This American Life Health Care special, October 2009

[Random]

OK, I have held long standing views on health care in America for a while now, and after listening to This American Life’s two-part special on health care from back in October, it threw a lot of my firmly held beliefs in doubt. I used to think that health insurance companies and drug companies were to blame for most of the mess, now I am thinking doctors, hospitals, patients, and drug companies. (Huh, NPR making me sympathetic towards health insurance companies?)

More importantly, after listening to this piece, I find the current healthcare debate in Washington completely bizarre and useless. It’s like the toilet is clogged, and instead of deciding whether to use a plunger or toilet snake, they have decided to go to the basement and rewire the fuse box. Nothing they are doing is addressing why health care costs are rising, and is really just using taxpayer money to paper over the cracks of a fundamentally flawed system.

I have never liked posts that tell me to listen or watch something on the web just to talk about the thing that I am being told to listen or watch, but after much debate with myself I decided that I would be remiss if I did not recommend people listen to this. It comes in at two hours total, but it is an entertaining and informative two hours that go by really fast. The podcast can be downloaded from the This American Life radio archive. You would want to listen to episodes 391: More is Less, and 392: Someone Else’s Money, broadcast on 10/9/09 and 10/16/09 respectively.

Some subjects covered by the show:
-How one third of medical procedures in the US are unnecessary or dangerous (and why we like it that way).
-How increasing the supply of medical care increases demand.
-Why we should have bean counters come between us and our doctor.
-Why health insurance companies can’t do more to lower health care costs (and why they might not want to).
-How increasing health insurance company competition raises prices for health insurance.
-Why a $10 package of hand wipes costs $600 and why people buy it.
-The benefits of hedgehog anti-psychotic medication.
-How did we end up with our system anyway? (Syphilis, a teachers union, the Nazis, and the IRS)

 

[Matthew Best]

The podcast can be downloaded from the This American Life radio archive. You would want to listen to episodes 391: More is Less, and 392: Someone Else’s Money, broadcast on 10/9/09 and 10/16/09 respectively.

Annoyingly, they can't be downloaded from the Archive. You can either listen to them online or buy a CD, which is a shame as I have a long journey coming up and would have liked to stick them on the Ipod.

 

[Random]

Nuts, you're right. It got downloaded to my IPod autopatically in October and I didn't get around to them until relatively recently. And they seem to have changed their deal with iTunes so that you can only download an episode for free for one week. Shoot.

You can still listen via the streaming feature on the website, but that is not as convenient...

 

[Matthew Best]

It's my own fault for unsubscribing in the first place. The problem was that I hardly ever got around to listening to the shows so unlistened-to podcasts used to build up on my hard drive and fill up my Ipod. The ones I did listen to were usually fascinating, but I don't have enough listening time to get through them all.

 

[WildCat]

More importantly, after listening to this piece, I find the current healthcare debate in Washington completely bizarre and useless. It’s like the toilet is clogged, and instead of deciding whether to use a plunger or toilet snake, they have decided to go to the basement and rewire the fuse box. Nothing they are doing is addressing why health care costs are rising, and is really just using taxpayer money to paper over the cracks of a fundamentally flawed system.

I've been saying that for quite some time here, but it seems that the goal of Congress is to pass a health care bill, whether or not it makes any sense doesn't seem to concern them.

 

[shemp]

Some subjects covered by the show:
-How one third of medical procedures in the US are unnecessary or dangerous (and why we like it that way).

Example: Last Saturday, I broke the fifth metacarpal on my left hand. I went to the local ER. They took x-rays and put a splint on it, and gave me a follow-up appointment with an orthopedist on Monday. He showed me that the bone was not aligned and needed to be set. So on Thursday I went back to the hospital for day surgery.

Forty years ago, the doctor would have done this procedure in his office. A nurse would have shot some novocaine into my hand, he would have pulled my finger (no jokes please), taken a x-ray, put a splint on the hand, and charged about $500 (in today's money). Instead, I had to have this done in a hospital, there were SIX people in the surgery room, and counting all the other people who interacted with me, there were about 12-14 people involved in some capacity. I don't know what my insurer is paying for this, but my copay alone was $600! And I'll have to see him at least three more times before I'm completely healed.

None of this is really for my benefit. It's all to cover everyone's butt. It's to prevent that 1-in-100,000 chance that something goes wrong and they get sued for big bucks.

I should have done it myself, like in the old western movies. A few slugs of whiskey, bite down on a bullet, and give it a yank!

