There have been a number of comments on my previous articles related ot the Health Care scam and more than a few private emails I've received trying to cast doctors as "victims" of the medical cost-push cartel scams that run through the entire industry.
Don't fall for the Marcus Welby crap.
Nobody who is part and parcel on a willing basis to an utterly-unsustainable system should be excused, just as you cannot excuse any of the officers and directors of a big bank.
The next generation of U.S. physicians is being saddled with record debt amid a looming shortage of doctors needed to cope with a rising elderly population. The burgeoning debt burden may be turning students away from primary care, which pays about $200,000 a year, toward more lucrative specialties and scaring off low-income and minority students fearful of taking on big loans.
Median tuition and fees at private medical schools was $50,309 in the 2012-2013 academic year, more than 16 times the cost when Moy’s father became a doctor. The median-education debt for 2012 medical-school graduates was $170,000, including loans taken out for undergraduate studies and excluding interest. That compares with an average $13,469 in 1978, said Jay Youngclaus, co-author of a February 2013 report on medical school debt.
Gee, I wonder why medical costs have gone up so much? It's all the tort bar and insurance companys' fault, right? None of it has anything to do with an educational debt load for the average medical school student that has gone up by a factor of 10 since 1978, right?
Being a doctor used to be a middle-class profession. A primary-care physician -- a generalist, in short -- is not a brain surgeon.
Since when is $200,000 a "middle-class" income when the median family income in this nation is about $50,000?
It's not, in short.
Record numbers of students still want to become doctors. First-time applicants to U.S. medical schools rose to 33,772 in 2012 from 24,884 a decade earlier, according to AAMC. New enrollment at U.S. medical schools grew 1.5 percent to 19,517 students, the highest ever.
Of course they do. We have a cartel in the country in the form of the Medical System and if you can get inside it you too can skim off your piece of the pie, and the best part of it is that you get to scare people into paying you by using their fear of death as a cudgel.
No, I will not excuse doctors. I will instead excoriate them and point directly to the Sherman Act for what, in my opinion, they should face:
Every person who shall monopolize, or attempt to monopolize, or combine or conspire with any other person or persons, to monopolize any part of the trade or commerce among the several States, or with foreign nations, shall be deemed guilty of a felony, and, on conviction thereof, shall be punished by fine not exceeding $100,000,000 if a corporation, or, if any other person, $1,000,000, or by imprisonment not exceeding 10 years, or by both said punishments, in the discretion of the court.
I have one question: Where the hell have you been and what have you been doing -- other than pocketing millions -- over the last 10, 15, 20 years?
Cancer clinics across the country have begun turning away thousands of Medicare patients, blaming the sequester budget cuts.
Oncologists say the reduced funding, which took effect for Medicare on April 1, makes it impossible to administer expensive chemotherapy drugs while staying afloat financially.
Oh, it's all the sequester? Let's look at the argument:
The federal government typically pays community oncologists for the average sales price of a chemotherapy drug, plus 6 percent to cover the cost of storing and administering the medication.
Since oncologists cannot change the drug prices, they argue that the entire 2 percent cut will have to come out of that 6 percent overhead. That would make it more akin to a double-digit pay cut.
So let me guess:
1. All these oncologists pay the same, average price? There's no variation in price and no market for these drugs? You can't choose to get them somewhere else -- like, for instance, in Mexico or Canada?
2. Further, all these oncologists cannot charge anything other than this same, average price that each of them paid?
Really? Honestly? That's the real situation?
Because if you do prove it, then you're proving that there is a cartel that is fixing prices and restraining trade.
And if not, well, then exactly what's this complaint about?
Which is it?
Oh, and I'm perfectly happy to find out that the answer is the first one, and frankly, I wouldn't be the least bit surprised if it is. But if so the solution to this problem and indeed virtually everything that is broken with both Health Care and our Federal Budget is then clear -- it's found right here:
Every contract, combination in the form of trust or otherwise, or conspiracy, in restraint of trade or commerce among the several States, or with foreign nations, is declared to be illegal.
Every one. Not "all except for the oncologists and drug makers." As for what happens to those who engage in such conduct? That's clearly defined too and leaves nothing to the imagination:
Every person who shall make any contract or engage in any combination or conspiracy hereby declared to be illegal shall be deemed guilty of a felony, and, on conviction thereof, shall be punished by fine not exceeding $100,000,000 if a corporation, or, if any other person, $1,000,000, or by imprisonment not exceeding 10 years, or by both said punishments, in the discretion of the court.
