Healthcare Equality for All!

 

ambulanceJust over a week ago a beloved family member collapsed in the middle of the night, was rushed to the hospital in shock and underwent emergency surgery for internal bleeding. Sophie received a post-operative blood transfusion and spent two days in intensive care. Thanks to expert, timely and compassionate care, today she is back home and doing well.

Excellent emergency medical care is the norm in the United States, thank goodness. What stands out from my family’s recent hospital experience is the administrative side.

Consider: while Sophie was being prepped for surgery, the nurse provided us a detailed estimate of the likely cost of her stay, breaking down the clinical variables and associated prices that would determine the final bill. On discharge day the charges came in as forecast. No surprises. No red tape. No Obamacare. We paid by credit card and were on our way. 

Our sojourn into market-driven medicine got me thinking: if high-quality, affordable, hassle-free healthcare is readily available for our nine-year-old Portuguese water dog, why isn’t this system an option for the rest of us?

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Animal rights advocates posit that human beings are just another species.  Nothing special. “A rat is a pig is a dog is a boy,” as PETA founder Ingrid Newkirk puts it. Well, PETA may finally perform a public service by providing U.S. citizens an arguable legal basis for accessing a market-driven alternative to Obamacare: veterinary medicine. 

Think about it: The other day, I witnessed vets in our local clinic treating dogs, cats, a chicken with back pain, and a tortoise named Hortense—human beings should be a snap to manage by comparison.

I have seen the future, and it works.

There are 56 comments.

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  1. Spin Inactive
    Spin
    @Spin

    Will I be able to take in anyone that I’m tired of and have them put down?

    While I’m on the subject, can we also start fining people who let their kids run loose?

    • #1
  2. Vance Richards Member
    Vance Richards
    @VanceRichards

    I knew something was up when you said, “the nurse provided us a detailed estimate of the likely cost of her stay.” In people hospitals cost is almost unknowable.

    But with dog years being what they are, I understand a puppy can only stay on his parents insurance until the age of four.

    • #2
  3. Fredösphere Member
    Fredösphere
    @Fredosphere

    Hey, I see where this is going. Let paramedics strap their patients to the roofs of ambulances, and watch health care costs plummet! ;-)

    • #3
  4. Peter Robinson Contributor
    Peter Robinson
    @PeterRobinson

    This thread is more or less predestined to turn humorous, I figure–all three of the previous comments make jokes, as is only fitting and natural–but you know what?  George has a point here.  Our own dog (a friend, I should add, of Sophie) had to have a tooth removed a couple of months ago.  It never occurred to me, but we had the same experience George had:  they told us up front what it would cost, and it cost just that.  And the treatment was prompt and friendly and expert.

    • #4
  5. Fredösphere Member
    Fredösphere
    @Fredosphere

    [double post]

    • #5
  6. jmelvin Member
    jmelvin
    @jmelvin

    You’re absolutely right Peter.  Human medical care could be straightforward with known or personally negotiated prices.  Various options could also be added or subtracted from the mix of care and user reviews could even be provided.  Some doctors already operate this way, but it is certainly not the norm in my experience.

    • #6
  7. user_989419 Inactive
    user_989419
    @ProbableCause

    Here are a (partial) list of people who weren’t involved in Sophie’s treatment:

    – An in-clinic person that gets pre-authorization from the insurance company for the treatment.
    – An in-clinic person that codes up the claim and submits it to the insurance company.
    – A person at the insurance company that pre-authorizes treatment, processes the claim and reimburses the clinic.
    – A person in the clinic that accounts for the insurance reimbursement and sends the final bill to you.
    – A person at the clinic that sends out reminder notices to you for bills past due.
    – A person in your HR department that originally selected the insurer, oversees the process and gets involved if there’s a dispute.
    – A person at the clinic’s network that negotiates the prices for all treatment options with the insurer.
    – A person at the insurer that negotiates the prices for all treatment options with the clinic’s network.
    – A bunch of lawyers for the clinic, the clinic’s network, the insurer, and your company.
    – A state or federal legislator that mandates coverage for some of Sophie’s treatments.
    – A lobbyist that makes sure no one treats hospital consolidation as an anti-trust issue.

    • #7
  8. Vance Richards Member
    Vance Richards
    @VanceRichards

    I have seen the future, and it works

    Do you really believe that is in our future?

