Miles to Go, Promises to Break

We are assured that whatever version of healthcare reform is passed, it will save us money and provide more access to healthcare. Promises can be made, but the laws of economics trump words.

There are indeed ways to reduce health care costs. Increasing competition and/or increasing innovation can reduce costs by increasing supply. Demand can be reduced; demand for health care falls when consumers take more responsibility through self-care, diet, and exercise. Demand can also be reduced by lowering the quality of the product or by rationing care. With a process controlled by politicians who are ignorant of economics and by lobbyists from the medical and pharmaceutical industry, which door do you think will be chosen? If you answered “ration care or reduce quality” you are correct. Fundamental reforms that increase competition will not be accepted by doctors; increasing consumer responsibility is against the interests of the pharmaceutical industry who depends upon millions of Americans taking drugs for conditions that could be treated in safer and less invasive ways.

I am sure of one thing—any healthcare reforms passed by government will take us more towards top-down, centralized healthcare and move us further away from a free-market. This will in turn create the need for even more “reform” that moves us further from a free-market. There are indeed many problems with our current healthcare system, but unlike our cousins in Canada and the United Kingdom, a dire shortage of healthcare is not one of them.

Allow me to share a tale. Last week, I began to experience light flashes in the corner of my eye; a few days later I began to experience what appeared to be black filaments floating in front of my field of vision. From that starting point, I will contrast my experience with the experience of a United Kingdom (UK) citizen who had similar symptoms.

My experience: My wife calls a Blue Cross hotline and speaks to a registered nurse. The nurse advises my wife to get me to an emergency room immediately as I was at risk of suffering from a detached retina.

UK citizen: “I went to see my GP (I’m from the UK). He didn’t seem to know much about it so he had to resort to looking in his pocket book of family health (which really gave me a lot of confidence). Despite his clear lack of knowledge, he suddenly decided he was an expert and told me that I was just worrying about nothing, everyone gets them etc. But I told him that this had just suddenly come on over a week, but he just said I was a worrier and that there was really nothing wrong.”

My experience: We consider our options. There is a local rural hospital close by or there is Dartmouth-Hitchcock Medical Center which is about an hour and half drive away. We decide that should I need surgery, Dartmouth-Hitchcock is the place to be. I pack an overnight bag and off we go.

UK citizen : “I wasn’t satisfied with that so I went to the opticians who were surprisingly well equipped with digital retina cameras etc. The optician was very nice and took great interest in finding out was wrong. He could clearly see that something was wrong (and unofficially made the correct diagnosis) and referred me to a specialist.” [Brownstein’s note—the only place that our UK cousin got good care was from the optician who is not part of the NHS (National Health Service.)]

My experience: I arrive at Dartmouth-Hitchcock where, in the emergency room, I am triaged into a high priority category. An ophthalmological surgeon is immediately called in who does a very thorough and caring exam. Fortunately, mine is a benign condition called vitreous separation, there is absolutely no retinal damage. I am referred to a local ophthalmologist for follow-up checkups. My wife and I go out to lunch, feeling greatly relieved.

UK citizen: “When I eventually got to see the specialist (this is the NHS I’m talking about, so it took a while), he said I had a detached vitreous in both eyes. He then shooed me away like I was wasting his time.”

Now a fair criticism of my account would be something like this: “You have insurance that allowed you to seek the best possible care. What about someone who has no insurance? A fair enough question indeed; I would not want to go through my experience having either no money to pay for care or to be told that it would be weeks or months until I could see a specialist.

Now, I realize that the current proposals do not call for socialized healthcare as in the Canada or the United Kingdom. But this is a slippery slope—more regulations cause more problems, which breed more regulations, which create lower quality care and less access. The answers lie in true market-based reforms that remove barriers to competition and give more access at lower costs to more Americans. Access to a waiting list, like the UK citizen experienced, is not access at all.


9 Responses to Miles to Go, Promises to Break

  1. Tesh says:

    I keep telling people the trouble is cost, not arguing about who foots the bill. (And when the government foots the bill, the costs tend to go UP in aggregate thanks to inefficiency and politics.)

  2. Frankvv says:

    I’m glad that you were able to get your eye fixed, and of course, that you did have a medical plan that took care of it. Hopefully the billing process will be clean; hospital bills Blue Cross, Blue Cross pays and life is good. However, my experience has been that the haggling will begin. The hospital will deliberately try to overcharge Blue Cross, knowing that Blue Cross will say no, then they may try to bill you for something that you had no idea that you even needed, had no idea how much it cost, etc. For consumers today that think that our healthcare system here in the US is operated under the rules of a free market they are sadly mistaken. If this truly was a fee market, you could have called three hospitals in your area, gotten a quote for the procedure, checked the qualifications of the surgeons involved, and chosen the service that provided the most cost effective solution available for you. But I challenge anyone reading this: ask your doctor for a price list, and he or she will look at you cross-eyed. Or call around for a quote. We do it when we shop for cars or big screen TV’s but for our health we put our trust in the hands of the insurance companies. Our healthcare system is driven by the medical community and financially controlled by the non-value added health insurance companies. These companies in my mind add very little value to the process; they inflate prices for the consumers, and make money basically by saying “no”. After all, they are for profit, and the way they make money is by not paying out if they don’t have to.

