Health Care: Reality Check
The Market Ticker ® - Commentary on The Capital Markets
Posted 2012-08-20 21:23
by Karl Denninger
in Health Reform
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Health Care: Reality Check
 

I'm tired of the lies.  Including those of Peter Orszag, who was President Obama's director of the Office of Management and Budget.  He said:

The vast bulk of health-care costs arise from an extremely small share of patients, whose insurance will inevitably bear a substantial share of their expenses.

That’s why competition in health care doesn’t work as well as in other sectors, and it’s also why the key to keeping costs to a minimum is to encourage providers to offer better, less costly care in complex cases.

Bullcrap.

In 1963 it cost $120.55 to have a baby in a hospital, according to one man who actually stroked the check.  There was no "insurance" for any such routine and expected medical procedures (have sex, child will likely follow if you do it often enough.)

This is great because the BLS says that the CPI was 30.4 in 1963.  Today it's 229.104, or 7.54x as high.

So we'll multiply $120.55 X 7.54 and we get $908.95, or what it should cost for everything, including the room for both baby and mother, drugs, the delivery room, circumcision (it was a boy, obviously) and lab fees.  This covered four days in the hospital, incidentally, not the less-than-24 hour "quickie" that is usually the norm today.

Now I'll grant you this was an "uncomplicated" birth.  And?  Most births are.  Some are not, but a routine birth was, in 2012 dollars, under $1,000 in 1963.

And trust me, babies are born the same way in 2012 that they were in 1963; they are emitted out of the same place in the mother, the same labor and delivery process happens, the cord still has to be cut, etc.

Oh sure, things go wrong and when they do it can get more expensive -- quickly. 

But find me a hospital that will deliver a baby, with a four day stay for mother and child, for $1,000 cash anywhere in the United States.  You can't because such a hospital does not exist.

Indeed, you can't even stay for one day in a semi-private room at Northwest Community Healthcare in Arlington Heights, IL -- just stay in the room, without any care being provided whatsoever -- unless you spend $1,365.  Incidentally, you can stay in the Mariott downtown on the MagMile in Chicago for $209 a night, or $259 if you'd like access to the Club Lounge, roughly 1/5th of the hospital (and quite a bit nicer, I might add; I've been in the latter.)  The Renaissance Schaumburg, a few miles from that hospital for those who claim that using downtown Chicago prices is being "unfair" (compared to a Suburban hospital), is $219.

And remember, the hospital room is just for the room -- no medical procedures, no drugs, no monitoring devices, no special facilities like an ICU unit, nothing other than the physical space.

We can talk about medical care cost escalations once we remove all of the cost-shifting, monopoly protections passed by government, EMTALA's impact and outright frauds that the medical industry foists on all of us that cause costs to be 5, 10 or even 20 or more times what inflation says this procedure should cost.  A procedure that is functionally identical to the one performed in 1963 and is an utterly routine and ordinary process that humans have undergone for thousands upon thousands of years.

The point of this, my friends, is that for $1,000 you could write a check for your childbirth expenses; "insurance" would be unnecessary.  If you were not well-off you could hock your car's fancy rims (which you had plenty of money to buy, right?) 

Guess what?  Most of the rest of "common" medical procedures are likewise overinflated in price by similar amounts for exactly the same reason -- cost-shifting, monopoly protections granted to these businesses, EMTALA and, of course, outright frauds and money-sucking off the government and private-sector teat.

The entire medical system is one gigantic scam

Period.

There's not a thing wrong with allowing people to buy really fancy medical care using really fancy equipment and procedures, decking out really fancy rooms in fancy hospitals, paying for it all in cash.  But there is something very, very wrong when utterly routine things like childbirth, hernia repair, gallbladder operations, an inflamed appendix, setting a broken leg or arm and similar wind up costing you 5, 10 or even 20x what the inflation-adjusted price is from, say, 1963.

