The Republican Plan, III: Comic Relief

(This is a multi-post series on the Republicans’ Roadmap for America’s Future. Part I was on how it slashes Medicare spending. Part II was on how it shifts risk from the government to individuals.)

The Roadmap brings up the issue that there is little price transparency in the health care market. This is the solution:

“The environment resembles what existed in the securities markets before the stock market crash of 1929. Abuse, fraud, and misinformation about the nature of stocks and the rules governing their purchase were rampant. In response, the Securities and Exchange Commission [SEC] was formed with the main purpose of bringing transparency to the market and restoring consumer confidence.

“With the increasingly rapid transformation of the financial markets and the growing complexity of financial transactions, the private sector began to take a more prominent role in developing accounting guidelines; and eventually the SEC began relying on the private sector to establish the basic standards by which it would be regulated. Since 1973, the SEC has recognized the nongovernment Financial Accounting Standards Board [FASB] as the authoritative standard-setting organization for financial accounting and reporting information. While the SEC has statutory authority to establish such financial standards, it has historically adopted FASB rules. The SEC allows the private sector to establish its own disclosure standards, so long as it demonstrates the ability to fulfill the responsibility in the public interest. The authority to enforce the standards, however, falls solely to the SEC.

“Applying this model to the health care industry will allow all stakeholders to come together, without heavy-handed government intervention, to establish uniform and reliable measures by which to report quality and price information.”

Enron? WorldCom? Self-regulation? FASB, the SEC, and the securities industry are their example?

By James Kwak

36 responses to “The Republican Plan, III: Comic Relief

  1. some guy in a cube

    This solution would be typical of free-market ideologues, and their stunningly simple-minded and naive view of human nature.

    The fact that the wealthiest nation on the planet cannot guarantee some basic level of health care for all of its citizens is absolutely disgusting.

  2. Eyes wide shut.

  3. Or, you could just mandate that all health care providers prominently display menus of prices for standard services.

    In fact, isn’t charging different prices for the same service (which hospitals do all the time) a violation of antitrust laws? What am I missing?

  4. When I first read something like that, for a moment I don’t know whether to feel reassured at how clueless they are or frightened by how confident and brazen.

    Then I feel better. Throughout history such a combination of wickedness and stupidity always destroys itself fairly quickly.

  5. Puttng your skepticism of the model to one side, it’s hard even to see a parallel. FASB and the SEC do not require to disclose anything to their customers – people that buy their products. How could there even be similar “regulation” of disclosures about health care pricing and quality? And do you really want that type of disclosure, which can be used to coordinate and collude?

  6. Your are missing that there are lots of exceptions to that rule, that the Robinson-Patman Act (to which you are referring) is almost never enforced, and that there is pretty broad consensus that it should be repealed.

    In a nutshell, charging different prices to different customers is to be expected in competitive markets, and may well be “efficient” in the economic sense.

  7. Ryan is onto something here. Securities Act of 1933, Securities Exchange Act of 1934 and Investment Company Act of 1940 all combined to create a regulatory framework for financial markets which endured for 60 years. A similar set of rules for medical care, all based in the concepts of disclosure and transparency, are exactly what is needed today.

  8. I have a high-deductible insurance plan ($5500 for my family of 4) so I’m in the habit of asking when I make tan appointment with a Dr. how much he/she will charge me for a given service. I had not been to my Dr. in over 4 years, so before I went to see my Dr. for a bad ear infection last week, I asked this of his receptionsist and she said “anywhere between $66 and $150.” When I asked for more clarity, she could not give it to me. I had a follow-up appointment today, and I told my Dr. that I was disappointed with this response and that his staff that deals with customers should have this information at their disposal. To which he replied, “I don’t even know what we charge. My billing service handles it. What were you charged?” That story, in a nutshell, represents a huge problem with our health care system today.

  9. The pragmatist

    Good for you Hips. With your high deductible plan you have plenty of incentive to ask “how much will this cost”. Most everyone else never asks because the bill will be paid by their insuance or they simply won’t pay. In the end we all pay, but it seems almost free at the time we receive the service.

