complicated and devious maneuvers to lessen the effect of price controls. For instance, we could slap a $5 tax on shoes and use the money for the hat program. Then we could have a maximum hat price of $15, but still pay the hatmakers $20 per hat. That would mean, of course, that some poorer people wouldn’t be able to afford shoes, and the government would end up subsidizing shoes, too. Even so, price controls on hats will have to be instituted in some form, because demand is so high.

Remember that it is government spending for hats that made the demand and the prices so high in the first place: nothing except removal of the government’s money will get the situation back under control. But let’s keep trying. . .
We’ve now legislated a maximum price for hats. Nevertheless, Mrs. Imelda has bought another 35 hats, and the rest of us are still trying to get our taxes’ worth of hats. Not surprisingly, the amount that taxpayers are shelling out for hats hasn’t significantly decreased, despite our price controls. The next step? Well, of course, restrict the number of hats each person can buy: ration them.
Now what happens? A lot of hatmakers go out of business. They can’t sell hats for more than the maximum price, and they can’t make up for the loss in income through selling more hats. Bureaucrats demand forms in triplicate and slap fines on them at every turn. The best hatmakers soon leave the field in disgust. We are now facing a decreasing supply of hats, if not an actual shortage, because there are far fewer manufacturers. But hats are a necessity, aren’t they?
Now, we will have to pass a law forcing hatmakers to remain in business whether they can make a profit or not. However, even a government order can’t make a business run for long at a deficit, whether it’s a hatmaker, a child’s lemonade stand, or a bank. The hatmakers will go out of business, one by one.
The government will have to step in and make hats. Given the quality of most government products, you can imagine what kind of hats we’ll get. And given the efficiency of most government manufacturing operations, we won’t be surprised if we’re told we can each have one hat, in our choice of four styles, every other year.
Lesson Four: What the government pays for, the government has to control. Government funding of hats led to government control of hat prices, hatmakers, and finally everyone who is even remotely connected to hats. The only cure would be to end government funding of hats.

What began as a seemingly praiseworthy law — to provide all Americans with hats — has ended up driving the hatmakers we know and trust out of business, and given us government-produced hats of considerably inferior quality and very limited numbers. This result is absolute, inevitable, and non-negotiable: none of the economic rules above can be avoided, and they can only be temporarily circumvented by allowing the government to interfere in yet more private business.

Comparing hats to medicine or to pharmaceuticals may seem even less appropriate than comparing apples to oranges, but the same economic principles apply.

For more information about government intervention in medicine, write to Objectivist Health Care Professionals Network, P.O. Box 4315, South Colby, WA 98384-0315.

8 Responses to “Healthcare Access - How Do We Improve It?”

  1. hashmd Says:

    The only way to get the bureaucrats to “get it” in regards the the healthcare crisis is to mandate that ANY program, ANY spending limits, ANY new “plan” they implement is applied to THEM!!!

    Think there is an HMO for the Senators or Congressmen/woman? No. Do they live on what Medicare approves or spends for care? No.

  2. moreena Says:

    Are you kidding me? Just saying,

    “Comparing hats to medicine or to pharmaceuticals may seem even less appropriate than comparing apples to oranges, but the same economic principles apply.”

    doesn’t make it so!

    I agree with the general economic argument here, all things being equal (although I’m no economist), but the authors completely ignore the social/psychological/cultural differences between hats and healthcare. If I had access to free hats, I’d want a whole bunch of hats! I’d go hat crazy!

    But hats are a whole lot easier to want than MRIs. My insurance pays all but $10 of my doctor’s visits, but I’m not knocking down her door every month, just because visits are (practically) free. What kind of idiots these articles (and those making the same argument) take us humans to be.

  3. SeaSpray Says:

    Hi Whitecoat-A while back, one of the ER docs used this similar analogy with the purchase of big screen TV’s.

    I agree, most people aren’t going to run out the door looking for their next FREE CT, etc., nor are doctors going to schedule them. (Most people DON’T want to go to the doctor OR get tested) Still…when you aren’t worried about where the money is coming from…and it WILL come from somewhere or compromise care.

    Quality vs quantity-how DO we get both??

    The health care business/medicine is a multi-layered complicated problem and I believe should be a nonpartisan issue that needs to come to the forefront.

    People are interested and DO care. I get more hits on a post I did questioning socialized medicine (and the one on kidney stones) then anything else.

