What Is "Kicking And Screaming, On A Sunday"

h/t Silicon Graybeard

I'll take "How Did Aesop Get Goat-roped Into Posting On A Four Day Weekend" for $1000, Alex.

From SiG:

The impression we get is that we're in a wolves' den of terrible free market forces where providers charge whatever they want and kill off their patients (the two don't seem to go together).  The problem is we aren't in a free market for medical care, with very few exceptions.  We have a bastardized system where the people who pay for the product aren't the ones most affected by it.   Healthcare is paid for by brokers (insurance companies) who skim off a percentage for themselves.  People paying for that insurance pay not just for coverages they want and need, but they pay for many others because lobbyists get congress to mandate all insurance plans cover their favorite expenses; everything from sex change treatments to addiction treatments to other psychological treatments.  Devoted teetotalers are required to pay for addiction treatment coverage.  Families beyond the child bearing years or with no desire or interest in having children pay for maternity coverage. 

Medical costs are scary.  One of the reasons they're so scary are the market distortions we see throughout the medical world. 

I have to believe free market reforms would help immensely, mainly because there's a handful of places where free market principles are already working.  In his usual, bombastic style, Denninger talks about some of this at Market Ticker.

When it comes to surgeries (Hospital Part "A" stuff) may I point to The Surgery Center of Oklahoma which routinely, even when it has to buy supplies and drugs at monopolist prices which are 100-500% or more of a market price, manages to undercut the local hospital in your town by that very same 80% I cited as necessary?  Were they able to buy supplies and drugs at market prices it would likely be 90%.  Oh, and you're one twentieth as likely to acquire an infection in said surgery center as your local hospital because they can't bill you for the cost of fixing their own mistakes and as a result they're far more-careful than your local hospital is.

RTWT


Deninger, as usual when he gets outside his lane, is an idiot.

Nosocomial (hospital-acquired) infections are not billable to the patient nor the insurer, they are a liability assumed by the hospital/provider that caused them. Any other approach goes by the quaint legal term "fraud".

They've only beaten this into providers' heads for something like a decade or two, which is why doctors and hospitals are death on things like ordering indwelling urinary catheters, which are virtually guaranteed to cause the patient a UTI if left in long enough. It's the same reason leaving sponges or instruments inside people in surgery is an own goal: the doctor and hospital eat the cost of all subsequent care for the sequellae of that little foul-up.

And surgery centers are rightfully regarded both within the biz and outside it as the bounty hunters of the medical world, because they cut costs by cutting corners on patient safety, and hiring itinerant staff moonlighting from other jobs. If anything goes dreadfully wrong, they ship their mistakes to real hospitals to fix. No wonder they can undercut costs, because they've outsourced everything but the procedure itself; God help you if anything goes sideways, because they can't handle that, by design. Accidentally punctured a lung while doing a boob job? Ship 'em to the ER, then the real hospital OR, to sew up that "Oopsie". And no, they don't include that in their annual statement of average procedure costs. Ask me how I know.

Go into a pissy-smelling elder-care lash-up, and realize that's the business model for the surgical center.

There's also the obvious: surgical centers are virtual medical drive-thrus: In and out, same day. People in hospital are there for days and days. Getting an infection isn't from lack of circumspect care (you @$$h*le!), it's from constant exposure to everything and everyone in the building, and the fact that, unlike the surgical center, your only time there isn't in the prep/operating room/recovery areas, but rather in areas open to everyone, and their families, including their coughing uncle and snot-nosed kids, startingin the main lobby. Anyone wants to argue for banning all visitors from hospitals on medical grounds forever except expectant fathers in full surgical scrub, and I'll sign your petition, buy your newsletter, and march in your parade; but let's stop acting like that's the hospital's fault. If we told people there was a "No Visitors" policy, they'd shit kittens, make YouTube videos, and write Congress to "Stop the Nazis!!!".

Deninger has his moments, virtually exclusively on financial items.
If he bothered to learn WTF he was talking about WRT health care, he might rise to the level of only bloviatingly inept, instead of completely ridiculous.

As for the health care market, if you aren't paying for your care out of pocket, you're not the consumer. You're just a guest at the table, exactly like the person who goes to a wedding reception. Your input may be noted, but the person paying the caterer's bill decides what's on the menu.

You haven't had a free market in health care since before nearly anyone reading this was born, i.e. the 1930s. Your first clue should be that you haven't seen a doctor make a house call in 50 years, because no one's paying for that: you don't want to, and the insurance won't cover it. So unless you live in a mansion and pay cash, you don't get that anymore.

