Why "consumers" can't drive down health care costs

Bloomberg has a great article up about how impossible it is to find out how much medical procedures cost. Mimi Ferraro spent hours trying to find the least-cost provider for an injection of cancer medication she needed. She made her decision based on information that came after numerous calls - to the insurance company, which told her it couldn't give an estimate on the cost until after she'd had the procedure (!) and then a week of waiting on the answer from her oncologist's office. It was wildly inaccurate. She paid $4,099.51 for a shot she was told would be about half that much. She could have gotten it for half that much at a local pharmacy - but it wouldn't have counted toward her deductible. Her high deductible, that is.

This kind of [high deductible] insurance is expected to help reduce health costs. Given a need to make higher upfront payments, patients may be more selective about the services they buy and keep spending low. But there is a significant flaw in this reasoning: Patients aren’t the ones who make the decisions about which tests and procedures to purchase. Doctors are. And doctors, along with hospitals and insurance companies, don’t let on how much the services cost.

Another significant flaw is that a plethora of studies have shown that people do not make good decisions about health care spending. They balk at spending for preventative measures and, when panicked, will spend far too much when it's too late. Not that they know how much they're spending.

Ferraro pulled together some studies that show no one knows what procedures will cost. She thinks that if every patient demands the cost information that she was asking for, costs will actually become transparent. I absolutely disagree. It's not in anyone but the patient's interest to make that transparent, and our for-profit system isn't set up to benefit the patient. Excuse me. I meant the consumer. I would also point out that not only are U.S. health care consumers blindfolded, this kind of treatment is emotional torture and very bad for your health.

But most Americans can tut-tut. It happens to someone else. We look for what they did wrong - like get sick, for instance - and feel reassured that it won't happen to us.

Who needs foreign-born terrorists to wreck our communities when we've got insurance companies!

Think again if you think being insured = security

Americans love to believe things that are demonstrably untrue - tax cuts equaling increased government revenue and a stronger economy, for starters. Oh, and the whole idea of for-profit insurance companies being an efficient way to finance our health care being another.

So I'm just passing this along - it's not going to make a whit of difference in the debate. The University of Arizona has found that being insured doesn't affect whether you have medical debt.

According to a study published online June 16 by the American Journal of Public Health, after taking age, income and health status into account, simply being insured does not lower the odds of accruing debt related to medical care or medications....

"On average, insurance coverage in Arizona is not protecting families from experiencing medical debt. From other studies we knew that paying medical bills is a problem for a substantial portion of both insured and uninsured Americans. This study helped clarify that the fact of medical debt is an additional and larger barrier to getting needed health care than whether a person is insured or not."

That's according to University of Arizona College of Pharmacy research scientist Patricia M. Herman.

But don't expect the Americans who are swayed by the big-business money that preaches anti-government ideology to take note. (Hell, the mainstream media didn't even take note.)

They're busy admiring Michele Bachmann's poll numbers in Florida, leaving the fact that she's a delusional liar to, at best, the papers' online blogs, to be read by the choir.

Social darwinist Bachmann is quite concerned about a mythical $105 billion "hidden" mandatory spending in the health care reform bill passed last year. That would be the most-debated bill ever passed. Right, Michele.

And the shot heard round the world was fired in New Hampshire. Uh huh. Obviously memory fails us all now and then. But when a third or so of Americans begin to channel the single-minded Walter Sobchak (You're goddamn right I'm living in the fucking past!") from The Big Lebowski, it's hard to know where to begin. As The Dude says, "Walter, I love you, but sooner or later, you're going to have to face the fact you're a goddamn moron."

The scary thing is that these folks aren't just channeling film rage, they and their leaders are unwittingly channeling mass murderers. Bachmann again: “But what I want them to know is just like John Wayne, who is from Waterloo, Iowa – that’s the kind of spirit that I have too.”

As one L.A. Times commenter wrote, "I don't think she was mistaken, she was just speaking in secret code to her minions. She well intends to rape the nation like [John Wayne] Gacy [who was from Waterloo] did to his victims..."

Another commenter offered a SOP right-wing solution: "Let's go to John Wayne's Wikipedia page and change it so that she is right."

More Docs Reject Privately Insured Patients!

A study expecting to find even fewer doctors willing to accept new Medicare patients found, sure enough, a modest drop in that percentage. But the shocker was a far steeper decline for doctors willing to accept privately insured patients.
The study shows 93.3 percent of doctors accepting insurance for payment in 2005, and 87.8 accepting insurance in 2008.

The drop for those accepting Medicare coverage during the same time was 95.5 percent down to 92.9 percent. Not the huge difference the right-wing media has been harping about - and they seem to have missed completely the fact that some doctors turn away patients wanting to pay with private insurance.

