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We Interrupt This Blog To Bring You An Important Message

A new starting point for our national conversation.

One of the key points of this blog is that the health care debate has never been about health care.  Never.  Money isn’t the prime driver.  Money is the only driver.  How do the hospitals, doctors and other medical providers get paid, and how much, are the real issues. 

Except for a couple of purists, no one really cares who pays the doctor or hospital as long as it isn’t you, the patient.  Do you really care if your $300,000 bill from the Cleveland Clinic or University Hospital is paid by Anthem Blue Cross or the federal government?  Honestly?  No.  All you really want to know is how much, if anything, you will owe once the dust settles.  And the providers?  The insurers pay more, but have a lot of paperwork.  Medicare pays less, but quickly.  Based on the number of medical providers that accept Medicare (darn near everyone), I’m guessing that there are no serious complaints.  The hospitals may even like having two major funding sources to play against each other. 

I have tried to teach my clients what I know of the game.  My senior clients learn about the origins of Medicare Parts A and B, the backroom deals that gave us Part D (Rx), and why costs are out of control.  Countless clients have been clued in that those obscene charges are negotiable before and after services have been rendered.

Your perception of our system changes today thanks to Time magazine.  Blessed with budget, time, and amazing persistence, Steven Brill has given us Bitter Pill, Why Medical Bills Are Killing Us.  Mr. Brill tracked claims and laid bare the abomination that is our system of billing for services – real or imagined.  Straightforward in his prose, laborious in his detail, Mr. Brill presents a system of overpaid executives and hyper profitable not-for-profits.

The real issue isn’t whether we have a single payer or multiple payers. It’s whether whoever pays has a fair chance in a fair market. Congress has given Medicare that power when it comes to dealing with hospitals and doctors, and we have seen how that works to drive down the prices Medicare pays, just as we’ve seen what happens when Congress handcuffs Medicare when it comes to evaluating and buying drugs, medical devices and equipment. Stripping away what is now the sellers’ overwhelming leverage in dealing with Medicare in those areas and with private payers in all aspects of the market would inject fairness into the market. We don’t have to scrap our system and aren’t likely to. But we can reduce the $750 billion that we overspend on health care in the U.S. in part by acknowledging what other countries have: because the health care market deals in a life-or-death product, it cannot be left to its own devices.

Steven Brill – Bitter Pill, Why Medical Bills Are Killing Us

You won’t agree with all of Brill’s conclusions.  I certainly don’t.  But read his work.  This should be the new starting point of our national conversation.