Go to prison.
Go directly to prison.
Do not pass go.
Do not drive a Porsche, do not live in a fancy house, do not collect your "salary."
Do get a 10 year date with Bubba.
All of you.
WHERE ARE THE DAMNED HANDCUFFS?
You may have already read or heard about Steven Brill’s excellent, long article in Time magazine, called “Bitter Pill: Why Medical Bills Are Killing Us.” If you think it doesn’t concern you, don’t be so sure. Brill documents how a trip to the emergency room for chest pains that turn out to be indigestion can exceed the cost of a semester of college, how simple lab work done during a few days in a hospital can be more expensive than a new car, and how a drug that requires $300 to make and that the manufacturer sells to a hospital for $3,000–3,500, can cost the patient to whom it is prescribed $13,702. He looks closely at the outrageous prices on itemized hospital bills and finds that individual services listed on them have been priced at double and triple what those same services cost separately—for reasons neither the patient understands nor the hospital can explain. And he recounts the horror stories of people reduced to penury after a brief hospital stay, even though they had some health insurance, money in the bank, and suffered from only minor ailments.
Put simply, Brill says, these bills tell us there’s no free market in our healthcare system, that hospitals set their rates knowing that someone in pain or in fear for his or her life is not going to ask to see the price list first before agreeing to some test or treatment. It’s no wonder that 60 percent of our fellow Americans who file for personal bankruptcy each year do so because of medical costs.
Charles Simic started out well with these two paragraphs. But then he immediately descends into the common lefty shibboleths that, unfortunately, are false when it comes to health care.
What makes articles like this so outrageous is that the facts are available to anyone who cares to look. The data on health expenditures via the Federal Government, for example, are easily found in the Monthly Treasury Statements (MTS), public documents available going back for a very long time -- as they are, after all, public.
This is where one finds the $1 trillion in total federal health spending, which incidentally is about $100 billion more than is counted in the various budget documents, even the so-called "as-spent" ones.
The argument that somehow Medicare is a "solution", that is, a "government option", is one of those common lefty shibboleths that is utterly devoid of factual basis. The fact of the matter is the Medicare and Medicare are federal government medical spending -- nearly all of it in fact -- and it is rapidly driving the federal government into insolvency!
This is "restraint"?
That may sound harsh. But Brill’s article makes one comprehend not just the talk in Washington about the supposed absolute necessity of replacing Medicare and Medicaid with “market-oriented” health care, but also the full human cost such a change would bring. If the elderly and the poor are stripped of the few protections these government programs give them, they’ll be left at the mercy of a medical industry and insurance companies whose already huge profits, so they imagine, will then get even bigger. Despite the claims that these are high-minded proposals that will fix our national debt, and despite their veneration as such by the political establishment and the media, what is being offered to the American people is nothing more than thinly-disguised money-making scams.
Well, in that Charles is right, but for the wrong reasons. And when you're right for the wrong reasons then your prescription for change is wrong too.
The reality of the health situation in the United States is that cost escalation is driven by a few rather simple facts, all of which happened and continue to happen specifically due to government protectionism and intervention, not the market and not "sadism" or "the profit motive."
It is the cartel-like behavior that causes this problem. Hospitals buying out independent imaging centers (think MRI) and then tripling their charges would be an utterly stupid act but for the ability to stop someone from setting up another one next door, undercutting their price by 90% and instantly putting them out of business. To prevent this you have CON laws in a significant number of states and where those are not present you still have active interference with the market, including forcible licensing and inspection routines along with subtle (and not-so-subtle) threats of refusal to allow doctors who are not "affiliated" presence in these hospitals.
Then there is the blatant "in your face" game-playing with drugs. A drug made in Mexico and available over the counter for $100 is sold to a hospital here in the United States for $4,000 and is then marked up nearly 10x to almost $40,000 when sold to a patient. Not only is it illegal for you to possess that drug without a prescription, which of course you can't get without a member of the medical cartel writing it, but it's also illegal for you to go to Mexico and buy it over the counter for $100 and then bring it back to the United States and undercut the hospital by selling it for $200 to anyone who wants or needs it.
Note that nowhere is an element of forgery, counterfeiting or misrepresentation present -- this is simply collusive cartel behavior that is specifically enabled and given legal force (without which it would instantly collapse) by an industry who lobbied government to get special laws passed that prohibit the forces of the market from working.
