In re: Medical care

Background story

http://www.msnbc.msn.com/id/48066135/ns/health-health_care/

The problem in the United States and health care is more a matter of perception than reality. If you read the above story, pay attention to the very last sentence … it is very telling,

You see, when it comes right down to it, as my dear wife pointed out to me, we have very good care in the US … very good. And she should know as she has had experience with both the Canadian government-provided health system and the US non-government provided system.

From her viewpoint, the difference, to put it my words, is that the US has a Cadillac system while Canada has a very reliable Ford or Chevrolet system. Both systems provide good care on the basic hospital stay … only in the US you might have your own TV set in a semi-private room and not necessarily want to leave right away, while in Canada you would have to rent a TV and be in a six-bed ward and you definitely want to escape as soon as possible. The beds, she says, are more comfortable the US than in Canada and the nursing staff much more responsive to the call button at each bed in the US.

SO, while you still would get excellent treatment, for the most part, you get more bang for your stay with the US system than Canada’s.

Another thing I have noticed, and it is an extension of our third-party payer system, is that when you leave the hospital they usually hand you the drugs you need to survive for a few days, with a prescription to get more if you need it. In Canada, they just hand you the prescriptions and the visit to the drug store is not covered (unless you have an employer-supplied private health insurance program).

So, a lot of the health care debate, renewed by the recent Supreme Court ruling on the Affordable Care Act (which is anything but, in my humble opinion), has never been about the care or cost, as much as who pays. In the story above, the woman delayed getting care because she didn’t have insurance and wanted to wait until the government-provided Medicare would pay for it. It almost cost her life, but she had been convinced by the doomsayers that they hospital wouldn’t do the operation unless she was insured. That, for the most part, is bovine scatology, especially when a person’s life at risk. Now, if it is elective surgery, non-life critical, well that is a different matter and should be.

In almost all cases, including my own, even when coverage was in doubt, the hospital usually will go ahead and do the treatment in life-saving cases … and then sort out who pays what and how much later. And a lot of the time, if you are poor or indigent, then some group or even the hospital will figure out a way to get the bill paid. In my case, I was out doing a stupid thing far from my home with minimal health insurance (and the insurance card was still at the office – unissued) when I had a very major heart attack. I could go into the long song and dance about that, but it really is irrelevant.

It will take time, and I suspect it will involve a modicum of stress, but paying the bills will get sorted out. Of course, looking at the initial bill usually is enough to make your heart want to stop beating, but that is how much medical care costs. It ain’t cheap, not if you want decent care with the providers getting a decent return on their efforts.

Unfortunately, we have somewhat demonized healthcare providers as being greedy and especially the relatively recent innovation of third-party payers who will pool your premiums with others folks to provide a fund for those who need to pay bills. That practice is only about 75 years old.

Now, it seems, we don’t want people who provide this service to get a reward for their trouble of doing it … or we don’t like the type of return they are getting, especially if they are really trying to be careful stewards of the money given them in premiums … read that contract closely, because they are going to go strictly by it or be accused of malfeasance or other fiscal crimes.

Again, unfortunately, there are those in the US who think the federal government can be a better steward than private organizations. What are these people thinking? How many government contracting scandals do you have to have? How many cases of fraud, etc., do you have to have before you realize that the government is not really the best steward of your money? At least the private insurance companies do have some incentive (rather than just altruism) to keep costs down … it is they get to keep some.

Yes, it would be better if we had more companies competing for our consumer business than less, but that is a product of our government regulation, which is more designed to protect and defend existing industries than it is just make sure that people are treated equally before the law in the contracts that they subscribe to.

That is the biggest complaint, at least mine, about especially today’s federal government: It is too busy picking winners and losers in the commercial world and not just making sure everybody just abides by the contracts that they sign. If you don’t think this is true, then just look at the Defense Department contracts and how money is spent there. Understand, I love the Army, the Navy, the Air Force, the Marine Corps and the Coast Guard (and all their reserve formations), but I have personally witnessed too much avarice and stupidity on the part of the bureaucracies that run their contracting systems and seen how much Congress meddles and muddles the whole process not realize that there is a lot fuzzy business going on. Plus, I am too much of a historian not to realize that corruption in government contracting not only is as American as apple pie, but it a basic theme throughout human history.

How can we expect health care to be any different?