Healthcare rationing: Real scary, page 3

Ahem.

Pardon me while I attempt to inject some logical thinking into this thread.

One thing I have learned in life is that if you find yourself in a problem, the proper course of action always includes figuring out how you got there so you don't get there again... or make it worse. So the question about healthcare becomes, should one agree that we need a better system, what exactly went wrong?

Not so long ago, healthcare was abysmal, but affordable. Back in those days, doctors would drive to a patient's home to make a house call. They would bring their little black bag and make diagnoses right there in your home, while you laid in your own bed. They usually brought the most common medicines with them, so you would have a supply until you could get to town to buy more. They would take into account your ability to pay, and many times would adjust their regular prices down a bit for those who were unable to pay the full amount. Many doctors actually became more wealthy doing this than by patients paying in cash, because the items they accepted in lieu of cash (up to and including land) became worth more in later times.

Back then, the family doctor was a trusted familiar face. they knew you by name, knew your children by name, and actually cared whether or not you were comfortable during your convalescence. They worked long hard days to offer a desperately needed service and were paid very well for that. It was rare to hear someone begrudge a doctor their high income level.

There were hospitals, and if the condition warranted it, the doctor would often transport you in their car. But hospitals were for the most severe cases, and you never heard of someone going to one for anything that was not chronically life-threatening.

Somewhere along the line, the house calls stopped. Now the patient had the responsibility to get themselves to the doctor. Since not everyone has someone right there at hand to drive them, and they were usually too sick to drive themselves. At the same time, the cost of medical care began going up. In no small part this was due to the advent of more expensive and more complex medical equipment... equipment that could save lives, but equipment that also had to be paid for and was not given to mobility.

Enter the insurance companies. Insurance was not new by any means, but it now became an almost necessity for anyone who was faced with the rising cost of medical care, especially long-term. As more and more people saw the coming of heinously high expenses just for basic care, more and more people began to purchase insurance against this potential financial disaster. that in itself sparked more problems: since the insurance rates were not directly tied to the cost of any single patient's expenses, human selfishness caused many people to demand the best treatment in return for their monthly payments. This translated to higher prices for the premium care that soon became the norm, and this caused more people to buy into insurance. It also led to higher insurance rates to cover the higher expected costs.

Widespread insurance also led to another phenomenon: people began using more expensive healthcare options for simple convenience. No longer were hospitals only for those with serious medical emergencies, but rather they became the most convenient, albeit the most expensive, option for those who didn't feel well. Suddenly, hospital emergency rooms found themselves treating mild fevers and colds instead of the critical patients they were used to. The cost for their treatment didn't go down, since they still had to be prepared for the more serious cases, but their workload went up, requiring new construction of larger facilities and more of that notoriously expensive equipment to comply with the higher demand for services.

Insurance companies also began offering riders that included ambulance services. Soon it was commonplace to call for an ambulance any time one didn't feel well enough to drive themselves. After all, it's covered under my policy, so why not use that benefit? Higher costs to the insurance companies = higher rates.

With all this money flowing so quickly, doctors as well began raising their prices to astronomical levels, in that age-old human custom called 'keeping up with the Joneses'. As the wages for doctors increased, more and more college students, trying to choose a career path, chose this lucrative occupation regardless of aptitude and for the sole reason of income. This of course led to an influx of doctors who were never cut out to become doctors, and subsequently to errors that cost patients their health, their limbs, and even at times, their lives. In a typical knee-jerk response, the court system began to award higher and higher awards to the victims of there errors, causing doctors to pay higher and higher malpractice insurance premiums to protect their financial life.

As with any industry, higher operating costs get passed on to the customer. So it was (and is) with the medical profession. Higher malpractice costs were passed on as salaries increased tremendously, raising the prices to record levels. Insurance became a necessity for anyone who could afford it at all. Those who could not afford it quickly realized they could take advantage of the system and have treatment performed and worry about the bill later. Since they had no real intention of paying due to a (usually factual) belief that they simply couldn't, people again chose convenience over economy. To a family living on $20,000 a year, what's the difference between a $10,000 bill and a $1,000,000 bill? Nothing; you can't pay either.

Now we get the inevitable government involvement. Medicare and Medicaid are established, the former to assist the elderly and the latter to assit the indigent. Both had the result of again driving up prices since now not only were the newly insured not worried how much their bill was, but they didn't even have to worry about the premiums. Also, in the case of Medicaid, the newly insured were those self-same people who were used to abusing the system due to their inability to pay. Old habits die hard.

To try to combat the expense encountered by government programs due to this unforeseen situation, programs were enacted to combat rising costs. Politically it would be suicide to remove benefits; public opinion, however, had turned against the now super-wealthy doctors and they made an easy target. In return for authorization as an official healthcare provider for a huge potential customer base, the government limited payments to doctors. Of course, since no one wants a cut in pay, the doctors simply raised their costs across the board to everyone else to make up the difference. No one complained, because it really wasn't their money that was being spent; it was the insurance company's money.

Hospitals also took their own initiatives to make sure they got paid. They began requiring proof of insurance for admittance whenever possible. This was a major boon for the insurance companies because it meant insurance was now a key to opening the door to healthcare. Of course, they took advantage of this fact to make sure they profited well, partly to make up for the problems they were experiencing as middleman between rising costs and apathetic customers, and partly to take financial advantage of a windfall.

Government stepped in with regulations to require hospitals to treeat patients regardless of their income or ability to pay. But these regulations could not legally be enforced on private hospitals. Since most people do not really care whether a hospital is a private operation or is publicly assisted when they try to gain admittance, this led to quite some confusion and stories of people being turned away from healthcare for inability to pay. In reality, no one in America today can be turned away from a publicly-assisted hospital in an emergency for inability to pay.

One more way doctors made up for this reduction in income was to accept kickbacks form pharmaceutical companies. These companies are like any others: they exist to make as much profit as possible. So seeing the opening and realizing that the only way to really sell their product was via physician prescription, pharmaceuticals began increasing the stakes when dealing with doctors. This provided some relief to the doctors, but also caused them to prescribe more frequent and more expensive medications, increasing the total cost to patients. of course, sensing another opportunity, insurance companies began to offer riders to cover medication, which, as with medical care, led to patient apathy and increased prices in another vicious spiral.

Hospitals began something similar, seizing on the practice of charging for every minute detail of care, and charging exorbitant prices to boot. Thus we hear of the $20.00 over-the-counter aspirin or the $5.00 Kleenex napkin. Again, higher payout leads to higher premiums.

And finally, as insurance rates spiraled completely out of control, employers in general recognized the need for prospective employees and began offering insurance as part of their benefits package to attract employees. Over time, this became less of an incentive and more of an expectation. As they fell into their own trap, employers began making up the difference by decreasing raises in both frequency and amount, leading to the static wages we have lived with for so long.

So what we have here is the perfect storm, a unique mixture of human greed, increased costs, apathy on the part of patients, corporate greed, lack of understanding, and governmental interference with poorly-considered programs. The question now is, how do we fix it?

--to be continued--