    We have seen how the Left likes to deal with inequality. If your dog gets a better run healthcare systemt than you do, the answer will be more regulation of dog hospitals not less involvement in human ones.

    • #8
  9. George Savage Contributor
    George Savage
    @GeorgeSavage

    Probable Cause: Probable Cause Here are a (partial) list of people who weren’t involved in Sophie’s treatment: …

     Oh, no!  Widespread adoption of market-based healthcare would destroy untold millions of jobs, bringing on a second Great Depression and the end of civilization.  I withdraw the suggestion, at least until we find another trillion dollars or so to lavish on shovel-ready medical infrastructure.

    • #9
  10. Muleskinner Member
    Muleskinner
    @Muleskinner

    When I was in college a med student was a pre-vet undergrad who got a B+ in advanced chemistry.

    • #10
  11. raycon and lindacon Inactive
    raycon and lindacon
    @rayconandlindacon

    Brilliant!  Our CiCi is the most blessed of Americans.  She is treated as a valuable member of the community… Unlike us mere humans.

    • #11
  12. user_959970 Inactive
    user_959970
    @MikeK

    Spin:

    Will I be able to take in anyone that I’m tired of and have them put down?

    While I’m on the subject, can we also start fining people who let their kids run loose?

     Already happening in a European country near you.

    • #12
  13. Blondie Thatcher
    Blondie
    @Blondie

    Most of us in the healthcare industry would tell you if you get the middle man out of the way (insurance, government) prices would come in line.  People have no idea what things cost and quite frankly don’t care if they aren’t paying up front. This line of thought would also work for paying taxes.

    • #13
  14. user_959970 Inactive
    user_959970
    @MikeK

    Muleskinner:

    When I was in college a med student was a pre-vet undergrad who got a B+ in advanced chemistry.

     When I was a premed, long ago, vet school was harder to get into than medical school. I think they are in a decline since the 2008 events but it should recover.

    • #14
  15. Zafar Member
    Zafar
    @Zafar

    Probable Cause:

    Here are a (partial) list of people who weren’t involved in Sophie’s treatment:

    – An in-clinic person that gets pre-authorization from the insurance company for the treatment.
    – An in-clinic person that codes up the claim and submits it to the insurance company.
    – A person at the insurance company that pre-authorizes treatment, processes the claim and reimburses the clinic.
    – A person in the clinic that accounts for the insurance reimbursement and sends the final bill to you.
    – A person at the clinic that sends out reminder notices to you for bills past due.
    – A person in your HR department that originally selected the insurer, oversees the process and gets involved if there’s a dispute.
    – A person at the clinic’s network that negotiates the prices for all treatment options with the insurer.
    – A person at the insurer that negotiates the prices for all treatment options with the clinic’s network.
    – A bunch of lawyers for the clinic, the clinic’s network, the insurer, and your company.
    – A state or federal legislator that mandates coverage for some of Sophie’s treatments.
    – A lobbyist that makes sure no one treats hospital consolidation as an anti-trust issue.

    Most of these ‘jobs’ are unnecessary with single payer.   An efficiency reflected in prices.

    • #15
  16. Profile Photo Member
    @Kozak

    So, lets substitute a human in your scenario.  They get rushed to my ER, in shock and need emergency surgery.  In the ER we present you with the estimated costs of the surgery and hospitalization.  What if you don’t like them?  Are you going to try and negotiate with us at that point ?  What if you can’t pay?  Do we show you the door?  Or offer the Euthanasia Special?  
    As an ER doc I would LOVE to be in the position of “negotiating” my fee with someone having an acute MI , “well bud, every minute we argue here is going to cost you myocardium, have them get me when you are ready to pay up”.   As it currently stands, I have to see everyone and worry about getting paid later.   When I see a patient I have no idea what their “payor status” so it has no effect on my treatment.  On my last job about 35% of our “customers” paid me… nothing.  And we really have no recourse. Can’t even write if off as charity care for taxes.
    I cringe every time I hear  conservatives say ” well anyone can go to the ER and get treated”.

    • #16
  17. Kozak Member
    Kozak
    @Kozak

    Zafar:

    Most of these ‘jobs’ are unnecessary with single payer. An efficiency reflected in prices

    Allowing the inefficiency to be transferred to other areas of care such as wait times, rationing and availability of drugs and services, worse outcomes.  See Canada and the UK. 

    No thanks.