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

Mark Zetzer February 28, 2013 at 01:11 AM
The unpredictability of health emergencies is why we need health insurance, and the same reason we need car insurance, home insurance, etc. Insurance is not a new or complicated service model; it's the same no matter what you're insuring. Cars, homes and human bodies are all pretty expensive to build and maintain, some have pre-existing flaws, and they all eventually die. You choose your coverage to protect their lives in advance, weighing risks and costs. With free market health insurance across states lines, you would have more providers and premium prices to choose from. The loss of hospital competition in Ohio and across the country is the result of the growing costs and restrictions placed on health providers since Johnson's 'Great Society' in the mid-1960's. Most notable in that loss is the many religious charity hospitals that once served the poor and the uninsurable. Bring the free market back to the medical industry and you will see more consumer choices emerge and prices come down for everything: hospitals, doctors, nurses, midwives, faith healers, shamen, quacks and insurance premiums. You would also see a return of the much-needed charity hospitals. Yes, Obama did not make health care unaffordable in America. The federal government already controlled most of the industry by 2008. But Obama's PPACA is the opposite of a free market solution and will only make the situation worse--and trample all over our civil and property rights in the process.
Nathaniel Brooks February 28, 2013 at 03:30 AM
Well Donna, where were you when Bush and Cheney were enacting the Patriot act, granting the United States government unrestricted access to any personal information they deemed of interest. Oh I know Bush and Cheney did no harm. Get real people. The Minstrel show those two clowns put on was a disgrace to the office, but everyone wants to sweep it under the rug like nothing happened. The absence of evidence is not the evidence of absence. Obama is no Angel, but at least he puts on a good show. I have a secret for you Donna, Obama and Cheney are related by blood lol. All the great actors in government are in bed together. They eat at the same tables, and drink the same scotch. Keep drinking the kool aid. I bet you think Monsantos cares about you as well. When are you people going to stop living in a bubble. This whole thing is a sham. The native Americans were living here for thousands of years without big oil, sky scrapers, microwaves, genetically altered food, polluted air, and polluted water. Also look up why the add fluoride to the tap water. Pick up a book I doubt you'll learn anything, but it's worth a shot.
James Thomas February 28, 2013 at 03:29 PM
This was an EXCELLENT piece in Time. Perhaps some of you spouting the typical right/left-wing bullcrap should just shut up and read this very informative article. Although I realize that's asking a lot from people nowadays.
James Thomas March 05, 2013 at 05:32 PM
Joe H, and all journalists. "This was an EXCELLENT piece in Time". Which is why nobody read it. Time and its like minded media partners are about as frequently consulted on the news of today as the New York Sun of "Yes, Virginia" fame.
Dave Cunix March 09, 2013 at 08:58 PM
I wouldn't say that nobody read the Time article. Blogs like mine that highlighted the work will help to bring the information to far more people. I suspect that Mr. Brill's work will find its way into the policymaking discussions of the next year. That may be all we can hope for.
Lou Schott March 19, 2013 at 11:45 AM
To: All of the kind people who want to know more about the Brill article, Could someone please summarize the key points of the article? If we know the key points then perhaps we can ask more useful questions. If we can rank order our questions then we can speculate on some helpful answers to the most important questions.
James Thomas March 19, 2013 at 01:24 PM
If there was no Insurance, what would life be like? Is outlawing third party liability the answer?
James Thomas March 19, 2013 at 01:28 PM
I'm a Librarian Dave, Nobody read it. That Issue never moved from it's spot on the shelf until I placed the next unread issue of Time in its place.
James Thomas March 19, 2013 at 01:29 PM
" Which is why nobody read it." Which further explains yours -- and many others -- stupidity.
James Thomas March 19, 2013 at 01:30 PM
Yeah, that's a valuable measuring needle. Your claim that "nobody read it" at some library you work at. Keep the laughs coming, funny man.
James Thomas March 19, 2013 at 03:08 PM
Dave and NolanJoeHomeownerderpspotterJamesThomasJackKelly, When you see something that happens is it not the truth? Does a librarian have to catalog the dust that builds up on the cover of an unread item for you to believe that it inspires no readership?
James Thomas March 19, 2013 at 03:14 PM
By the way, NolanJoeHomeownerderpspotterJamesThomasJackKelly, Have you taken down the Psuedo James Thomas Page you Created?
James Thomas March 19, 2013 at 03:15 PM