 

[Random]

Example: Last Saturday, I broke the fifth metacarpal on my left hand. I went to the local ER. They took x-rays and put a splint on it, and gave me a follow-up appointment with an orthopedist on Monday. He showed me that the bone was not aligned and needed to be set. So on Thursday I went back to the hospital for day surgery.

Forty years ago, the doctor would have done this procedure in his office. A nurse would have shot some novocaine into my hand, he would have pulled my finger (no jokes please), taken a x-ray, put a splint on the hand, and charged about $500 (in today's money). Instead, I had to have this done in a hospital, there were SIX people in the surgery room, and counting all the other people who interacted with me, there were about 12-14 people involved in some capacity. I don't know what my insurer is paying for this, but my copay alone was $600! And I'll have to see him at least three more times before I'm completely healed.

None of this is really for my benefit. It's all to cover everyone's butt. It's to prevent that 1-in-100,000 chance that something goes wrong and they get sued for big bucks.

I should have done it myself, like in the old western movies. A few slugs of whiskey, bite down on a bullet, and give it a yank!

Imagine if you had gone into the ER and a nurse had told you, "Well, we have tow plans. For $500 dollars we will give you a local anesthetic and a doctor will yank your finger and jam it into place. For $600, we have a professional six-man surgical team standing by in the OR." Which one would have picked?

Health insurance enables us to seperate ourselves from what healthcare actually costs, and as a result we order more healthcare, driving up costs accross the board. You said yourself that you had no idea what the insurance company was paying, why would you?

 

[Brainster]

What has amused me is the whole "something for nothing" attitude about the bill. Hey, we'll insure everybody who's got a pre-existing condition. For nothing. We'll insure women at the same rate as the men for nothing. We'll insure the old for only a little more than the young for nothing. And if you raise the obvious question of who's going to pay for it (young, healthy men), everybody acts as if you farted in the elevator.

 

[WishboneDawn]

Annoyingly, they can't be downloaded from the Archive. You can either listen to them online or buy a CD, which is a shame as I have a long journey coming up and would have liked to stick them on the Ipod.

Don't know if this is a good solution for you but here's a link with a list of software (free) that will record streaming audio. I do this sometimes if there's something I'd like to have for a later date.

 

[WishboneDawn]

D'oh.

Haven't posted enough yet to post links. Try googling, "record streaming audio about.com".

 

[WildCat]

What has amused me is the whole "something for nothing" attitude about the bill. Hey, we'll insure everybody who's got a pre-existing condition. For nothing. We'll insure women at the same rate as the men for nothing. We'll insure the old for only a little more than the young for nothing. And if you raise the obvious question of who's going to pay for it (young, healthy men), everybody acts as if you farted in the elevator.

Does your employer deduct more money from women's paychecks than men's paychecks for health insurance? Do they deduct more from older workers than younger workers?

 

[shemp]

Imagine if you had gone into the ER and a nurse had told you, "Well, we have tow plans. For $500 dollars we will give you a local anesthetic and a doctor will yank your finger and jam it into place. For $600, we have a professional six-man surgical team standing by in the OR." Which one would have picked?

Health insurance enables us to seperate ourselves from what healthcare actually costs, and as a result we order more healthcare, driving up costs accross the board. You said yourself that you had no idea what the insurance company was paying, why would you?

The former option is no longer offered. The medical industry has taken what was a simple procedure and turned it into a long drawn-out expensive process. Also, you're comparing $500 vs. $600, when the real comparison is $500 vs. perhaps $10,000. The overall cost of the procedure has skyrocketed because it has been made unnecessarily complex. (For those who haven't been keeping score, all figures are adjusted to today's dollars.)

 

[Random]

The former option is no longer offered. The medical industry has taken what was a simple procedure and turned it into a long drawn-out expensive process.

And everyone likes it that way. Patients like it because they think they are getting "the best" care they can get. Doctors and hospitals like it because they can charge more money in fees, and oddly enough insurance companies like it for the same reason.

Insurance is cost-plus business. Figure out what your expenses are, add say 5% for profit, then divide that cost among the customers. If the cost of healthcare drops in half, health insurance company expenses drop, but that 5% will shrink as well. As long as enough people are paying their premiums to make up for any people they lose over increased premiums, the insurance companies don't have a motive to bring the cost of healthcare down overall, even if they will try to weasel out of individual claims and situations.

That's why the current Senate bill is so stupid. It just makes it easier for people to buy health insurance, so rates are just going to go up even more.