    • #17
  18. user_199279 Coolidge
    user_199279
    @ChrisCampion

    Zafar:

    Probable Cause:

    Most of these ‘jobs’ are unnecessary with single payer. An efficiency reflected in prices.

     Right, because those “jobs” would get transferred to a government employee.  You can almost taste the efficiencies!

    The VA would like to offer you its condolences.

    • #18
  19. user_199279 Coolidge
    user_199279
    @ChrisCampion

    Kozak:

    When I see a patient I have no idea what their “payor status” so it has no effect on my treatment. On my last job about 35% of our “customers” paid me… nothing. And we really have no recourse. Can’t even write if off as charity care for taxes. I cringe every time I hear conservatives say ” well anyone can go to the ER and get treated”.

     I work in the budget office for a hospital.  That percentage is close to the norm.  The hospital (or provider) essentially eats these costs, they’re passed on to those who can pay in higher rates/premiums, and the system perpetuates.

    There’s no avoiding costs, unless you start removing things that have costs – like salaries, facilities, and treatments.  Single-payer won’t “fix” this or do anything of the kind, since it’s all related to reimbursements, not costs.  The only way to cut costs – “bend” the curve – is to reduce cost elements.  The largest element is labor, and the highest-paid groups in that element are doctors and nurses.

    • #19
  20. Nick Stuart Inactive
    Nick Stuart
    @NickStuart

    George is right about it being the future, our future. We humans will be sneaking off to see a veterinarian for immediate treatment, cash paid under the table, instead of waitlists and shoddy treatment at the Peoples Hospital.

    • #20
  21. Z in MT Member
    Z in MT
    @ZinMT

    Chris Champion, what about your salary?  Probable Cause is barking up the right tree.  Your standard vet office has one admin person, several tech vets, and usually a couple vets.  Your standard family practice has three to four office people for every doctor.  Emergency room care will always be high cost, but the poor reimbursement is because the popular culture has taught low income people that they can get free medical care at the Emergency room.  

    • #21
  22. George Savage Contributor
    George Savage
    @GeorgeSavage

    Zafar:

    Most of these ‘jobs’ are unnecessary with single payer. An efficiency reflected in prices.

     Zafar, the key efficiency of single payer is electoral.  If a majority are satisfied with the system, it is a political success (c.f., US Veterans Administration).  Since a majority of voters are pretty healthy and access health care services mainly for routine matters, single-payer is typically an unalloyed boon…from the politician’s vantage point.  

    The calculus would be markedly different if only sick people were qualified to vote.  And, yes, it is “efficient” in a sense to be able to ignore nearly half of a total available market and still count yourself a success.

    A sixty percent vote in a US election is a landslide.  A private business offering a product that 40-percent of its customers cannot stand is in deep trouble.  A problem for a politician–the disgruntled “customer”–is an opportunity for a market-based enterprise.  The nature of markets is to reward competitors and upstarts who seek out the dissatisfied and do a better job serving their needs.  The risk to the incumbent is that someone doing a better job with a slice of the market will wind up doing a better job for all of the market, so the big sleepy incumbent is forced to respond, preventively if it is well managed, in order to stay on top.

    • #22
  23. George Savage Contributor
    George Savage
    @GeorgeSavage

    Kozak:

    So, lets substitute a human in your scenario. They get rushed to my ER, in shock and need emergency surgery. In the ER we present you with the estimated costs of the surgery and hospitalization. What if you don’t like them? Are you going to try and negotiate with us at that point ? What if you can’t pay? Do we show you the door? Or offer the Euthanasia Special? As an ER doc I would LOVE to be in the position of “negotiating” my fee with someone having an acute MI , “well bud, every minute we argue here is going to cost you myocardium, have them get me when you are ready to pay up”. As it currently stands, I have to see everyone and worry about getting paid later. When I see a patient I have no idea what their “payor status” so it has no effect on my treatment. On my last job about 35% of our “customers” paid me… nothing. And we really have no recourse. Can’t even write if off as charity care for taxes. I cringe every time I hear conservatives say ” well anyone can go to the ER and get treated”.

    Kozak, the vet resuscitated Sophie and diagnosed the source of the bleed using ultrasound before cost was ever mentioned, just as with a human patient.  I went out front for the sign-in procedure as our dog was being prepped for surgery. The paperwork exercise–unencumbered by endless government regulation–was infinitely simpler than the usual experience in a human hospital.

