Quote:
Originally Posted by sebastian_dangerfield
The relevant psychological factors at work in use of a health insurance card, credit card, or student loan, are near identical. Divorce a person from the act of feeling money leave his wallet, or writing a check for something, and he will spend more.
I'm not advocating writing anyone off anything. I'm advocating a shift, slowly, incrementally, toward more of a direct purchaser model. Prices will drop as the revenue stream from third party payments decreases (supply, demand, etc.). It's not in debate whether a third party payment structure drives prices upward. It's just a question of how much. We can reverse the trend toward an exclusively govt/insurer-run HC system and in doing so, reduce costs.*
There's no constrained supply in education. A huge percentage of the $600bil in non-performing educational debt is tied to for profit institutions that let anyone in the door and charge a ridiculous tuition, often above that charged by an actually accredited, and 10X better state school.
*The loudest argument against trying to do this is that the common person cannot manage his finances, or his health care. Essentially, it is "We have to have a third party take care of a large part of this country because these people will not be able to, or won't care enough to, take care of themselves." There's a lot of merit to that. I think we'll always need Medicare to take care of those who simply don't have resources. But as to the second group - those who are able but would rather spend the money elsewhere, or not bother being responsible for themselves - I'm having a hard time justifying why they deserve anything. Just about the same kind of hard time I have justifying why bankers whose firms should have collapsed in a true free market should receive bonuses on par with what they received in 2007. These "free riders," it seems to me, should be left to fend for themselves. (I know... I know... "How do we separate the merely irresponsible from the truly needy?" Vexing.)
|
I dunno. I have health insurance, my fiance doesn't. (He will when we get married next year, but that's not particularly helpful right now.) Both of our necks got jacked pretty badly in the crash last week*, and right now, we need the same exact care. It's not a consumer choice that we're left with. If we don't get our necks checked out and treated, it probably would get worse and more expensive and/or debilitating.**
I don't really see how it's possible to shop around for the "best value" in physical medicine. There's no website he can check to see where the prices are the best. There's not even a physician out there that posts her rates. When I made the appointment for us, the clinic (chosen because it's one of the entities I work for) said that his cash outlay would be anywhere between $78 and $350, depending on what happens. How on earth can he make a informed choice as a consumer when until he's seen and treated, no one has a clue how much he'll be charged? And this is just the initial assessment. If he needs PT or radiology or whatever, it's not like he has the knowledge or experience to determine what the cost effective, best for the consumer choice is.
*Hopefully Farmer's, the other guy's insurance,will pick all of this up, but the initial charge will be to my fiance, and we know that the insurance company will go through all bills with a fine toothed comb.
**His sometimes painful sciatica and hernia remain untreated, because he's very aware of the costs of taking care of those two things. His asthma is sort of treated, but only because my dad is a lung doctor and keeps his albuterol prescription filled and will hand over the occasional samples of Symbicort and Singulair that happen to be dropped off by drug reps. Albuterol, for those wondering, costs $47.90 more or less every three weeks if you do not have health insurance.