I first heard of this a few years ago with a doctor in Fort Collins, Colo., who wouldn't accept private insurance. He said he did so so he could practice medicine instead of argue with bureaucrats whose primary concern was profit, not patients. The insurance companies also didn't pay him enough - and he's a family doctor, not a country-club suburban specialist.

Dr. Tara Bishop's study was in the 27 June 2011 Archives of Internal Medicine. She's assistant professor of public health at Weill Cornell Medical College and practices at New York-Presbyterian Hospital/Weill Cornell Medical Center. Dr. Bishop is concerned that the growing numbers of physicians saying no thanks to insurance companies could bollocks up President Obama's reform - which depends on everyone buying private health insurance from this deadly industry.

It's one more reason to simply expand Medicare to cover everyone.

There are economic sectors where the free market delivers most effectively, no doubt. Manufacturing computers and running casinos come to mind. Other tasks - like covering the cost of health care, fighting fires, policing our communities, educating all the children - societies that tax themselves to provide those services for all come out ahead.

Pretty simple. You want the Pakistan model or Paris?

Ave Cassandra Is Back

Back in 2007 or 2008, a marvelous guy running for state representative here in Colorado sat down and talked with me about universal health care. Joe Miklosi is a smart progressive who already knew that the U.S. system is fatally dysfunctional. So I was preaching to the choir.

But at the end of our talk, he did something no one else had. He gently touched my arm and asked me if I was taking care of myself - or if I was reopening a wound every time I shared my brother's story. Hmm. I assured him that working for health care reform was my way of working through my grief - so that no one else would have to lose someone the way we had, etc.

Hmm. In fact, I was pouring salt in the wound on a daily basis. As it turns out, I'm also very bad at organizing and activism. You have to be well organized and optimistic to be good at activism!

So I quit. And now I'm back, but just at Ave Cassandra, not at Health Care for All Colorado, a great group of activists but not for me. I'm not going to post every day, and no more salt, no more activism. I'm just going to pay a bit of attention again. And share the good stuff. And continue to urge my adult children to emigrate to a country with social policies that demonstrate concern for community, including people who are sick. WWJD and all that.

Second Amendment Health Care

Richard Verone had a growth in his chest, ruptured disks, and no health care. Typical 59-year-old American. Not the majority, but typical. He figured his care might take three years. So he robbed a bank.

Not so that he could get the cash to go to India for care, or to buy into the expensive insurance for folks with pre-existing conditions. Both of those options might cost more than the bank even had on hand, and besides, someone might get hurt. Think it through: all kinds of things could go wrong. Just the time in jail would do it, he figured. So he handed a note to the teller that demanded $1. The note said he was armed. Then he sat down and waited for the police.

The fly in the ointment is that, according to news reports, he's very likely to get just 12 months, not three years. He wasn't carrying a gun, so it's a lesser charge. Kind of unAmerican of him, now that I think about it. What - he's not in favor of the Second Amendment?

First They Came for the Uninsured

When the Nazis came for the communists,
I remained silent;
I was not a communist.

Then they locked up the social democrats,
I remained silent;
I was not a social democrat.

Then they came for the trade unionists,
I did not protest;
I was not a trade unionist.

Then they came for the Jews,
I did not speak out;
I was not a Jew.

When they came for me,
there was no one left to speak out for me.

- Pastor Martin Niemöller

Overwrought to compare that to the U.S. healthcare crisis? Perhaps. It probably feels different if you haven't lost a loved one because of it.

Pastor Niemöller's point is that if a society doesn't value solidarity - even solidarity to protect those in disagreement with one another - then we allow predators to pick us off.

Solidarity is a value often mentioned in other industrialized nations. Not at all in the U.S., where it sounds subversive - doesn't it?

Death as a Rorschach Test

After a post at Slate I realize, once again, that Paul's death is a kind of Rorschach Test.

Usually people who are in favor of healthcare reform get it, immediately - how the U.S. healthcare system failed him in a far bigger way than misdiagnosing his appendicitis.

Physicians almost always get it immediately.

People who are afraid of change, and who don't understand that our health care system is a kind of ever widening net of dysfunction - not so much. For them it's all about misdiagnosis - if they've gotten past the point where it must have been Paul's fault, because the U.S. healthcare system is the best in the world (maybe needs a slight tune-up, but nothing major) - that being the case because we're the best.

And once a group starts thinking it's the best despite all evidence to the contrary, that's the beginning of the end, whether it's a sports team, an automaker, an army or an entire nation.

The United States does a lousy job of protecting what it claims is its most precious asset - its people.