    I’m a proud naturalized American. But I grew up under the Canadian system and for the most part, never had any issues. In fact all three of my grown children were born in Ontario, and we never had any out-of-pocket expenses. We chose our Doctors, we decided which hospitals to go to, or clinics to visit, and although in some areas service could be slow during peek hours; I have found that things are not really much faster here when push comes to shove. I have had several hospital stays both in Canada and the US, and never noticed anything different. Oh, and in October 2008 (ironically, Breast Cancer Awareness Month) my wife was diagnosed with breast cancer. She had a mastectomy (here in the US) and reconstructive surgery and is doing well, but for 8 months after the initial operation we were still fighting over various bills that Blue Cross says were redundant or not necessary and the medical community was then trying to go after us to pay. Again, we never once saw a price sheet, knew what we were going to be charged for anything, etc.

    So, although my first choice would be a true free market where doctors and other medical practitioners could compete freely in an open market, as you point out, that is not going to happen. So with that said, we need to get a plan were everyone has access to some level of healthcare. And I’d rather have the government control that that somebody who has the poser to say “no service for you buddy”. Oh, and the Canadian system is overall, pretty darn good. Are there issues of abuse and poor service? Absolutely! But guess what, that happens right here in the good ‘ol US of A as well. So something has to change. And as far as trying to take ownership for my own health I am doing that. My good cholesterol is up and bad is down. I’ve lost 10 lbs and have gone from power walking to running four miles everyday. By doing so I have lowered my blood pressure and am now off of all medicines, and feel great!

    I will now get off of my soap box. Barry, I truly hope your eye is recovering well. Sounds like a very scary experience.

  3. Tesh,

    The gorilla in the room which nobody will challenge is the monopoly power of the AMA. Until that issue is tackled costs can not fall without rationing.


    I am well, thank you.

    You are correct, we are very far from a free-market. For someone who has no insurance it is truly a nightmare as you say–getting a price is not easy.

    I recall a student who was a manager at a blood lab. An uninsured patient came in, with little money, who needed tests. He was mandated by law to charge her list price rather than the discounted price that Blue Cross paid. The next time you have blood work take a look at the difference between the list and the insured price–it is huge. But the law prohibited him from offering her the same discount.

    The drug companies don’t like your attitude. They have a pill for everything and they depend on patients who won’t exercise and eat right.

  4. James D says:

    Again, we seen that when the power of gov’t is injected into a market situation, the word free disappears. Maybe the silver lining in all this fiasco is that if the gov’t runs healthcare into the ground, people will be forced to take better care of themselves. Of course this would improve health in general and the gov’t would declare victory, but at least we might actually be forced to take care of ourselves.

  5. Frankvv says:

    Note that so far with the health reform debate there has been very little talk about how to get people to change their eating and exercise habits: maybe discounts could be offered for those that make measureable differences to their lifestyles.

    Those that can least afford it pay list. Those who have insurance get a much lower rate. What kind of law is that? Makes no sense to me! Several weeks ago my wife cut her finger very deeply. Rather than going to the emergency room, we went to a walk-in clinic. While we were waiting a young couple came in with a high fevered 3 year old. He had a very wheezy cough. The clinic’s policy was to pay upfront for services, then they bill the insurance company. That way they get the price they want, not what the insurance company wishes to pay. The charge to see the Doctor was $150 out of pocket. The couple did not have the money and left. I was unfortunately preoccupied with getting my wife fixed up, but the scene continued to haunt me. What happened to that kid? Did they go somewhere else for treatment? Did he recover on his own, or Lord forbid, did he get much sicker? I to this day wish I had stepped up and offered to help the couple. Perhaps if I had offered to pay a portion, they would have gotten the care they needed for their son. What an awful scenario!

  6. Frank and Jim,

    The proposed healthcare reforms that I have read will further prohibit insurance companies from establishing different rate classes based upon risk. This would be the equivalent of prohibiting car insurance companies from charging 16-year-old drivers or drivers of sports cars more. This will tend to discourage personal responsibility. I’m planning a blog post on the topic.


    Legally enforced price floors is government sanctioned price fixing. So-called reforms may bring more of it.

  7. Lyn says:


    I’m glad for your outcome.

    Complementing your points raised, there is a great analysis by Thomas Sowell over at the Investor’s Business Daily site, in which he finely illucidates the unavoidable market forces that play against government managed care. The result, as you point out, is lower and deteriorating quality of care. Sowell also looks primarily at the UK for examples of the amplification of systemic illogic over the longer term, and its horrible outcomes:

  8. Thanks, Lyn.

    The conditions that Sowell describes are no exaggeration. Americans should read directly accounts in British newspapers about the deplorable filth and food in UK hospitals.

  9. James D says:

    I find it pays to remember to follow the money trail. None of the indicators any of the insurance companies, doctors or hospitals use are reflective of my general health. They may claim to have been successful because I survived my appendix coming out, but don’t point out that changes in my lifestyle would have inexpensively (read: no money going into their pockets) prevented me from needed the operation. If I am healthy, no one gets paid (except Nike as I go through more running shoes).
    As for discounts for the healthy…not going to happen. Because I’m not using the medical system much, they need to squeeze every dime out of me they can get! Can you imagine uproar if some Congressperson suggested from the floor that we should run health insurance like car insurance! It would be entertaining to watch that person get tossed out of office on their ear.
    No, sadly the only person who truly has a vested interest, monetary or otherwise, in your good health is you, and most Americans choose not to look at this fact when making decisions. Matter of fact, I can’t even think of a scenario that would make if profitable for the insurance/medical community for Americans to be healthy. And if all the money points to my being ill, I’d better take darn good care of myself!

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