Every one of these politicians needs to shut the hell up until they put a stop to this crap.  And make no mistake -- absent the government protections that have been given to this industry there is not a snowball's chance in hell that their pricing would survive 30 seconds in an actual competitive market where people had to write checks.

These politicians are all scam artists in bed with the medical shysters who are interested in exactly one thing -- bleeding the entirety of this nation dry.

The proof is in the numbers.

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User Info Health Care: Reality Check in forum [Market-Ticker]
Jackl
Posts: 2228
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It's the American dream, don't you know?

Buy a Senator.
Bury an amendment.
Go to lunch with the banker.
"Finance" everything.
Lie to the man across the counter.

Get rich, hide assets overseas, separate yourself from the "citizens"


The dream of American Nobility.


Vitchilo
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But you know... Romneycare fixed everything so well in Massachussets that prices have skyrocketed and they now have to put price controls...

So you know, it's gonna work even better on the national level... because we say so! Trust us, we're politicians!

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Poorsaver
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Sunshine Tax State
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My daughter just had a baby, cesarian, otherwise normal. Three day hospital stay at Kaiser. Bill was $22K. Fortunately, she had the insurance coverage from her employer. It's really out of control.

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"I'm going to need a hacksaw"----Jack Bauer
"You can get killed walking your doggie!"----Vincent Hanna
Dazedncornfused
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I stand by my previous post:
http://market-ticker.org/akcs-www?post=1....

Shall we next complain about the current college fee structure? I paid for much of my college with a paper route, but still had enough left over for the motorcycle and party budgets.

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Stand up and be counted or line up and be numbered.
Vang
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Karl,

It's completely tangential to your post, but circumcision is completely unjustifiable. Its supposed medical benefits do not exist; it causes severe pain to newborns; it damages sexual function for life (some of which can be regained by "foreskin restoration"); and is emblematic of a society where the suffering of men is disregarded where similar abuses of women would lead to protests.

I don't mean to derail this thread at all, but, as someone who is working through his own anger from his circumcision, it's hard to not say something when circumcision is treated as a normal part of birth.

Bluebird
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Around my area, Springfield and Dayton Ohio, they are building all new hospitals. Sometimes, it is 2 old hospitals merging together and then building 1 new hospital. Other times, it is a major hospital building a satellite hospital in a suburb. And sometimes it is just an older hospital building a new addition. The point is, the new buildings are everywhere!

Who is going to be able to afford the health insurance to be able to have surgery in these new buildings and to also afford the insurance to see the doctors who practice at these hospitals.

What is going to happen to all these new hospitals after the medical bubble bursts?

Morla
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Poorsaver, $22K billed or $22K paid by insurance? When discussing health care costs it's important to specify whether you mean the phony scare price they quote or the actual price that's paid.

Hell, for that matter, Karl, what price are you comparing 1963 to? Quoted or actually paid in practice? See the system wants as much of everyone's money as it can get, all of the time. The actual supply and demand for care is an afterthought for a monopolistic entity, it is only concerned with how much you can possibly pay it vs how much you are currently paying it. Obviously the differential is greater for the uninsured....

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Fear of govt IS the government.. Statism is a pack of unbacked threats; If govt gets out of control, ignore it and go about life as you see fit. Where's your crown, King Nothing?
Themortgagedude
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saint louis
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And the medical bubble will burst.

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I'm already visualizing you with duct tape over your mouth.
Debtpie
Posts: 534
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About 27,000 State of Iowa employees get 100% free, all inclusive, health care courtesy of the tax payers.

Think they're concerned about cost?

Hell no, it's all free!

New Republican Governor wants them to pay 20% of the premium...unions crying out like a stuck pig...no way, unfair...BS!

Quote:
Iowa’s state employees would be required to pick up 20 percent of their health care costs under a demand Gov. Terry Branstad will make during union negotiations this year...If successful, it would cost state workers roughly $46.3 million a year


So, 20% is $46 million...that means the State of Iowa is spending $230 million a year just on health insurance premiums...MARTHA!...and every time I turn around my property taxes go up because of "Budget shortfalls" within the city and state? We had the money to build a $32 million library though...WTF...who checks out/reads paper books? It must be really nice spending other people's money like that...

