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Saturday, May 15, 2004


Editorial: Un-covered/A shameful health care system

Editorial: Un-covered/A shameful health care system

I just couldn't let this go by. The linked article says:

"But every other affluent nation in the world -- including Japan, Canada, Germany, Italy and Australia -- has nearly universal medical coverage, and they spend much less on health care than Americans do today. A new study sponsored by the Kaiser Family Foundation estimates that the United States could provide medical care to every uninsured American for about $48 billion next year -- an increase of only 3 percent in national health outlays."

Now, on the one hand it says that all those countries "spend much less on health care than Americans do today." Isn't that intended to imply that we could save money if we did the same? But then the next sentence explicitly says that nationalized health care would cost 3 percent more than we spend today. Is "more" suddenly "less"? Who are they kidding?

You know, this wouldn't bother me so much if we weren't comparing apples and oranges here. The truth is that much of the world gets cheaper drugs and medical equipment because Americans pay the price to develop medical technology. We Americans pay for it with our taxes, as companies write off research costs to lower reduce taxable profits; and we Americans pay for it with our wacked-out third-party payer insurance system.

We could fix that, yes we could. We could change the tax laws to tighten up on the Pharm industry, and we could switch to a single-payer insurance system. Of course, the rest of the world would have to pick up the slack, or risk having the Big Pharms cut back on research. Is that really what we want? Continuing refinements of existing drugs, but no new cures?

Besides, who knows how well these single-payer insurance systems will work over time. We know that our system at least produces an adequate supply of high quality health care providers, because the market set the price high enough to reward them for their work. If history teaches us anything, it's that centrally planned "markets" always produce the opposite: low quality in short supply. It will take a generation or two, or course, to see come to fruition, but does anyone really doubt that it will? I can't imagine anyone familiar with the Soviet queues for toilet paper and shoes to really want to see that happen to health care.

That doesn't mean we shouldn't "fix" our health care system. In fact, if you really want to help the uninsured, here's what you do: make it illegal for doctors to charge cash patients more than they charge insured patients. Simply outlaw it. Frankly, I don't understand why it's legal now. Anyway, cash patients should cost less than insured patients, because they give doctors the money without so much paperwork.

If you ever read the papers that your insurance company sends to you, you can see that doctors routinely bill the insurance for much higher amounts than the insurance company pays. I've seen the bill be twice as much as the final payment. The doctors know they aren't going to be paid what they ask for, but they do it anyway. Why not? It creates pressure on the insurance to raise their payments; it lets the insurors brag to their customers, the employers, how much they are saving them; and it locks people into having insurance.

The only people that the current system doesn't help are the uninsured. If they use a service, they get billed the same amount as anybody. But they don't have the leverage to get away with paying less, and making the doctor eat the difference. If they tried to pay less than the billed amount, they'd get bill collectors. More likely nowadays, they'd just get turned away.

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