Posted On: Friday - June 11th 2021 9:34AM MST
In Topics:   Economics  Americans  Healthcare Stupidity  Inflation
(Continued from Part 1 and Part 2.)
In Part 2 of this quick look at the question of Nationalized healthcare, something lots of Americans figure would be just peachy, taking the side of the public defender, Peak Stupidity produced Exhibit A: The British National Health service. It's not like we got in depth on this, but we brought up the problems of government bureaucracy and government control, the latter of which I think is the worst of it, with any government run system of well, anything. It's not just about registering and titling vehicles, though. This is 20% of the economy and a life-and-death issue by definition.
Let's put on our prosecutor's hat now, if His Honor will indulge. (Carrying of cell phones, even for web surfing, no matter how many hours you have to wait for your rolling-through-the-stop-sign charge, is strictly verboten!). We bring up Exhibit B. (Big GASP! from the jurors.) Whaaa? What's that?! I present to you the case of pre-1980s America. The date is arguable, as some would go back to the big Socialism push, medicaid/care included in the mid-1960s.
Our commenter MBlanc46, under Part 2 post, left a comment that stole some of the prosecution's thunder here. He can go back longer than I can, but it's not like lots of us don't have parents who regaled us with stories. Even the young people who can't imagine any such thing, do they talk to their parents, grandparents or friends thereof? Oh, right, "OK boomer", as in "this is not on my phone, so I don't believe a word of it" would be the attitude.
"They made house calls." Yes, I never experienced this, but that is the case. I'm not going to put this one on the advantages of the much-closer-to free market system that was in place. Maybe it was the availability of a 2nd car for the wife, or even a 1st car for some. Perhaps medicine had gotten too advanced to be regularly practiced out of a bag the size of a big toiletry kit.
Compared to the shitshow of today, US Feral Government and State governments were not involved in the medical system to any significant amount prior to medicare/caid). Of course, there were State boards for doctors (nurses too, I guess) and State supported medical schools to give benefit to the State. How much did the government have to do with how Doctor Jones ran his practice, especially the billing part of it? You pay your money to the nice lady on the way out. Maybe you presented an insurance card (more on this). Maybe you were one of those deadbeats, but then that was a problem for any small business. The difference from today is that nobody dictated that you must keep treating the deadbeats and treat what are obviously the new deadbeats as they show up.
OK, that brings up charity and the hospitals, many of which were charity run. Some people simply can't pay their way, and not many of us are OK with letting them die out there on the hospital steps. People, and most especially Americans are very charitable, when the government hasn't usurped that with its own fake charity with their money. (This is a subject for another post.)
There are charity hospitals today, though to a lesser amount. Profit or non-profit, the doctors (rightly) and hospital admins. (not so rightly) make lots of money, the nurses get the going rate, and then there's the issue of the revenue. When it comes down to the complicated bureaucratic system of today, they all must play by the same government-made rules.
Besides the important aspect of consumer choice, the prices for medical care back in the old days reflected the lack of the burden of paying for so many deadbeats, and the decreased costs of employing personnel to figure it all out.* As I wrote in Part 1, the damn system is so complex that this operation of 51 employees that a friend ran had 11 people just in billing. They don't make as much as doctors but probably pretty close to what the office nurses make. Doctors were only 2 or 3 out of the 50, so that means this totally unproductive cost is ~20% of the payroll.
I've got a few numbers, and I'll give one of mine and Mr. Blanc's . A friend found a bill from his Mom for the hospital charges for his birth in the mid-1960s: $300 or $350, it was one or the other. For us 10 years ago: $3,500 in advance, if everything went smoothly, doctor and epidural shot not included. That's a factor of 10 in 45 years. This site gives me a 7x increase to be expected, but you all know what Peak Stupidity thinks of the official inflation numbers, especially as of the last decade (not a factor in this calculation). That's not too bad, surprisingly, but then, I don't know if I can determine, or my friend can, whether that price in the mid-1960s was for all charges. For us we'd be talking over 10 grand, but then that includes ultrasounds (see Part 1 with a discussion of the changes in medical science/tech vs. the business end).
Mr. Blanc's example was a $2 bill for a doctor visit for him Mom in the early 1950s. I suppose if you know the guy well, and it's not your first visit, you could get away with $75 now, cash on the barrel head. That's a factor of 35 (I like round numbers, to fit with my lack of faith in the accuracy of the inflation numbers), but that same inflation (cpi) site would get me a factor of over 10, using 1950 - 2021. Hmmm. I would guess we are paying more in "real" dollars in general. Yes, we get new treatments that wouldn't have been possible in 1950, but then, again, see Part 1.
What I especially miss about lack of government involvement in the old system that worked for America is this: We couldn't have had a Kung Flu PanicFest, IMO. Sure, the Lyin' Press was a thing, and there were only 3 channels (OK, 4 if you count that "learning channel") of TV that could set the narrative. I don't think Feral Gov't officials were quite as corrupt, self-serving, and non-caring about Americans. The big difference is the medical system. Without government controlling the business end of healthcare to the degree it does now, what could it do? Send posters? Yes, send posters. Yes, see I have no problem with a Center for Disease Control that compiles data and issues warnings. Back in the day before the web, your Doc might get some info sent to medical establishments all around with warnings and advice about the new flu or what-have-you. Based on his judgement your Doc could heed it and even put up the poster in the waiting room, or say "bullshit" and throw it in the trash. Then there's that middle ground of just keeping in mind they signs to look for in his patients. Big incentives could not be given to insurance companies (via eliminated co-pays and deductibles), because the Feral Government was not in bed with them yet.
That brings up insurance. When trying to explain the better way of the past (in America, at least) in a few acrimonious comment exchanges I'd have on unz.com threads, I'd always run into this: "What if I'm in a serious car wreck?!" for a young person or "What if I get cancer that costs a million dollars to treat?!" Hey, I never said insurance was not a valid business model. If the insurance company can figure rates the RIGHT way, without dictates about pre-existing conditions, forced payments for transgender surgery, etc., prices can still be pretty damn low for a young person or even reasonable for someone older with no existing serious problems. "Do the math!", as they say, and believe me, there's a whole field for that, consisting of people called actuaries.
The big difference between actual simple insurance plans vs. what people call "insurance" today, is that today's plans are healthcare plans, not insurance plans. One doesn't get oil changes, brake jobs, and bodywork for his car paid for by insurance, as opposed to check-ups, unnecessary visits to the doctor for stupid shit, and well transgender surgery. I have gotten simple catastrophic health care insurance before, and it was not too bad in price. If I had stepped on a nail though, well, it didn't cover squat, and it wasn't supposed to.
In fact, when I was in a wreck myself, it was (very thankfully!) not too big a deal, and I paid my own money. However, when the doctor mentioned a CAT scan, "just in case", I asked the price. "$1,200? Nah, I'll be OK. Thanks."
The problem with economics of healthcare now is that the incentive for irresponsibility is built into the system. People know that some government agency or insurance company (as in, the rest of us) will cover them anyway, no matter if they don't worry about insurance. This lack of responsibility is very hard to reverse. That will be the subject of the final post on this.
* This is why I HATE paying someone to do my taxes and never have so far. It irks me to have to pay more money just to get through the system that I hate to begin with!