Q: Who's the state of Iowa's insurance company?

A: Wellmark Blue Cross and Blue Shield



Q: What companies CEO raked in an $11 million salary last year?

A: Wellmark Blue Cross and Blue Shield



Q: Who just built a 600,000-square-foot five-story building at a cost of $250,000,000 to process those insurance claims.

A: Wellmark Blue Cross and Blue Shield

Not long after completing the building, they stabbed everyone with 10 to 30% premium increases...public outcry big time...they actually claimed that premium money was not used to construct the building...that's how stupid they think we are...

https://myaccount.nytimes.com/auth/login....

http://blogs.desmoinesregister.com/dmr/i....

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A Leader, or an Opportunist? "A leader has the capacity of vision, the ability to see where things are headed before people in general see those things." Mitt Romney --- DebtPie's definition: a leader decides where "things" should head and "leads" us there.

Themortgagedude
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Morla. I was born in 196x. I cost less than 100 bucks. Fayette County Hospital in Vandalia Illinois.

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I'm already visualizing you with duct tape over your mouth.

Morla
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What I want to know is if Karl's numbers for the modern day are the actual price or the phony collusion price. The actual cost may be lower than we think, but still much higher than it needs to be because the consumer is denied any choice in how to pay. It's insurance, medicare, medicaid, or bankruptcy. Collusion removes cash as an option entirely.

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Fear of govt IS the government.. Statism is a pack of unbacked threats; If govt gets out of control, ignore it and go about life as you see fit. Where's your crown, King Nothing?
Mrbill
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Does that quoted price get used in any sort of tax-writeoff scheme?

Or is it merely a negotiating tool?

The answer to this would help me understand quite a bit about the incentives in the system, and just how F-ed up they are.
Morla
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Quote:
Or is it merely a negotiating tool?
Well I can tell you it's not that. The insurance company already knows internally what the provider's cost basis is.. As does Medicaid. But the lowly consumer needn't trouble his pretty little head with real numbers, his betters will take care of all that for him.

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Fear of govt IS the government.. Statism is a pack of unbacked threats; If govt gets out of control, ignore it and go about life as you see fit. Where's your crown, King Nothing?
Mo
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Quote:
Q: Who just built a 600,000-square-foot five-story building at a cost of $250,000,000 to process those insurance claims.

A: Wellmark Blue Cross and Blue Shield

Not long after completing the building, they stabbed everyone with 10 to 30% premium increases...public outcry big time...they actually claimed that premium money was not used to construct the building...that's how stupid they think we are...


Trust me all these BCBS are rolling in dough. I wouldn't be surprised to see them out in front of their buildings burning money.

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Comrader
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pa
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i was born at home along with 4 brothers and sisters from 1951 to 1959 all were $25 each, mom and dad still have the bills, doc made house calls
Verreken
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Karl

There is an additional factor. There is a lot of unnecessary texts and procedures which are done for CYA purposes to protect against medical malpractice lawsuits. Doctors and nurses are fallible human beings. Unless there is also some sort of tort reform, the cost will not go down.

The politicians are mostly lawyers
Azusgm
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One thing about that room charge would be the nurse you rarely see. Nurses are rolled into the room charge right along with medical records, IT, etc. Not many nuns staffing hospitals anymore. Equal pay for equal work jacked up the cost too since nurses back in the day almost all were female and paid less than a man would have been in the same position.

I do agree with you that a hospital does not need to look like a palace. Consultants and hospital administrators came around in the 80's and informed us that a family's choice of hospital was determined by the woman of the house. A woman's first inpatient admission is usually for childbirth. Patients were hospital shopping at the time. Voila! New and improved labor and delivery units were constructed all over town. The construction competition continues.