    If we had a system where most people cared how much a health care provider charged for a service it would go a very long way towards controlling health care costs. And it would not be long before doctors knew what they were charging for services.

  10. In Health Care we trust

    Everyone is looking at it from the ecomonic/ideolocgial & ivory tower perspective.

    Look at it from the Healthcare provider/Hospital side & you’ll see is back to the past.

    All these changes will foster a 2 level system. You can see that now with many dental provider after dental insurance’s reimbursement have gone down the drain.

    The cash provider. They will be specialized clinics & hospitals. Some state presently allow this (FL-TX,etc). This clinics are small hospitals& presently specialize in a specialty. Well expect them to broaden their services to meet the clientele. I expect the HCA of the country to transform into these. Some state like NJ have forbidden this type of set up, because rightly steals revenue from the Hospitals that has to take everyone in.

    Of course there will still be the big, well endowed research medical centers->NY Presbyterian, NYU, Mayo, etc. that will also provide services in the big cities.

    The public hospitals will make a come back. In most places is County General, which will have its clinics & provide the services. In NYC, you got the Health & Hospital Corporation, for NY State -SUNY Downstate & Upstate. CA has the UC system,etc. In NJ, you got the UMDNJ system in the two worse cities – Newark & Camden, and for a while, as is slated to close within 120 days, the city of Hoboken took over failing St.Mary’s Hospital & made it Hoboken University Medical Center.

    What this plan targets is to make Medicare what Medicaid is now. In my home state of NJ. They put you in one of several HMOs. However, no physician in the HMO plans book accepts these patients. So they end up in the free/federally funded clinics with a 4 mo. wait list -some do an excellent job & some don’t. These hospital&clinics rely on medical residents & physicians extenders (Nurse Practioner& Physician Assistants) to provide cheaper care.

    One thing that has to be done is to push the simple supply & demand issue. More physicians=less cost for providers. AMA would go apeshit, but from 18000 medical students a year to 50000 & reduce the importation of foreign residents. As well as free medical education.

    The end of life issues are the expensive one. Trust me I deal with it all the time. But the reasons care is extended is essentially psychological. You would not believe the amount of time when care is extended that the patient has all the paperwork set, but a relative or an inexperienced resident decides to act, because they personally feel better about it, even if it goes against wishes.

    It does not matter. Healthcare as is with boomers in mind is not doable. Something has to give. Obviously the single payer, universal is not going to happen with Obama (his butt cheek says – owned & paid for by Goldman Sachs). So expect the following.

    Affinity based healthcare -> VA, Military, etc.
    Cash healthcare -> Good dental, luxury clinics & surgical
    Well endowed private university medical centers -> research, odd stuff, local care.
    Public Hospitals&Funded clinics& charity->Medicare, Medicaid, illegal aliens, psychiatric specialties,etc.

  11. James, you (and everyone) should really read The Ratchet Effect.

  12. Then again, we could adopt the already proven single payer system (for centrists; the already proven model of socialized medicine for leftists) and deliver care for half the per capita cost, and with better health outcomes. (The French live, on average, two years longer, and that’s with the smoking, the wine, and the butter.)

    Alternatively, we could continue to discuss how many angels could dance on the head of the free market ideologues’ pin.

  13. I hope you paid $66…cash. But if the guy has a billing service he may not care that much about getting “one in the hand” as opposed to 150/66=2.27 in the bush.

    Clarity and consistency of pricing along with more insurance options (in terms of benefits, deductibles and premiums) would go a long way in reducing costs and help individuals choose insurance plans that more appropriately meet their needs. Ultimately I think we want to get to a point where for some individuals, insurance as we know it (a pooled paid provider plan) is truly optional. They have enough money budgeted for their yearly health needs plus some reserve and in the event of some catastrophic illness they have an advanced directive for minimal (i.e. less costly) interventions. Isn’t this what will truly drive down the cost of insurance- to make it a more elastic product and therefore subject to downward market pressure?