Likewise, anti-gouging laws prohibit me from selling gasoline for $3/gallon every day of the year, except when there's a hurricane coming, at which point I charge $6. I can make a clean argument that such "anti-gouging" laws are wrong, in that the market price for gasoline in a hurricane might well be $6, and if it's $3 instead everyone who drives by will buy up all my gas -- which means the guy who really needs it will get none since I'll run out!
But that's not what happens here. In the gasoline example there are 4 gas stations on pretty much every exit on the highway and they all have signs up posting the price before you pump the gas. And these "anti-gouging" laws don't require collusion -- a singular and unjoined decision to boost your price is enough to get in trouble.
In the medical example not only is there no posted price anywhere, with the price being retroactively determined after the service is provided but there is active collusion between providers and overt acts to remove lower-priced competitors by buying them out or, if they refuse to cooperate, freezing them out of their practices through various means. These sorts of actions in virtually any other line of work are rank violations of the Sherman and Clayton acts -- laws that proscribe such anti-competitive behavior and attach felony criminal penalties along with treble-damage civil liability to violations.
The final shibboleth is that there was something immoral about what Ron Paul said in Tampa, when he made the comment that taking your own risk might mean that someone who is uninsured because he accepted his own risk might die as a consequence for lack of the ability to pay and obtain care. What's left unsaid by Ron Paul or anyone else for that matter, including the author of this piece, is that the reason everyone considers such "insurance" mandatory is because of the cartel behavior that leads prices to be FIVE TIMES what they would be in a free market.
The Oklahoma Surgical Center points this out quite clearly. There prices are posted before the procedure is undertaken and they are quite-typically one fifth of what is often charged uninsured people in "conventional" hospitals. For the same procedures.
The solution is not to further ensconce cartel behavior into the government and then try to "restrain" it while leaving the basic structure alone that led to the problem in the first place.
Rather, it is to first remove all such special protections from this industry en-masse and then prosecute any and all medical providers, irrespective of whether they are doctors, hospitals or drug and device makers who act in an attempt to restrain the market, de-capitating the medical cartels and imprisoning all involved from doctors to CEOs.
THAT will solve the problem.
Trying to place a cartel inside the government, which is what Charles proposes, is not only ethically bankrupt it will financially bankrupt our nation if we don't cut that crap out.
Seriously folks, this sort of distortion cannot exist in anything approaching a free market.
The IFHP just released the data for 2012. And yes, once again, the numbers are shocking.
This is the fundamental fact of American health care: We pay much, much more than other countries do for the exact same things. For a detailed explanation of why, see this article. But this post isn’t about the why. It’s about the prices, and the graphs.
The "why" is simple -- our "health industry" has convinced the government to protect it from competition enabling behavior that is illegal in virtually every other line of business and then has used that privilege to screw every American.
This is then used as an "excuse" to "require" everyone to buy "health insurance" which then screws you even more and harder.
This isn't the market folks, or anything about the fundamental realities of an older America or any other "real" change. It is entirely manufactured out of whole cloth through explicit and intentional acts taken by the health industry in collusion with government that have, continue to and will rob you blind.
There is no solution to the fiscal mess our government is in nor any way to avoid the impending destruction of our economy and government unless we take this industry out back behind the woodshed and terminate with extreme prejudice its ability to extract 4, 5, even 10x or more the cost of procedures, drugs, devices and even bed space in a hospital paid in literally every other developed nation in the world.
In Montana, for example, Hoey’s pharmacists group found that generic Lipitor, generic Plavix, diovan and Nexium together cost $359.38 per month through UnitedHealth’s AARP Medicare Rx Preferred plan at a Walgreen preferred pharmacy in Helena. The same drugs cost $327.73 at the independent Anderson Family Pharmacy in Great Falls. Hoey said his group relied on data from Medicare’s website.
Just wait until you see what's going to be disclosed soon.....
Specifically, wait until you see what other first-world nation citizens pay for these same drugs.
Soon, you will be able to.
And once you do then you will understand why we do not need this "coverage" at all and that the only reason it is "needed" is that you were raped by the medical industry in the setting of these prices in the first place and then those prices were protected by laws prohibiting the cross-border operation of the market which would otherwise instantly result in you being able to buy these drugs for dramatically less -- in fact, so much less that you could almost-certainly pay cash.
You are likely to be rather angry, I suspect, and you should be.
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