By the way, NolanJoeHomeownerderpspotterJamesThomasJackKelly, Have you taken down the Psuedo James Thomas Page you Created?
Dave Cunix March 19, 2013 at 07:43 PM
Lou, the key point is that we are being distracted by an arguement over WHO pays the bills without ever discussing WHAT bills we are paying and WHY. Much of the last four years of Health Insurance Issues With Dave has been devoted to opening the rest of the discussion. Brill investigates real claims - the actual bills people have been forced to pay for their health care. Yes, it will take a bit of effort to read the whole article. Our attention spans have shrunk. Our willingness to put forth the effort to learn all of the details has diminished. But it is only through taking the time to master the issues will we be able to have a complete discussion and have real change and progress.
Murphy-Solon March 19, 2013 at 08:42 PM
The elephant in the room is the fact that our health industry feels that they are entitled to more of our country's wealth than we can afford to pay them. The government can cut Medicare benefits till the cows come home but if healthcare costs continue to rise at twice the rate of inflation, then the problem will only worsen. To say that all insurance is the same is foolish. Cars can be fixed or replaced at a reasonable cost while people without healthcare insurance cannot be replaced and can be financially ruined. Excluding food, there are 3 products we cannot live without and they are healthcare, higher education and fuel. What a coincidence that these are the 3 industries that don't respond to market forces.
Dave Cunix March 19, 2013 at 08:49 PM
Exactly.
Mark Zetzer March 19, 2013 at 09:26 PM
Goods and services that don't respond well to market forces are the result of State intervention. Get rid of the taxes, regulations and prohibitions that interfere with consumer choice in healthcare, higher education and energy, and you will see the prices for these goods and services come down, as long as the folks who are using these things are the ones who are paying for them. So Dave, WHO pays is just as key as WHAT they're paying for. The same is true for every other good or service the State interferes with, that's why the government should stick to the Constitutionally limited role of protecting civil and property rights and stay out of the delivery of goods and services.
Murphy-Solon March 19, 2013 at 09:42 PM
Those are just talking points compliments of your favorite political party. Medicare is a less expensive delivery system vs. private insurers. Since the 1960's, if the price of milk had increased at a similar rate as healthcare has, then a gallon of milk would cost $28. That is true with automobiles as well. Last time I checked these two industry groups are also subject to government regulation. These industries cannot raise their prices like the healthcare industry because the people would cease to buy their product. With healthcare, when a doctor tells a loved one that without kidney dialysis you loved one will die......you have no free choice there....it's what I like to call a "mortality monopoly".
Dave Cunix March 19, 2013 at 10:20 PM
Theory vs. Reality - a fun discussion if you have nothing better to do and your money isn't involved in the outcome. Sadly, we do have more important issues occupying our time and our money is very much at stake. Mark, if you wish to be so adamant about your opinion, please take the time to read the core material. Then explain to us how the government is the problem in the cases Brill follows. Government is a lot like food in that we don't do well with either too little or too much. We may never find the right balance, but the idea that anarchy is preferable is difficult to take seriously.
Mark Zetzer March 20, 2013 at 12:16 AM
Markets are not anarchy, they are self-regulating because they operate by persuasion rather than force. If market actors make mistakes, the market punishes them. When governments make mistakes, they seize even more power and money as a purported remedy and only create even more unintended problems. "Government is not reason; it is not eloquence. It is force. And force, like fire, is a dangerous servant and a fearful master." George Washington "That government is best which governs least." Thomas Jefferson
Mark Zetzer March 20, 2013 at 12:36 AM
Medicare notoriously underpays and is unsustainable. http://www.forbes.com/sites/scottatlas/2012/12/18/lets-be-honest-medicare-is-insolvent-and-doctors-soon-wont-accept-it/ Healthcare costs have been driven up by declining market choices; milk is much less regulated and is therefore subject to more price competition. Kidney dialysis and other major medical procedures would be the most affordable when subject to market forces. Compare the costs of these same procedures done for pets; pet owners have choices in veterinary care that they do not for their own care!
Garry Kanter March 20, 2013 at 12:38 AM
There is no evidence to support the Smith theory that markets are self-regulating. There is all of recorded history showing that they are not. Mr. Greenspan learned that, and he was "shocked".
