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View Diary: Some Common Sense Reasons Why Health Care Markets Don't Work (83 comments)

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  •  Here's another aspect: (8+ / 0-)

    The free market types want to tell us that the problem with our health care system is that people are too well insured - that health care costs too much because people are using "too much" health care.  The analogy they often use is that of some luxury commodity.  Say, fancy restaurant meals, for an example.  if people had restaurant insurance so that they didn't pay at the point of consumption, they would go out to a fancy restaurant every night and thereby drive up to cost to society by consuming too much.
    The key fallacy here is that consuming restaurant meals is pleasurable.  Consuming almost any luxury good is pleasurable.  Consuming health care is NOT pleasurable.  Consuming health care is somewhere on a scale from mildly annoying (a visit to your doctor) to really miserable (heart bypass).
    The second fallacy in this argument is that the control over big ticket spending in health care is largely in the hands of the doctor, not the patient.  You may control how often you visit the doctor's office, but that's the cheap part and most people go too seldom.  But if you go into the ER with chest pain, it's the doctor who says you need a heart cath, not you.  And you are in no position to bargain or question at that point.  
    One last pet peeve of mine: We often read stories that a public (usually county) hospital is loosing money.  What a stupid formulation.  We never hear that the sheriff's office is losing money, or the courts, or the jail, or the fire department.  And yet all of those are county services too.  How come only the hospital is expected to operate by the logic of business?

    "Wouldn't you rather vote for what you want and not get it than vote for what you don't want - and get it?" Eugene Debs. "Le courage, c'est de chercher la verite et de la dire" Jean Jaures

    by Chico David RN on Sun Jul 08, 2012 at 02:34:35 PM PDT

    •  Some really good points Chico David RN . . . (1+ / 0-)
      Recommended by:
      ladybug53

      . . . and I think another aspect of your first point (insurance causes overconsumption) could easily bring yet another party to our little table here . . . lawyers. I would be interested to know if some routinely administered tests and procedures are done so because of their legal value as much as their health value? And I don't mean that in a disparaging manner to the health providers! Please don't take it that way! It's just that we have become such a litigious society.

      And I like the part about the County services. Cook Co. hospital is always a political pinata here in Illinois. And they so don't deserve it.

      Thanks for reading! And for stirring my grey matter with the response. I may have to go research some county level stuff here!

      To these unfortunate citizens aid must be extended by Government--not as a matter of charity but as a matter of social duty. - Franklin D. Roosevelt

      by rudyblues on Sun Jul 08, 2012 at 02:49:41 PM PDT

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      •  rb, North Carolina and the GAO looked at the cost (4+ / 0-)

        of lawsuits. The outlay worked out to .05% of health care costs. iirc the costs of tort reform would save very little. trial lawyers are often the only resort in a non free choice system where mistakes that can be hidden at the patient's personal or financial peril.

        Most judges will not let "frivolous" suits go forward. Not enough time or resources for such foolishness.

        A red herring.

        Science is hell bent on consensus. Dr. Michael Crichton said “Let’s be clear: The work of science has nothing to do with consensus... which is the business of politics. Science, on the contrary, requires only one investigator who happens to be right,”

        by Regina in a Sears Kit House on Sun Jul 08, 2012 at 07:08:34 PM PDT

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        •  Agreed! (5+ / 0-)

          One of the best pieces of evidence on this is in Atul Gawande's work in the extreme high cost of health care in McAllen Texas.  Texas has some of the most restrictive laws in the country on malpractice, but contains the most expensive medical market in the country.  
          That said, some ordering of tests is driven by medico-legal considerations though - uncomfortably for those of us who generally favor robust government - that is more often regulatory than tort based.
          What I mean by that is that regulation in medical care is often a pretty blunt instrument.  One finds a circumstance in which many physicians are not living up to the standard of care.  So the Medicare system promulgates a regulation to fix that problem.  But the regulation turns out not to make the fine discrimination that is needed for optimum treatment at most efficient cost.  The regulation would not have been needed if the docs had been doing their job in the first place, but the regulation often results in increased costs for marginal benefit.
          I am directly involved with one such case in the area of congestive heart failure.  Patients with this diagnosis tend to be hospitalized frequently.  So Medicare has come up with regulations about what must be done for each such patient each time they are hospitalized in a laudable effort to reduce that rate.  But sometimes it's too much of a one-size fits all prescription and results in a bunch of diagnostic testing that probably contributes little to the care of the patient.

          "Wouldn't you rather vote for what you want and not get it than vote for what you don't want - and get it?" Eugene Debs. "Le courage, c'est de chercher la verite et de la dire" Jean Jaures

          by Chico David RN on Sun Jul 08, 2012 at 07:48:10 PM PDT

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          •  Medical decisions need to be made by . . . (1+ / 0-)
            Recommended by:
            Regina in a Sears Kit House

            . . . medical professionals!

            Medicare should be in the business of oversight, not prescription. If the docs didn't do their job, then an appropriate penalty. Don't tell the docs what to do, that's what the Hippocratic oath is about.

            To these unfortunate citizens aid must be extended by Government--not as a matter of charity but as a matter of social duty. - Franklin D. Roosevelt

            by rudyblues on Sun Jul 08, 2012 at 08:01:09 PM PDT

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        •  Thanks, Regina. I didn't think . . . (1+ / 0-)
          Recommended by:
          Regina in a Sears Kit House

          . . . it would be a deal breaker. Just another layer on the onion. I for one would be a little reluctant to bring suit in a health care case unless the negligence was as plain as day. There are just so many factors in the health care outcome.

          The paper I read also went into the fact that we "trust" that the providers of the health care we buy are "in it" for the right reasons (I think he called it "level of care" or something like that). I think the vast majority of health care providers are there for the right reasons.

          Thanks for reading and thanks for commenting!

          To these unfortunate citizens aid must be extended by Government--not as a matter of charity but as a matter of social duty. - Franklin D. Roosevelt

          by rudyblues on Sun Jul 08, 2012 at 07:53:57 PM PDT

          [ Parent ]

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