  14. I think the range in prices is appropriate: not all ear problems are equal. If one is complicated, it should cost more to diagnose and treat.

    If the range is for the same thing, then that is wrong (and the status quo).

  15. Summary: Nothing learned.

    “Doing the same thing over and over and expecting different results is the definition of insanity.”

  16. From all I’ve read, I don’t think Republicans find it disgusting. I think they find it *liberating*.

  17. “Applying this model to the health care industry will allow all stakeholders to come together, without heavy-handed government intervention, to establish uniform and reliable measures by which to report quality and price information.”

    People will be able to dig around in Consumer Reports and call around getting the best price on cancer treatment when they get a diagnosis, or spinal repair surgery after a car accident, or price those stents after a heart attack.

    They say and write stuff like that for brown-tooth tea baggers who believe it, and vote.

  18. The free market might work for common procedures, but let’s face it, if you get leukemia, you’re not going to go to the cheapest oncologist — you’re going to go to the best, and price be damned. The difference between getting leukemia and your car getting into a wreck is that there is a natural limit on what body shops can charge — if they charge too much, the insurance company simply totals out the car and buys you another one. But you can’t buy another life — if you’re dead, that’s it.

    In short, it may be possible for the free market to work for routine care — indeed, the low wages that primary care physicians make indicates that it *is* working there — but the free market won’t — can’t — work for your *life*, because you only get one of them, and it is literally of infinite value to you because if you don’t have life, you have *nothing*. Which is why oncologists make half a million a year in wages, and primary care physicians make $80K/year in wages — you don’t die if you go to a cheap primary-care physician, but if you go to the wrong oncologist when you get leukemia, that’s it — you’re *dead*.

    These are facts. These are facts we have numbers to support. For life-threatening illnesses, the free market does not — CANNOT — work, because there is no inherent monetary value that can be placed upon a life, which is literally of infinite value to the possessor of said life. In our universe, anyhow. Who knows what the numbers look like in the right-wing universe where unicorns are real, cotton candy grows on trees, and the free market works for life-threatening illnesses?

    – Badtux the Healthcare Penguin

  19. Has anyone done a good study of how much money is being sucked out of the system by criminals — outright fraud and expert “billers.”? Just from scuttlebutt here in california, the number has to be huge.

    Back at the beginning of the decade, for example, Columbia/HCA settled their billing fraud case for 3/4 Billion. If that was the sort of tax for doing dirty business like the one Ameriquest paid (~$250M for Billions in Fraud), the numbers have got to be absolutely staggering. Produce the efficiency that David Cutler was talking about and combine it with an elimination of $10’s of Billions in theft and you’ve really got a whole different animal. Right now it’s like we’re trying to keep a cow on life support while it’s eaten alive by leeches and pirana.

  20. This (terrible) plan isn’t proof than Republican’s are morally bankrupt. This (terrible) plan is proof that they are intellectually bankrupt. It just goes to show that even the Republican’s (at least the ones in Washington DC) don’t actually believe in free enterprise and capitalism. They are all closet socialists. Which makes sense. They are all a bunch of politicians. Of course they think the solution is for the government to DO something to solve this problem. They (and the Democrats) have got their eyes closed as tightly as possible so as not to see that AS LONG AS THE PERSON RECEIVING THE SERVICE DOESN’T PAY FOR IT, HEALTH CARE WILL BE MASSIVELY, WILDLY EXPENSIVE, CORRUPT, INEFFICIENT and OVERUSED.

    You want to bring the cost of health care down? There is only one way. Eliminate Medical Insurance plans that DIRECTLY PAYS THE DOCTORS AND HOSPITALS for their services. If people want to buy health insurance, fine, but any payouts MUST go directly to the person that buys the policy. They want to buy a health insurance policy that pays out $5,000 if they break a leg? or $100,000 if they get cancer? or $20,000 if they get appendicitis? Be my guest. Or they could get a $250,000 dollar LIFE INSURANCE POLICY that would pay out just in time to take care of all of those ‘last year of life medical expenses’. Whatever. Softhearted people want to give lower income people tax breaks for buying ‘major medical bundled policies’? If you insist.