    • #23
  24. George Savage Contributor
    George Savage
    @GeorgeSavage

    Nick Stuart:

    George is right about it being the future, our future. We humans will be sneaking off to see a veterinarian for immediate treatment, cash paid under the table, instead of waitlists and shoddy treatment at the Peoples Hospital.

    Exactly.

    • #24
  25. Locke On Member
    Locke On
    @LockeOn

    Spin: Will I be able to take in anyone that I’m tired of and have them put down?

     This is in fact right on point, as a very large fraction of healthcare expenses are at end of life.  We set the tradeoff between cost, pain and suffering on one side and extension of life on the other rather differently when Sophie is our pet, or our mother.

    • #25
  26. Zafar Member
    Zafar
    @Zafar

    George Savage:

    Zafar:

    Zafar, the key efficiency of single payer is electoral.
     

    They key efficiency of single payer is that if the system covers a procedure there’s no arguing over whether you actually can get it (you can) or how much you have to pay (as much or as little as anybody else).  It’s much much simpler, and that simplicity translates into cost savings. Gatekeepers cost money – best minimise the need for them.

    Please note: single payer is not the same as single provider.  Single payer systems can accommodate multiple providers – which is where competition comes in and plays a key role in ensuring innovation and good provision of a real product (medical care).

    Hybrid systems (eg Australia) have both single payer (which covers the vast majority of likely needs) and optional additional insurance (for whatever else you want, plus the convenience of being able to schedule your procedure rather than waiting and being served in order or greatest need), as well as public and private hospitals.

    It works pretty well, and costs the country less (10% of GDP) than healthcare in the US does (18%). I’m not ideologically committed either way – the results favour single payer.

    • #26
  27. MLH Inactive
    MLH
    @MLH

    Zafar,
    Who is this “single payer” of whom you speak?

    • #27
  28. George Savage Contributor
    George Savage
    @GeorgeSavage

    Zafar:

    the results favour single payer.

    I disagree.   I could go with a slightly modified form of your statement:  “the officially reported results favor single payer.”  Since the single-payer is the government, and the government keeps the statistics, there is an obvious conflict-of-interest here.

    The Veterans Administration scandal is the latest illustration of the trick.  The VA is the single-payer for many US military veterans.  Every statistic gives the impression of an orderly and manageable system; except we now know that many people are kept off the official wait lists in order to keep up appearances.

    The UK’s National Health Service uses the same playbook.  After outrageous and politically visible emergency room delays led to legislated maximum waiting times, the wait moved off the books.  Now patients wait, and sometimes die, in ambulances.  The care is no better but the politics are transformed:  all is bright and cheerful; just look at those numbers!  Free healthcare tip:  If you find yourself in urgent need of medical care whilst in the UK, take a taxi.

    The key to maintaining a single-payer healthcare system’s electoral advantage is to maintain an illusion of healthcare.  “You’re covered!” sounds great provided you don’t know what this means if you wind up with an obscure and thereby politically invisible problem.  A broken arm will always be repaired efficiently–hard to hide that from the average voter–but if you have malignant melanoma or acute coronary syndrome, who’s to know?

    Finally, just as I do not need a bureaucrat setting a global mobile telephone budget for the country, I don’t fixate on how much of GDP people choose to spend on other goods and services, including health care.

    • #28
  29. Kay of MT Member
    Kay of MT
    @KayofMT

    Had a cat once who needed to be neutered, so asked my Vet what he would charge, and he said, “$25.”  “Why so much I demanded? (1975) old Joe at the stables said he would do it for $5 and a gunny sack.”  Kay, he patiently explained, “I worked my way through Vet School on $5 and a gunny sack, now I have to pay for all my equipment.”

    This same Vet, who let me help him remove hundreds of quills from my 3 dogs who caught a porcupine one day, gave me a discount because he said, “there has to be some advantage to having 3 dogs, and a customer who helps.”

    This same Vet stayed with our show pony one afternoon and all night at a county fair when he was poisoned by another competitor, trailored him home the next day, and charged a very modest fee. I don’t think my 12 year-old daughter’s tears affected him at all.

    • #29
  30. user_961 Member
    user_961
    @DuaneOyen

    I didn’t see anything about malpractice attorneys, that is, “ambulance chasers”.  They don’t find it profitable to chase dog ambulances, it appears.

    • #30

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