    Back in June, after watching Michael Moore’s film about health care (Sicko)I did a post on the Pros and Cons of Socialized medicine(actually don’t remember my exact title) because while I knew he would provide a skewed perspective it still got me thinking. So, I put my (lay person’s), opinions, feelings, concerns and questions out there and also linked posts from back then that had been done by Scalpel, Panda Bear and others. The NHS Blog Doc posted it on his site as another view from across the pond. It seems that some of our friends from across the border or the pond are happy with their system while others are not.

    Scalpel is doing a great job with his posts on this topic!

  4. hashmd Says:

    Moreena,

    No, you may not be pounding down your doctor’s door every month.

    BUT…you certainly are not disincentivised to do so to demand to have an MRI of your knee or ankle when you injure it. Does every injury need an MRI? No. Yet I have patients DEMAND (not ask, not recommend, DEMAND) that I order it. Do I have another 20 minutes to spend explaining why not? No. Do I have an incentive to make my patients happy? Yes, it is now called Pay for Performance where patient satisfaction scores make a difference of THOUSANDS of dollars a month to my practice! So it is easier for me to go ahead and order the MRI–no copay for most of my HMO patients. I would be the bad guy to you if I said no, and the bad guy to all the social engineers for ordering “unnecessary tests” when I say yes. A lose/lose situation for us all.

    The idea they are placing in their fable or parable is that each individual patient is no longer responsible in understanding the true costs of their care nor the impact of their demands for care which raise the cost for everyone else.

    If you had to pay the full cost of the office visit, the full cost of the MRI, you would be afraid to come in; just like the uninsured. You would neglect your health for years just to avoid the possible financial devastation a diagnosis of cancer would bring.

  5. Teri Pittman Says:

    My husband and I have had 3 MRIs between us in the last two years. I had one for unexplained hearing loss in one ear. I now know that I don’t have a tumor. I still have no idea why I lost hearing in that ear. (The doctor didn’t even think to ask if I’d had measles as a child. I had to bring that one up.)

    My husband had two when he blew out the muscle on his calf. By the time they read the results and called him to tell him that he needed surgery, his calf had already healed up. His legs are in great shape, so he was able to come back without surgery.

    In both cases, we gained nothing by these expensive MRIs. We really learned nothing from them. And since the doctors didn’t really do anything for either condition, we might just as well have been uninsured and not gone in.

  6. SeaSpray Says:

    Thank God I have always been very healthy for most of my life except for the routine colds,flu and bronchitis a couple of times.

    A stupid kidney stone wreaked havoc with me and I have had so many tests as a result of it since May, 2004. CTs, KUBs, IVPs, renal scans and multiple procedures. I have had so much radiation that it is just one of those things you give to God. I am surprised that I wasn’t out there glowing with the fireflies this past summer! :)

    I am so grateful to have insurance and that my uro doc participates!

    The Mag 3 renal scan with lasix alone is 3,000.00! (Next Wednesday will be my 6th one and BTW #5 showed I was healing and I am even more optimistic about this one)

    But what if I didn’t have insurance? I still have balances on co-pays for everything being done. Then there are the bills from the hospitals, specialist docs, radiologists, anesthesiologists and ER docs. I can see how someone could lose their home with something truly catastrophic.

    Then you hear that in countries with socialized medicine they have to wait a long time to get these test/procedures. Again, speaking from personal experience…I can’t imagine not being able to tackle the problem in a timely fashion. Socialized medicine is not the Utopia that Michael Moore presents.

    Wouldn’t it be great if we could combine the best ideas from socialized medicine and our health care system into a program where everyone is happy?

    I wonder which could happen first…the Utopian health care solution or peace in the middle east?

  7. SeaSpray Says:

    Nurse K-Please be advised that Sprayage is deeply saddened to see that you have gone private with that fun blog of yours. :(

    Sprayage states that you are among her favorite new blogs that she frequents often. You have a gift for that exquisite humor that just jumps out in ways one doesn’t expect and you indeed almost got Sprayage with a coffee nasal lavage a couple of times. :) Is THAT where you got Sprayage from? LOL! :)

    Hope you don’t mind I did this Whitecoat.

  8. GoingLikeSixty Says:

    Stopping the gifts and junkets for docs from big pharma would be a nice first step.
    http://goinglikesixty.com/2007/10/13/shrink-accepts-gifts/

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