    But the payment HAS to go to the person that buys the policy. And if it only costs the patient $2,000 (plus pain & suffering) to get that broken bone set, THEY GET TO KEEP THE DIFFERENCE.

    End result. Medical costs would plummet. People would bitch and moan over high prices – and tell their friends and neighbors about great places they have found to get health care, and tell everyone they know about places that are a total rip off. People would start keeping an eye on the bottom line, and change to a different doctor or clinic if they felt like they were getting overcharged. They would have a MOTIVE to consider price. Innovative centers would spring up to provide care for less. Creative businessmen would provide drive though doctor’s visits, and charge cut rate prices for phone consultationss. People would think long and hard about shelling out two grand for an MRI, and suggest that they get an xray instead. People would get used to putting their little unexpected medical bills on their credit cards. Prices would plummet.

    Of course, socialists will be outraged to discover that rich people were spending far more on health care than poor people and receiving far more care. So what? Rich people spend far more on housing, clothing, food, and cars than poor people, and therefore live in much SAFER neighborhoods, eat much HEALTHIER food, and drive much SAFER cars.

    PEOPLE DIE every day because they get in an accident in a car without side air bags. People die every day because they drive around in cars with bald tires. People die EVERY DAY because they live in the inner city instead of in a nice suburb. People die EVERY DAY because they’ve spent the last twenty years eating cheese puffs instead of fresh fruit out of season, and not having free memberships in a health club, and no one to buy them running shoes and act as their personal fitness coaches. In fact people die everyday because they have stressful, unrewarding jobs. Why is health care a priviledged commodity. Why should I be shocked that rich people get better health care and not be shocked SHOCKED that the government doesn’t provide out of season fresh fruit delivered to my door? And asparagus!! And why not private cook/nutritionist for every family in America – to make sure each and everyone one of us had healthy, delicious and nutritious meals and snacks available to us at no charge. I bet if we did we’d all eat better,and live longer than we do right now – grabbing ho hos and ding dongs as we run out the door. I bet we would all live longer if the government stepped up to that ‘funding crisis’.

    In fact I would bet that statistically speaking we would save far more lives by legalizing drugs and cleaning up the inner city than by providing poor people with free health care. And I bet it would cost a lot less too per year of life saved.

    You see, asking how government can solve the health care problem is asking the wrong question. It’s not the governments BUSINESS to provide everyone with goods and services. Anytime it tries, it fails. And the more goods and services it provides, and the bigger percentage of the population it tries to provide it for, the more dramatic the failure.

    The only way the GOVERNMENT can solve the health care problem is to get out of the way and quit screwing it up health care by providing perverse incentives to everyone involved. And the more money you throw at the problem, the worse it will get.

    You want to fix heath care? There is only one way to do it. Fix the system so that the person who receives the care is the person that pays for it.

  21. As regards cost containment —

    It has been proposed that costs are merely a reflection of supply and demand, without including the further observation that changes to the system can change inputs to supply and to demand. Remember that econ 101 formula: Sf(a, b, c…) ? That is to say, supply is a function of a bunch of things. There is a similar thingie for demand. By addressing the inputs to supply, we can influence the cost of that supply. Shift the supply curve relative to P, and you get a different intersection of S and D.

    It is either ignorant or dishonest to go around making the point that supply and demand are all there is to cost and quantity supplied, without going on to note that supply and demand can be shifted, relative to price.

  22. What would these disclosures be? In the financial markets, the disclosure rules are about the resulsts of operations. You can’t lie, and the rules are meant to make it hard for your to decieve, about results of operations.

    But the rules say nothing about how you price your widgets, what you say to your customers about widget pricing, or the quality of your widgets. Those are entirely different topics, and it’s hard to see what kind of regulations would be needed here.