Also, you're comparing $500 vs. $600, when the real comparison is $500 vs. perhaps $10,000. The overall cost of the procedure has skyrocketed because it has been made unnecessarily complex. (For those who haven't been keeping score, all figures are adjusted to today's dollars.)

But thanks to insurance, we don't see the $10,000 cost, you just get a $600 co-pay.

 

[TriskettheKid]

And everyone likes it that way. Patients like it because they think they are getting "the best" care they can get. Doctors and hospitals like it because they can charge more money in fees, and oddly enough insurance companies like it for the same reason.

Insurance is cost-plus business. Figure out what your expenses are, add say 5% for profit, then divide that cost among the customers. If the cost of healthcare drops in half, health insurance company expenses drop, but that 5% will shrink as well. As long as enough people are paying their premiums to make up for any people they lose over increased premiums, the insurance companies don't have a motive to bring the cost of healthcare down overall, even if they will try to weasel out of individual claims and situations.

That's why the current Senate bill is so stupid. It just makes it easier for people to buy health insurance, so rates are just going to go up even more.



But thanks to insurance, we don't see the $10,000 cost, you just get a $600 co-pay.

Costs are insane, I'll give you that.

The last time I was in the hospital, it was for a sprained ankle. While the hospital itself was nice (they wrapped my ankle, with ice in the bandage, before my X-ray), I wasn't a fan of the prices of what was being offered.

In the end, all I paid was my co-pay ($30), but had I taken anything of what they were offering (other than the bandage for my ankle), I would have been hit, and not been covered under the insurance I have.

Makes me long for the days when I was still living at home, with access to family friends who are doctors.

At this point, I'm going to get better healthcare if I make friends with as many different doctors as possible.

 

[Matthew Best]

D'oh.

Haven't posted enough yet to post links. Try googling, "record streaming audio about.com".

I found a better way. You can right click on these links and the shows will download:
Episode 391

Episode 392

 

[shemp]

Costs are insane, I'll give you that.

The last time I was in the hospital, it was for a sprained ankle. While the hospital itself was nice (they wrapped my ankle, with ice in the bandage, before my X-ray), I wasn't a fan of the prices of what was being offered.

In the end, all I paid was my co-pay ($30), but had I taken anything of what they were offering (other than the bandage for my ankle), I would have been hit, and not been covered under the insurance I have.

Makes me long for the days when I was still living at home, with access to family friends who are doctors.

At this point, I'm going to get better healthcare if I make friends with as many different doctors as possible.

There's a great idea! Let's cut health care costs by providing medical training to someone in every household!

 

[shemp]

And everyone likes it that way. Patients like it because they think they are getting "the best" care they can get. Doctors and hospitals like it because they can charge more money in fees, and oddly enough insurance companies like it for the same reason.

Insurance is cost-plus business. Figure out what your expenses are, add say 5% for profit, then divide that cost among the customers. If the cost of healthcare drops in half, health insurance company expenses drop, but that 5% will shrink as well. As long as enough people are paying their premiums to make up for any people they lose over increased premiums, the insurance companies don't have a motive to bring the cost of healthcare down overall, even if they will try to weasel out of individual claims and situations.

That's why the current Senate bill is so stupid. It just makes it easier for people to buy health insurance, so rates are just going to go up even more.



But thanks to insurance, we don't see the $10,000 cost, you just get a $600 co-pay.

Unfortunately, several wrongs don't make a right. I agree that nothing positive will be done about health care because nobody has a real incentive to do it.

 

[BeAChooser]

I agree that nothing positive will be done about health care because nobody has a real incentive to do it.

So let's give them an incentive. At least the leaches in Congress. Democrats are now claiming that the health care monstrosity they jammed through the Senate (without, in most cases, even reading the legislation) will reduce the deficit a $100 billion or so over the next ten years and a trillion dollars in the decade after that without impacting the quality of care. Fine. If it does indeed do that, let's increase the salaries/pensions/perks of the democrats who voted for that bill by whatever percentage the deficit/debt is decreased as a result. Let's reward them for a job well done.

BUT, if the fears expressed by opponents comes to fruition, i.e., the legislation increases the deficit/debt and lowers the quality of care, let's punish those democrats. Let's reduce their salaries/pensions/perks by whatever percentage costs actually increase plus whatever percentage reduction in quality takes place over time (amongst those they told would not have the quality of their health care affected). Fair enough?

And let's do one more thing. Let's put all of them in the new system. No more excluding themselves from the effects of the programs they enact.