Friday, March 30, 2012

Medicine And Capitalism

In response to my last post, Anonymous (he sure does get around!) eructated forth the following:
You, my dear sir, are a hypocrite,

As you admit yourself, and what anyone who have come across your blog before knows, you are a staunch defender of the free market and capitalism. The most basic part of *that* is a well-functioning market where the price of goods and services are determined by supply and demand.
As my old friend and foil "eradicator" once posted on AuntMinnie, much of what we see happening in health care today is anything BUT capitalistic, and bypasses any semblance of a "well-functioning market". Prices of goods and services are NOT determined, at least not properly, by supply and demand.

Let me explain.

In healthcare, at least in our particular, peculiar version of it, the consumer has few choices. Basically, one goes to a physician on an approved list, has tests at facilities that have negotiated contracts with the third party payer, Medicare, or whatever, and has little knowledge overall of what he or she has bought. Or rather, what has been bought on the patient's behalf. The only decision the patient can make is which insurance to buy and how much, and usually even that is out of their hands, having been preordained by their employer anyway.

My socialist friend Anonymous (why else would he get so snarky, unless perhaps he wallows in this unsavory stuff?) makes a fundamental mistake in his (get over it, pronoun-pc'ers) analysis. What BadRay is doing is NOT offering the consumer the opportunity to CHOOSE for themselves to pay less for ummm, an unknown level of care (yes, for the lawyers I shall say unknown). Rather, it targets institutions interested in skimming profit, and this is very clear from the teaser on the website. Said institutions are choosing on behalf of the consumer, and the patients haven't a clue that their child's scans are being read by  the lowest bidder for the job. Like Enron, BadRay does nothing at all to promote choice, nor does it add any particular real value to the system. If anything, it restricts choice, deciding more or less by itself who should read, and pocketing a middle-man fee for insinuating itself where it doesn't belong.  This is not capitalism, it is manipulation, pure and simple.

Can health care operate on a purely free-market basis? I'm not sure, frankly. The only example I can see on first blush is that of patients going to other countries to have expensive procedures done at a lower price. Those who do so, those who are able to do so, that is, do indeed exercise choice in an international free-market. I don't have the figures, but I suppose most do OK, assuming their surgeons are well-trained, and the facilities are up to snuff. But with the lower price tag comes some strings, mainly the lack of recourse should something go wrong. It's sort of like buying something on eBay, but maybe not even as secure. Caveat Emptor.

Here's my own humble opinion: The whole mess needs to be scrapped. Every last facet. Medicare and Medicaid must go. They are bloated, corrupt bureaucracies, and for the most part have created the tangled quagmire that now drags us down. Overpayments and underpayments are the rule, not the exception. A lot of docs have made a lot of money off of both by gaming the system, and that is not acceptable.

I'm not going to go into much detail, because I don't have time or energy or intelligence enough to do it, but I think my friend Bart was on the right track with his idea that I published years ago. Basically, let the government buy the most basic of catastrophic insurance for everyone, and then the individual fills in the gaps. Remove interstate restrictions, etc. This is not the insurance exchange envisioned by Obamacare, by the way. I'll add to Bart's plan the thought of removing Medicare and Medicaid from the equation, or at the very least, revamping them from top to bottom.

But I digress...

I have no problem with profit. I think profit is a better and more benign motivation than power. I DO have a problem with cheating, with gaming the system, with manipulating people's lives and health to make a buck. But that sort of garbage isn't really capitalistic anyway.

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