Yaldor
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bad example since in 50 years there has indeed been (hedonic) improvments to health care

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For every prediction of an imminent crash the probability of it being correct is almost zero
Flaps10
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seattle
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Quote:
Does that quoted price get used in any sort of tax-writeoff scheme?


Sure it does. The doctor can then honestly state that he had to write off many thousands every year against amounts billed.

I have also been in the doctor's office when a person negotiated for a cash price and it was 1/3 of the original amount. I also had my son in the ER a few weeks ago and they hit me up for payment up front for a huge discount (which I actually appreciate).


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"Better to die on your feet than live on your knees"
Spence
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Yaldor, good point but it's even more complicated than hedonics. At the first level you could compare mother and infant survival rates. But at the second level, you would have to add in the cost to improve the survival rate. In 1963 they may have had higher infant mortality (I assume but am not sure). But now days they can spend millions to help one baby survive that would have died in the '60s. Those millions are cost-shifted to everyone else now.
Lunatic_fringe
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Karl, not too long ago you wrote about the Surgery Center of Oklahoma and I've been going through past blog posts from them, It's been fascinating reading from an obviously libertarian leaning doc. I just read something that I don't think you've covered before regarding the outrageously high bills pumped out by the hospitals that they have no expectation will be paid in full. As you might expect, it's a scam.

http://surgerycenterofoklahoma.tumblr.co....

"...Let’s keep going. Unsatisfied with their tax-free status and disproportionate government payments, the hospitals pulled off their ultimate heist: the uncompensated care scam. Declaring any amount of their bill which they did not collect, “charitable care,” they managed to secure even higher Medicare and Medicaid funding based on this fiction. Uncle Sam provides DSH (disproportionate share hospital) payments to hospitals based on the amount they claim they didn’t collect. This incentivized the hospitals to produce the most outrageously fictitious bills they could, as this padded their DSH payments. This “uncollected” amount also helped maintain the fiction of their “not for profit” status. The more hospitals “lost”, the more they made, kind of a reverse-Enron, overstating losses instead of gains.

(Insurance companies discovered that they could “sell” their services to “re-price” these false bills and make billions in this way. I have discussed the mechanics of this in prior posts. Let’s stay on these hospitals, though.)

Still not satisfied and continuing the poor mouthing lie, hospitals justified their outrageous bills by saying that they were going broke from all of the “charity” care they were delivering. You can see now that they were being paid for this “charity” care by the taxpayer even if the patient wasn’t paying them. The hospitals began more aggressively “shifting the costs” to those who were paying their bills, even though there were no costs to shift.

(Insurance companies were drowning in their champagne as they saw this as this gave them justification for raising premiums and padded their “re-pricing” profits.)"


It's enough to make you sick...
Azzi
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Just lost my job last week to a layoff. There is no way I can afford COBRA family coverage at $15K/year.

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The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants. - Thomas Jefferson
Pay_lay_ale
Posts: 251
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"bad example since in 50 years there has indeed been (hedonic) improvments to health care"

Umm, there really hasn't been any in most routine procedures. Fixing broken bones is done the same way it was 50 or 100 years ago. Same for removing an appendix, gall bladder, or tonsils. A routine vaginal delivery is done the same way it's been done for millions of years. A C-section has been around for thousands of years. It's NOT rocket science.

Yet the CRIMINAL sick care cartel will charge you $25000-$100,000 for an appendectomy, a simple surgery that takes under an hour. They bill an insurance company an average of $2500 and consider that paid in full. I can afford $2500. I can't afford 10-40x that.

It's only in been in things like cancer, heart disease, and organ transplants where any real progress has been made. Yet they haven't cured them, only extended life for a few months or a few years for the most part at the cost of tens of thousands to millions of dollars.

But you can greatly reduce or eliminate the risk of those with proper diet, exercise, and lifestyle.

Mortgageguymn
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If childbirth were still $121, I'd get a lot more women pregnant.
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