The High Cost of Universal Health Care, Chapter I

I listened to Hillary on "Good Morning America" today as a friendly press threw her a few softballs so she could publicize her campaign and get Obama off her back. I felt like the painting "The Scream" as she guaranteed that "universal health care" would soon be a reality. Of course, by that, she meant "free" health insurance for everyone. Please realize that no federal program is ever really going to be "free." It was implied that such coverage would not result in more taxes, so I'm really wondering where the money machine is located that is going to pay the already horrendous medical bills that even more Americans will have when Utopia arrives.
My point is that "coverage," or "insurance," is not the remedy, but the cause of the obscenely high price of health care we have in this country. I'm not talking about a responsible adult seeking to transfer some of his own risk to a respected provider or a benevolent corporation offering to help with the medical bills of its employees. I'm talking about a perceived bottomless lake of money that must go through paperwork and other channels to pay providers. Government funded health care is dangerous because it does not allow for interaction by the most important party in the process of health care: the patient. It is an intimate bargaining interaction between a designated provider (e.g. Medicare, etc) and a designated consumer (such as the hospital, clinic, or doctor).
The first mistake was taking health insurance decisions out of the hands of the insured patient. It seemed "convenient," at one time, to let the hospital and the insurance company "duke it out" while the patient, with other fish to fry, waited for the remainder of the bill that would arrive. As a result, most patients are not even aware of the horrendous bills that are sent to insurance companies. I'm not saying these companies are innocent and without blemish, but blaming the health care crisis on insurance providers is like blaming global warming on your thermometer out on the back porch.
Just recently, we had to take my son to the emergency room at 6:00 AM for what we had feared was appendicitis. The sign at the emergency room -- conveniently in English and Spanish -- says that there is a 200 dollar charge for that room. My insurance company says they will cover up to 200 dollars for an emergency room visit. Fair enough? Sounded good to me.
Three months later (that is not a typo) the bills started to come in. Our part of the emergency room bill, according to our insurance company, would be 250 dollars, since they had paid the first 200 of the bill themselves. Because we had turned in our insurance card, we got the "special rates." That 450 dollars was just for being admitted. Then there was the bill from a doctor who was not even physically present in the small town we visited -- his office is 200 miles away, but he somehow did the X-rays and interpretation of them. $450. Then I got a letter from my insurance company that they had paid all they were obligated to pay and would pay no more. I was angry with them until I realized they had paid 400 of the 1500 bill for other incidental charges. I steeled myself for the 1100 dollars the hospital and doctor would bill me for the balance. Two more months later, and the charge never came. Why? Because it was a bill for my insurance company alone. They never expected me to be able to pay that one "out of pocket." At least I'm hoping.
Need I add that my son did not have appendicitis? There was no surgery. The doctor who billed us never examined him -- only the on-duty physician at the emergency room. There was no hospital stay. We paid for the prescription out of our pockets to resolve a minor problem. As best I can tell, that brief encounter was billed at about 2500 dollars, and my son wasn't even sick. I am grateful they could tell me that, and am willing to pay. But was it worth 2500 dollars? Did we need three doctors and four offices with staffs to tell us that?
I came to the realization that I could have saved myself a ton of money if I had not told them I had insurance. Those ER rates are for the uninsured. I am currently paying 700 dollars a month for insurance that is primarily benefiting medical institutions.
A beloved aunt of mine spent her last two days of her life at a major hospital recently. They mainly kept her comfortable for her suddenly diagnosed inoperable cancer. Gave her a place to die. The bill for that two-day stay was $66,000, not counting doctor's expenses, etc. Don't feel sorry for me for paying for it. You helped. Medicare covered it. I'm trying to figure how many people, working and giving 15% of their income to social insecurity, were necessary to pay for that two-day stay that did not involve surgery or heroic intervention of any other type. And she was only one of maybe a thousand who died like that in one day.
If we get "universal health care" we will all have that coverage. At first look, it seems wonderful. I wouldn't have to pay 700 dollars a month to insure my family against something that's never happened and I hope never will. But I realize someone has to absorb that money. How many families are there in the US? How much money is that if we multiply it by 700?
Hillary and others say that this will help the poor. Well, I've lived where she hasn't. In Costa Rica, everybody pays 25% off the top of their check for health care. As a result, they get "free" medical coverage in the "free" medical clinics, and they are proud of it until they have to wait 36 hours to get treated for a stab wound. In Ecuador, there was also "universal" health coverage. I helped drive friends to the hospital at 3:00 AM so they could stand in line and get in some time during that day to an overcrowded facility. The rooms had five or six people in each of them. You hoped they had not lost your folder. There had to be a record of your eligibility.
In both countries, I did not have to suffer through this. Why? I did what the Rich People did (and if you are in the US and reading this, you are one of the Rich People). I went to the private clinics and the private hospitals. They saw me right away, and we got the best medical care, while my friends lost children or died waiting for a doctor to show up. I watched people die in emergency rooms. But they had their folders.
In the US, "universal health care" will crowd the emergency rooms even more. It will make a six-figure visit to the doctor a probability. Meanwhile, the rich will continue to be first in line at clean, private clinics, where the best doctors go. In South America, there never were enough doctors, because they were usually on strike. But don't blame them. There wasn't enough money to pay them. The private doctors always were there for you, because they were paid out of pocket instead of through a government dole.
This will not be the last thing I have to say, but I want to make this clear. The problem is not "evil insurance companies" or "oppression of the poor." Affordable health care is out the window because health care providers have found the golden goose.
Ideally, we could solve the health care problem in America in one day. If all Americans cancelled their insurance policies tomorrow, and announced that they could only pay "out of pocket," hospital costs would plummet. But of course, I know that's a silly fantasy.
What I recommend is making an arrangement with our own insurance companies. We pay the bills we can afford, and then send the receipts to our insurance companies for reimbursement.
Yesterday, I got a letter from my insurance company, telling me they were not going to pay for the second billing they had received on my son's treatment. Of course, they won't have to. The fact that a hospital can even send out a double bill, and no one calls it corruption, is amazing to me.
The last thing we need is to turn health care funding over to the government. The greatest need we have is personal responsibility -- we need to be in the middle of the equation in every medical transaction that involves us. When those commercials for free motorized buggies and hospital beds, meds-to-your-door and chairs that rise up to meet you come on, notice that they want to take care of it themselves. Is that because they love you? Actually, it's because your Social Security number is another key to the golden door that is American bureaucracy that, in the last generation, paid 800 dollars for a hammer or toilet seat in a military contract. Now, they are paying 20,000 a night for a hospital bed.
And we let them.

More later. I've not even started on this one.