Greed, M.D.

Follow the money:

The RAND Corporation recently published a study of 360,000 families who used Health Savings Accounts (HSAs) to control their own spending on routine medical expenses. These HSAs were coupled with high-deductible insurance to cover unlikely-but-expensive serious accidents and illnesses.

According to health economist John Goodman: “Not only did spending go down by as much as 30 percent, there was no noticeable decrease in quality and no discernible difference in outcomes among various income groups.” Nor did patients with chronic conditions such as diabetes skimp on preventive care relative to healthier patients. The study authors estimate that widespread adoption of HSAs could reduce overall health costs by as much as $57 billion. Health economist Greg Scandlen thinks it could be much more.

Scandlen notes that the real cause of rising health costs is not “fee for service” but rather a third-party payer system that encourages wasteful spending.

Suppose you received part of your salary in the form of a tax-exempt “food plan” which covered your meal expenses except for a nominal co-payment. If your out-of-pocket expense for a steak dinner was only 10% of the actual cost, you’d likely consume more steak than if you paid the full cost yourself. How many of us would be prudent diners if we ate out every night on the boss’s expense account? Similarly, it’s no surprise that patients covered by tax-exempt employer-based health insurance spend more than patients with HSAs.

That's all well-and-good, but let me point out the fly in the ointment: corporatization.

You can be certain that big corps would jump all over the chance to move to high-deductible health care plans and have employees use HSA funds. The problem, however, is that those corporations will not refund the savings difference to employees in the form of higher wages and salaries. No, they will pocket that difference as "increased profits," the CEO will get a pat on the back along with a fat bonus, and the average worker bee (that's you and I) will be stuck having to pay even more out of pocket for a less robust medical insurance plan.

Those of us who unfortunately work for large corporations see this sort of thing happen on a daily basis. The one thing you can be absolutely sure of in big business is that if you don't watch out for yourself, you'll get trampled by the Greed Stampede of Harvard MBAs and other useless pimples on the ass of society.

I'm no fan of government in healthcare, but let's stop talking around this big-assed elephant squeezed into our tiny little living room: doctors, hospitals and insurance companies have brought much of their current plight down on their own heads. They are happy with the system as it is, because it favors their current business model. Dr Hsieh's proponent views of the "pay-per-service" model are perfectly understandable: he's a practicing physician. It works very well... for him.

If I, however, tried to charge customers on a per-service fee basis like they do, my revenue would flat-line in a matter of weeks, because nobody would buy from me. I have to provide my customers with a comprehensive bid, spelling out in precise language what I am and what I am not providing at the quoted price. I must then sign a contract which legally binds me to specific terms, conditions and scope of services. If I sign that contract and have missed something in my proposal, I get to eat it. That's called "assumption of financial risk." It is a very basic principle of business from which much of the medical profession has enjoyed the luxury of isolation for many years.

Medical professionals and hospitals don't want the "bundled services" option because it forces them into an assumption of risk business model. That means they have to think, plan, and act intelligently, or they'll go out of business. As for this "argument":

In theory, bundled payments will encourage “efficient” care. But in practice, they create perverse incentives for doctors to skimp on care, especially for the sickest patients. If you’re an otherwise healthy 25-year old with pneumonia, hospitals will gladly treat you because the standard pneumonia payment will exceed their expected costs. But if you’re a frail 60-year old diabetic who catches pneumonia, some hospitals may seek any semi-plausible pretext to transfer you to another facility. You’ll become an unwanted medical “hot potato.”

Well, so much for the vaunted Hippocratic Oath, huh? I don't know about the other States, but in Texas every medical facility -- from the M.D. Andersen Cancer Center to the lowliest private practice -- has a sign at the front entrance which clearly spells out that they are obligated by State law to provide prompt, proper and thorough care to anyone who enters, regardless of their ability to pay. My point here (this is the good part) is that TAXPAYERS ALREADY PICK UP THE TAB FOR THOSE WHO CAN'T PAY.

The problem is not a lack of universal healthcare, it's the structure of the payment model. That problem was generated by two groups of people: doctors and lawyers. The latter comprise pretty well everyone in Congress -- who are lobbied by doctor organizations and big corporations... and now we've followed the money trail back to its source.

No matter which side of the political fence you are on, whether you love or loathe the idea of Obamacare, understand this: nobody in big business or government gives a flying crap about your health, whether you receive timely care, whether you live or die... and you should never forget that medicine is big business. The government and Mr Obama are not fighting for what's best for you, and neither are the doctors. They are motivated by the only utterly reliable human trait: self-interest. The ongoing fight over our medical system is about power, about who wields it and who gets trampled.

Question everything -- especially if it's stated by a politician or a doctor.