SiG is also right about government involvement driving costs up, but barking up the wrong tree if you think the money is what's doing it. That's like trying to figure out how the car is running by sniffing the tailpipe, instead of looking under the hood.

That model is correct for college tuition, (which, IIRC, has been a tenfold increase over GDP growth, not a 4-fold one), but that's because colleges control tuition. The feds just pay it all at full rate, hence the move to make student loans for worthless degrees non-dischargeable through bankruptcy. The feds and colleges would go bankrupt, as they need to.

But with healthcare, the thing driving up costs isn't the availability of government money, it's the availability of "coverage", to a vastly wide Mississippi River of recipients, while forcing providers to accept literal pennies on the dollar in federal compensation.

The average reimbursement for an ER visit to doctors is something like 2¢ per dollar of billed cost, both to the doctor and the hospital.

{Welcome to the other half (besides covering uninsured/homeless/illegal alien patients) of why your Tylenol was billed at $54@. They bill $54, they get $1 from the government, which covers the pill, the pharmacist, the pharmaceutical supply stock, the pharmacy tech, and the nurse.
My average is around $40/hr, so if it takes me one minute to read the order, get the pill, bring it and some water to you, and watch you swallow it, I've already spent 67¢ of that dollar, before we even get to what the pharmacist makes per his/her minute for verifying you weren't allergic to it and that the dosage and form are correct, and the tech for restocking the machine every shift, let alone the cost of the actual pill (1¢-9¢@, unless they expired and we had to throw some out). If the form ordered needed to be changed, because you can't swallow pills, we're already in the hole, financially. And that's just one aspect of the most basic element of care.}

Imagine if the federal government offered hunger insurance that was like Medicare. In return for no premiums from you, the government issues you a card good for a meal. So you go to McDonald's for the Big Mac Combo, and Uncle pays Mickey D's 12¢ for the Big Mac, fries, and drink.

So, you tell me: how long will Ronald and his minions stay in business, before we even get to paying order-taking flunkies $15/hr to screw up a cash register order with pictures of the food where number keys used to go??

This is also why coding is a medical thing, because if I, the doctor, can find a way to charge for every single thing in a Manhattan-phone book sized list of options, I can manage to squeak out a living, after hiring the coding clerk, an accountant, a lawyer, and two people to prepare the invoices in the format of every different insurance company in existence, simply by ringing you up for everything except the golf pencil you used to fill out the seventeen-page health and insurance questionnaire when you walked into my office. (Government forms and payment being the worst offender there.)

This is the point where the Big Mac would be one thing, even with the bun, but the special sauce, lettuce, pickles, and onions would be billed separately.

See if you can figure out why I personally pay for simple services out of pocket, and refuse to carry anything but a catastrophic illness policy. I get the cash price with my PMD, and I get my prescriptions generic on the local pharmacy's low-cost plan, for about $3.33/mo, which is cheaper than my co-pay was with gold-plated Hollywood movie industry Blue Cross.

The government doing the care at all is what fornicated the system up, and pooch-screwed your costs, while simultaneously requiring you to pay for unwanted things mentioned, as part of insurance companies' Faustian bargain with your congressweasels.

Government poisons everything it touches, like it was a wasp with VX venom.
True x1000 with health care.
Write it on your hand in case you forget.

And if you figured out (correctly) that in response for having to virtually give away Big Mac Combos to everyone disabled or over 62 with a government Meal Card, McDonald's would immediately raise the price for the same combo to $300, so that they would not only get their actual $6 from Uncle, but simultaneously screw everyone under 62 by forcing them to pay full freight, I should let you know there's an open supervisory position in the hospital's billing office, and you're over-qualified.

If your rejoinder is that you'd just go to Carl's Jr. or Burger King, be advised that they're on the same program, and for you really snotty ones, Uncle Sam has also made hamburger and condiments prescription items, and banned hamburger buns, home barbeques and George Foreman grills.

That's the medical system you woke up to five minutes after FDR got done screwing with wages and compensation starting during WWII, and then LBJ invented Medicare to troll for more of the senior citizen vote starting in 1966.

Nota bene that Baby Boomers couldn't vote on anything until 1967, at the earliest.

"Greatest Generation" my ass.
Greatest shuck-and-jive con artists, chiselers, and math-impaired gullible goofballs ever burped onto humanity, more like.

Who else would've voted for FDR four effing times?