    What comes to mind is simple price posting – you have to put up a list price. That might be fine, or it might be a great way for all similar service providers to monitor their competitor’s pricing so that they can collectively keep prices up.

  23. Rush Limbaugh admitted what most people outside the extreme right of the republican party already knew. In an interview with William Shatner (no shit), where the Captain made the point that millions of Americans can’t afford medical insurance. Rush’s response was that millions of people can’t afford a house on the beach either, and so have to settle for a “bungalow” somewhere. The Captain responded that he was talking about health care, not real estate. Rush’s response to that was “What’s the difference?”
    There it is. The conservative philosophy in a nutshell. No money = no house on the beach, no leukemia treatments for your child, and no justice. No difference at all. This is where Ayn Rand’s lunacy takes us.
    Greenspan didn’t believe that fraud should even be a crime.
    I think the philosophy of Rand, Milton Freidman, etc. makes about as much sense as Marxism. Hopefully, it will end up in the same dust bin.

  24. DLR makes the statement that as long as the customer doesn’t pay for health care directly, it will always be massively expensive.

    Jesus mother and God. What about Europe?

  25. As I mention above, that works for common procedures, but not for life-threatening illnesses. The 5-year survival rate for leukemia victims at top-rated university affiliated medical centers is around 30% and treatment costs $1M on average. The 5-year survival rate elsewhere is half that and 40% cheaper on average. So, if you become ill with leukemia, are you going to go to the $600K medical center, or to the $1M medical center? And will the question of whether the insurer pays directly, or pays through you as an intermediary, make any difference?

    My bet: If you have any choice at all in the matter, you’ll go to the $1M university medical center, because you want to live, you don’t want to die, and it doesn’t matter whether they charge $1M, $2M, $3M, or higher, you’ll go there if there is any way possible because there is literally NO price that is higher than the value you place upon your own life. The free market simply DOES NOT WORK once we’re talking about life-threatening conditions and the treatments for them. And such conditions account for 80% of medical spending, so that means that the free market simply cannot work for the majority of medical spending.

  26. It’s all really simple: rush limbaugh is a moron but he has the microphone. nothing honest comes out of monopoly media. the idea of ‘analyzing’ what these bought and paid for creeps regurgitate at the will of their masters is ridiculous. Unfortunately, the historical figure who understood this best was Lenin. You cannot reason with obstructionists, or engage in endless debates wherein one side is determined to scuttle all reform and the other side is determined to move just slightly to the reform side without stepping on any contributor toes. Nothing short of massive protest waves will change anything in america. the model ought to be Vietnam or civil rights, and it will take active incessant street demonstrations like those at the 1968 Democratic convention to make any progress. You, James and Simon are preaching to the choir. Readers of this blog know better than to take seriously a single sentence of Republican nonsense; the ones to lean on remorselessly are the Democrats, who have been selling out their constituents since at least 1992 and whose only desire is to get themselves elected and cash in personally. McGovern, Carter, Mondale, Dukakis and Gore were certainly putzes, but at least they preserved some democratic values. Clinton and Obama might as well have been Repubicans. What they really stand for is opportunism, and if i read one more paragraph about how smart they are i may stop reading altogether.

    incidentally, Ayn Rand is misunderstood completely by readers of this blog. the greatest evil in her pantheon was cronyism, and history has proved her correct. She is not advocating selfishness, merely expressing the moral truth that no man should be enslaved for the benefit of aother. The greatest evils of the past fifty years have paraded under the banner of altruism: Vietnam and Iraq are the best examples.

  27. I think what he’s saying is that the wealthier individual who contracts leukemia will have a better chance of survival and that this is just. The wealthier guy will have bought the $1M leukemia policy while the poorer will have only the $300k one (or something). The rich guy will get gold-plated treatment. The poor one won’t. Wealth has its priviliges, he’s saying.