Soft Support for Reform

Back when politicians thought all healthcare reform could be was adding a few more kids to the SCHIP program, just like every other single-payer supporter I know I liked to point to polls showing that a majority of Americans knew we needed to overhaul our system, that government needed to guarantee healthcare, that it was the dastardly insurance industry's grip on our politicians that was to blame and so on.

All along there were the Celinda Lakes warning that public support for healthcare reform has always been soft, and easily manipulated by fear-based campaigns.

Like this, you think?

RX FOR DISASTER
83 MILLION OF US WON'T KEEP OUR INSURANCE

And for those who do manage to keep their current insurance -- well, it won't cost $2,500 less, as Obama promised. Lewin estimates it will cost $460 a year more because of new cost-shifting from the government-run plan to private health plans.

That's right. The $1.3 trillion House health-care bill would cause millions of Americans to lose the insurance they have now -- while the rest of us would pay even more than we do now.

It's times like this when you truly appreciate the smart analysts out there, like Paul Krugman and Ezra Klein - who quoted Steve Pearlstein today:

Among the range of options for health-care reform, there's one that is sure to raise your taxes, increase your out-of-pocket medical expenses, swell the federal deficit, leave more Americans without insurance and guarantee that wages will remain stagnant.

That's the option of doing nothing, letting things continue to drift as they have for the past two decades as we continue to search in vain for the perfect plan that would let everyone have everything they want and preserve everything they already have while getting someone else to pay for it.

They say that people deserve the governments they endure - a pretty hardhearted assessment of, say the Cambodians under Pol Pot. But when it's a democracy, and when there's every opportunity to become educated, wouldn't it be true to say that a people deserves the health care system they're too afraid to change?

I'm feeling like picking fights about this - pretty unproductive I admit.

Flurry of Pundits on Healthcare Reform

Health Reform Can Pay for Itself, by Timothy Noah at Slate

Why Health Care Reform Will Pass, by Jonathan Chait, The New Republic

More Disapprove than Approve of Obama on Healthcare, Gallup Poll

Real Consequences of Inaction, at Healthcare NOW

Will Obama Wipe Out on Healthcare?, by Howard Fineman in Newsweek

Healthcare for Dummies, by Dana Milbank in the Washington Post

Americans: OK with Inequality

Jacob Weisberg has a nice piece at Slate on the reform package. What really caught my attention, however, was this commenter:

Weisberg writes: "[The British system] doesn't cover many procedures we regard as standard, such as PSA tests for men in their 50s..."

The PSA is more likely evidence of what's wrong with the US system, not what's wrong with the British. It has become a standard even though there is little, if any, evidence it saves lives. Yesterday's NY Times ran a story that pointed out, "the federal Centers for Disease Control makes it clear on its Web site: there is no medical proof yet that routine screening for lung, ovarian, prostate and skin cancer reduces deaths from those cancers." But many men will suffer wretched complications from treatments in response to the screening.

But that's my minor quibble with Weisberg. The major one is this: "Morally speaking, Americans are surely more accepting of economic inequality than their European brethren. But the random unfairness that condemns the uninsured to bad health and the risk of untimely death offends the social conscience."

If only it were true that the bad health, disabilities and deaths that result from the lack of access to health care really offended Americans. Sure, there are some who are really outraged, some who are disturbed, and others who just can't be bothered to think about it. But there is also a group (large or not?) who are really satisfied knowing that there are winners and losers in American life and they are only too happy to be on the winning side. If we acted to create a more equitable system, how would they know who the winners and losers are and which side of that line they're on? Knowing that others are suffering, and believing that everyone in life pretty much gets what they deserve to get, they oppose any change that would bring relief to the suffering or make life "fairer."

Those who are passionate about universal care aren't large enough in numbers to bring about a change. Those who aren't passionate are too disturbed at the thought that reform may bring some change to what they already have to support it. And those who are happy with the way things are aren't going to support any change at all. If any reform bill passes it will have to be diluted too much to avoid imposing real change on health care providers or the currently insured. We're going to fall short again.

No doubt we'll fall short for just those reasons, although I sure hope that Obama gets us on track to a solution.

This comment makes me think about hearing some asinine Republican representative on C-Span last night pontificating on how every American has access to health care - it's just that not all of us have health insurance - two very different things, he wisely noted.

Right. Tell it to my brother. Tell it to all the American parents and children who've died because they did not have health insurance - and because they did not have health insurance they did not go to the doctor in time, and because they did not have health insurance the hospital treated them differently than had they been insured.

And I think about some commenter on a radio station saying that he sure did expect to have better health care - far better health care - because he was insured - otherwise what the hell was he paying for?