Murphy-Solon March 20, 2013 at 01:09 AM
A bone marrow transplant for survivals sake is not like persuading someone to buy a car. The government doesn't underpay, rather the medical industry overcharges. That's why we have twice the medical expense per capita then any other industrialized nation. I read the story Dave references when it came out 2 weeks ago because it was headline news. I would suggest you do the same because there's a whole side of the story that you are unfamiliar with. Just read it, it's not going to cost you anything.
Murphy-Solon March 20, 2013 at 01:20 AM
The Republicans deregulated the Savings & Loan industry and it cost the taxpayers billions, they deregulated the banking industry in the 2000's and it cost the taxpayers trillions, they deregulated the oil & gas industry and we had untold environmental damage in the Gulf. Now they refuse to confirm a director for the Consumer Protection Bureau because the banks, mortgage lenders, credit card companies and payday loan companies don't want to see the billions in fine print theft disappear. The Republicans are payed handsomely by the lobbyists to spout this "In Corporations We Trust" dogma. I don't.
Mark Zetzer March 20, 2013 at 01:32 AM
Garry, if you want evidence of self-regulating markets, just look at ebay. It's completely unregulated as far as I know, yet bad actors are shunned. In fact, only very stellar actors are trusted. If a seller doesn't have 98% or greater positive feedback, they may suffer fewer bids. What kind of feedback do you think Obamacare will get? I'm sure federal admins will not even solicit feedback, especially when IRS agents are called in to collect! It's central planning that is theoretical, not markets; socialism has never worked as promised, but since it sells itself on emotion all reason is thrown out.
Murphy-Solon March 20, 2013 at 01:38 AM
I just completed Jon Meacham's biography on Thomas Jefferson. It's an excellent read and I would recommend the book to all. My point is that you can pull a quote from Jefferson and apply to any context that suits your fancy. A deeper insight into Jefferson yields a feud bordering on hatred towards Alexander Hamilton and the Federalists. Jefferson was against the Bank of America because of the power it placed in the hands of the aristocrats. Jefferson was a staunch supporter of the common man. The type of political power that Corporate America, including the healthcare industry, enjoys with our government is anathema to everything Jefferson stood for. He did not envision a government that was a playground for the rich and powerful. Just the opposite.
Mark Zetzer March 20, 2013 at 01:40 AM
Murphy-Solon, I'll try to read the article before posting again. But I can tell you right now that the reason the medical industry overcharges is because most consumers don't directly pay for medical goods and services, they don't get to choose their insurance plan, and even their choice of providers is artificially limited. Only with more choices will come lower medical costs for those who can pay, and more charity providers for those who can't.
Mark Zetzer March 20, 2013 at 01:48 AM
Murphy-Solon, I agree with you on the Republicans' disastrous 'deregulations'. They're all just more crony capitalism dressed up to look fair. I also stand with Jefferson in opposing a central bank. For the record, I am a Libertarian and rarely vote Republican.
Danarino April 11, 2013 at 02:56 AM
Mark - do your research before you sign onto empty liberal straw man propaganda. "Those evil Republicans" is code for inept governance - but your safe, you're a libertarian. The propagandist media counts on good Americans to back down, and sit down and shut up. The truth is the S&L deal started by in Carter's term w/ Volckers policy but the wheels were in motion since the 1930s for the S&L crisis. Banks wanted them gone anyways- and they got their way. Clinton got the ball rolling in the Banking melt down repealing GlassSteagall and tinkering with the CRA more than needed. Throughout history ONE CONSTANT proves true over and over- and that is THE GOVERNMENT does a sucky job at doing THEIR JOB when it comes to oversight. (Read: Fannie/Freddie) That is THEIR RESPONSIBILITY- no one elses. Your childish blame game generalization usually is nothing more than propagandist lies repeated over and over by a liberal "ends justify the means" censoring media. Nunquam Deditionem, good buddy.
Murphy-Solon April 11, 2013 at 11:18 AM
Danario, you are right that Glass-Steagall was enacted in the waning days of the Clinton Administration. That said, to blame the media while holding Republicans blameless for deregulation is silly. Even today, the banks, mortgage lenders and payday lenders are paying good money to the Republicans to water down Dodd-Frank. Thy have fought the re-enactment of Glass-Steagall and "too big to fail" still exists. The banks and not Fannie/Freddie were the drivers of the mortgage mess. You should read Sheila Bair's book "Bull by the Horns". After reading that book, there's no way you can hold the Republicans harmless.

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