    As far as I can imagine in a moment, he has a point regarding the effect on costs. I think health care costs would have to come down a lot if it were more of a pay as you go system. One problem that brings up, though, (again just thinking quickly and roughly)is that the poor and middle class would likely get fairly lousy care outside of basic stuff. I tend to think that specialized care is inherently pretty high $ stuff.

  28. Medicare SHOULD BE what Medicaid is now. It is CHARITY. The contributions that a person makes to the plan is less than the cost of care that is being paid out.

    In fact, it isn’t even charity. It is stealing from an innocent third person to donate to the charity of your choice.

    Keep your hands in your own pockets. If you want to donate to charity do it with your own money.

  29. Let’s say you have leukemia but don’t have $1 million dollars to pay for the fantasically expensive treatments. So you are going to die.

    There are millions of people in Africa who are going to die because they don’t have the couple of hundred bucks it would take to buy clean water or basic medical care.

    There are millions of people who live in AMERICA’s inner city, who are going to die because they live in a ‘bad neighborhood’, but can’t afford to move to a better one.

    There are thousands of people who are going to die because they don’t have enough money to drive a Lexus or a Volvo to work instead of a cheap little tin can with bald tires.

    There are thousands of people who are going to die because they voluntarily take well paying, dangerous jobs instead of safer, lower paying jobs.

    Why should I feel more sorry for you than I feel for them? Why should I spend my hard earned money saving your life rather than saving theirs? I could certainly get a lot more bang for my buck saving their lives than saving yours.

    Why should the United States consent to be taxed at an even more ridiculously higher rate than they currently are to spend a million dollars to save one life?

  30. Uhm, because the United States is a democracy, and the U.S. government is the government of America and Americans, not of Africa or Haiti or whatever? In a democracy, if government policies do not reflect the needs of the majority, then said government policies are incorrect and will result in that government being overthrown at the polling place (see: November 2008). The majority, on every poll available, has stated that all Americans should have a government-guaranteed right to health care. That’s what the majority believes in every poll — various mechanisms for achieving that government-guaranteed right get lower scores in the polls, but even Medicare For All (a French-style system with single-payer for major medical and Medi-Gap for minor medical) has over 50% support in the polls. On the other hand, the majority has NOT stated that all Americans should have the right to a Volvo, or a right to live in the suburbs, or whatever.

    From an economic utility point of view, the majority’s concerns are quite warranted. The majority do not make the $1M needed for effective leukemia treatment. Indeed, $1M leukemia treatment could not even exist if the majority did not have access to $1M leukemia treatment, because less than 20,000 people get leukemia each year and of that 20,000 people, less than five could afford to pay $1M out-of-pocket for leukemia treatment — a number insufficient for constructing the infrastructure and developing the drugs for leukemia treatment. Thus the majority have decided that if we are going to have leukemia treatment at all, we need some guarantee that we can get the medical treatment we need when we need it, and that it is appropriate for government to take a role in this. You disagree with the majority, and that’s fine — but in a democracy, that’s also irrelevant.

  31. Actually, a pay-as-you-go system is utterly impossible. The U.S. currently spends over 15% of U.S GDP on health care. Sick people do *not* make 15% of U.S. GDP. The number of people who have serious illnesses — those which are life-threatening and which account for 90% of that spending — is probably less than 3% of the U.S. population in any given year. The net result of a pay-as-you-go system would be a catastrophic collapse of the medical infrastructure needed for treating life-threatening illnesses, since you can figure that, on average, those 3% of sick people are making only 3% of U.S. GDP.

    The resulting collapse would also cause the infrastructure needed for the wealthy’s health care to collapse — it’s impossible to fund development of new drugs and procedures with only the contributions of the wealthy to compensate you — so it is clearly *not* in the best interests of even wealthy Americans to suggest that we go to a pay-as-you-go system, because it would cause a collapse of the infrastructure needed for *their* health care too. So clearly a pay-as-you-go system is not going to work, we need some way of pooling funds so that well people are funding the medical care of sick people in hopes that if they themselves get sick, *other* well people will in turn fund *their* medical care. We call this “insurance”, and it can be administered by private pools (“insurance companies”), public pools, or by some combination of both. But without pooling of this sort, our modern health care system simply is impossible — there’s simply no way to fund development of the expensive procedures inherent in modern health care without pooling of some sort, 3 < 15 by a huge amount.

  32. Taxation is theft in your universe? Wow. And unicorns are real and cotton candy grows on trees no doubt.

    Taxation in a democracy is how a majority makes sure that the common infrastructure needed for modern civilization is funded by everybody who benefits. You benefit from the medical infrastructure that is funded by Medicare payments — if you get sick, probably 50% of that infrastructure was built by and paid for by Federal money. You want the right to be a deadbeat and refuse to pay for this common infrastructure. Me, I just shake my head and point out that you ARE proposing that you be a deadbeat — well, unless you refuse to use any medical facility funded with federal funds, which is, err…. none of them.

  33. >>>>You disagree with the majority, and that’s fine — but in a democracy, that’s also irrelevant.<<<<

    Not to nitpick, but it doesn't seem to be irrelevant at all if you're well enough financed and organized.
    Oh, and the general voting population remains basically willfully ignorant and uninterested in policy.

    Also, as to another point you were making, could we use pay-as-you-go up to a certain limit, keeping insurance just for catastrophic care? I have to think that that would help to control some costs.

  34. 1. Each hospitals has a Charge Master. It contains the “list” price of every service, drug and device they offer. Every patient is charged in accordance with the Charge Master. If you know the billing code for the procedure or service, the hospital can tell you what the “charge” is. However, Medicaid, Medicare, private insurance and the uninsured pay different amounts, generally ranked in that order (from lowest to highest unless State law provides for significant discount for the uninsured). Contracts/legislation provide for different reimbursement bases: DRG’s (Diagnosis Related Group which pays a single amount for a stay), per diems (fixed reimbursement per day of care), discounts off billed charges. The private insurer, PPO or HMO gets reductions to charges based on patient volume, cash flow considerations and the degree to which they can direct admissions to the facility. Every private patient is subsidizing Medicaid and Medicare patients.

    For physician charges, if you know the procedure code, you can call your insurer and ask what they pay for a particular code. Ask the doctor what the code is and call.

    2. RE: France and why it’s cheaper–see:
    http://online.wsj.com/article/SB124958049241511735.html
    (As an additional point of reference, depending on area of specialty, private insurance in the US pays physicians from about 110% to more than 300% of the Medicare rates.)

    3. Insurance is typically a risk control device: that which cannot be budgeted or anticipated is transferred to a pooling agent through the payment of a premium. Health care has moved away from risk management into paying for certainty. When we demand that it cover normal, high-probability, predictable expenses, we pay more because our behavior changes. If we had to pay $150 per month out of pocket for Nexium to avoid heart burn from a $20 pepperoni pizza once a month, we’d stop eating the pizza or switch to the over the counter drug at $12.50. On the other hand, leukemia, cancer or severe trauma is beyond almost anyone’s ability to pay. When horrible things happen to our community members, it is our tradition to help–we build the barn again, knowing that if it happens to us, we have a safety net. And, the bigger the pool, the more predictable is the expense. The laws of large numbers favor large groups: price stability and predictability. Would you rather have your insurance pay for allergy meds so that you can keep a cat or know that your chemotherapy regimen won’t bankrupt you?

  35. Are you kidding? The R’s would like every member of our society to die, except the essential members, who they would say, should eat cake. This is the same environment now that jeopardized Marie Antoinette’s neck. A revolution is coming. We really don’t need Congress anymore, why don’t we turn to pure Democracy where everyone votes on bills on the internet. Let us rule, since those we elected have chosen to abdicate the responsibility they have for governing.

  36. If I have a proposed Medicare voucher can I get my operations done in Thailand where the quality is good but it’s a lot cheaper.?

    Can I get my prescriptions filled in Canada or Mexico where the medicine cost about 2/3 less ?