In a new article, Bitter Pill: Why Medical Bills Are Killing Us, Time Magazine delves into why medical bills are so high. 

I had a fibrous cyst creating a boil on my neck several years ago. After a round of antibiotics, a doctor performed a 15 minute outpatient surgery, assisted by a nurse, in an examination room. It wasn't even an operating room. Local anesthetic was used. The incision was about 3/4", and I was given a prescription for Vicodin I really didn't need before I left. 

The bill was about $850. I was shocked. I might have expected $250, but $850?

Well, $850 is nothing in today's medical world. 

Time describes instances of non-life threatening household accident injuries that run up bills in the five figures. More serious problems like treating cancer can run up bills in the six- and seven-figure range with ridiculous line items described in excruciating detail in the article.

What makes the pain of high healthcare costs worse is that the health care providers seem to be profiteering with markups that are as outrageous as they are unjustified. So-called "nonprofit" hospitals are actually profit-making institutions. Have you noticed how your local hospital is adding on new additions like crazy while the rest of the economy is slow. It's a boom economy in healthcare, forcing unjustifiable costs on a public suffering in a totally separate economy.

The article argues something I've already written about here: the healthcare industry isn't a normal market and doesn't really operate in the normal economy the rest of us have to live in. It doesn't compete for the business it gets and there's very little operating to restrain their costs. Yes, your insurance company probably gets a discount of 40%-50%, but even with that discount it's hard to justify the line items on the bills. 

Of course, there are people who can't pay their bills and become write-offs and they become part of the high cost of healthcare, but not such a large part that bills need to be as high as they are. Likewise, insuring themselves against lawsuits filed by people who can't accept that (a) shit happens or that (b) some people's conditions are terminal no matter WHAT care they get is a costly problem.

Putting some controls on the legal problems the industry faces is an obvious need, and one that can be addressed. However, the reasons for high healthcare have mostly to do with greed—getting whatever the traffic will bear—rather than providing the best service possible at a reaonable price. It's an industry that has forgotten that its primary purpose is to provide a service, not to break the back of those it serves with unjustifiably high expenses.

Look, I like capitalism, but I've come to decide that there are places where capitalism doesn't work. We don't want police and fire departments, libraries, and parks to be run on a "what the market will bear" basis. I would think that we especially don't want our healthcare system run that way.

You have no better argument for socializing medicine than the system we have now.

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Capitalism rewards those who pursue monetary gain.

Oh the humanity! Somebody doing something because they want to earn money in exchange for their services!

innovation is often repressed and gotten rid of out of fear of impact to their business wihtout regard to public or social innovation.

I'm not sure you're familiar with the word "competition." Hint: it's one of the main motivations for innovation.

Also you can't just try to assert that pursuing monetary gain is a polar opposite to bringing innovation. You almost sound like clergy when they talk about how evil money is.

rewarding individul effort based on what you can do which is different than what i can do.

I cannot parse this. Do you mean rewarding individual effort based on how it compares relatively to others' efforts? If so, how else is it supposed to work?

I didn't mean the pursuit of money in itself bad, but is what we reward heavily and unfairly to our consequence.

I'm not sure you're familiar with the word "competition." Hint: it's one of the main motivations for innovation.

Yes it is but there are others. More powerful forces then competition. Forces that lead to sharing of knowledge and therefor more complete science. Pure discovery, human connections like working in a team, and being of service, rank higher than competition and money in artistic and scientific (seems to be tied together) endeavors.

I cannot parse this. Do you mean rewarding individual effort based on how it compares relatively to others' efforts? If so, how else is it supposed to work?

What I do well may not be what you do well. I may be a great telemarketer while you could be the mozart. I will initially and possibly forever make more money than you at my sales job does that make me more important than you? In my opinion no it doesnt. Right now it doesn't work that way. if it did then great teachers would be getting corporate president bonuses for the effect they have on the future of the students they teach. And that would be a bonus worth giving and paying for in my opinion over the douche bag who comes up with a better legal ponzi scheme. it also means the street person who is disabled isn't look at like a lazy bum because they can't hold a job for more than a few days. People if they have a choice would rather work honestly for a LIVING, but if they can't get a living wage than why not find a way to do so.

I fully agree. When psychologists study the mind's reward mechanisms, it turns out money is way down on the list. Yet money seems to be the ONLY measure in making most political and social decisions.

No one has mentioned that capitalism assumes growth. Unfortunately we live on a single  finite planet. Limitless growth is impossible. As resources are depleting, competition increases. Capitalism has now started to feed on itself. 

Capitalism also depends upon competition. The idea that innovation stems from competition is just silly. Innovation is far more likely through cooperation.

People see the great success of capitalism in the middle of the last century. They don't see, or are not willing to look at, where that wealth came from - namely the parts of the globe who didn't understand capitalism and were ripe for exploitation. This exploitation is now coming home to roost.

Capitalism is in its dying throes. And good riddance. 

At SOME point, humanity has to learn to share the planet.

No one has mentioned that capitalism assumes growth.

Capitalism assumes growth in the sense of growing its business. That can mean no more than taking business away from the competition.

The idea that innovation stems from competition is just silly. Innovation is far more likely through cooperation.

Historically speaking, please name the groundbreaking innovations of the past which were the result of committees. Perhaps we've unjustly forgotten the support staffs of Archimedes, Galileo, Newton, and Einstein. I have been under the impression, though, that they mostly worked solo.

Maybe today, when so much work is done in university science and engineering departments or in projects subsidized by business interests or governments can we speak of scientific-revolution-by-committee, but if so, it's a relatively new phenomenon.

Not to mention that for all the government sponsored 'medical research', as well as all the non-profits (Cancer Society X) raising money to 'find a cure' - I have yet to hear of a single big break in medicine that wasn't discovered/owned by a for-profit company.

Most of the non profit "Discovery's" are bought by for profit companies. That is the dirty little secret about this, it's all for profit, if it's not then no need to release it.

Committees don't have ideas, individuals do.

individuals can have concepts or a hypothesis. real end results requires a group, real proof demands a group or committee. One may conceptualize the discovery while 10 other groups try to prove it and/or debunk it. Its slow and painful. Your concept gets dragged and voted on. Re-tested and all the while it finally becomes initially proven, YEAH!! So now you get all the credit but some might say the dreaded "committee" did most of the hard work.

Capitalism assumes growth in the sense of growing its business. That can mean no more than taking business away from the competition.

not true. industry's like oil need not only more customers but more oil to produce more things for our consumption. thats why its called consumption. This is just one example. If the free markets really checked itself (which is NOT what a free market is supposed to do) they might be able to slowly grow. that is the whole point to rampant capitalism consumers consuming as much as possible.

The AIDS cocktail funded by both private and public funds worldwide was a group committee effort, NASA would be another. Every research lab private or public has several scientist on staff that add to every discovery.

"Capitalism assumes growth in the sense of growing its business."

No, under capitalism, the entire system must grow or die. Otherwise what's wrong with the recession we're in now? The economy is still growing, but too slowly to give investors enough ROI to meet their debts. 

" taking business away from the competition."

Yes, that's necessary, too. In order to succeed under capitalism, you either have to come up with some earth-changing idea or fuck over the other guy and take his living from him. The REAL capitalists these days, the banking and investment clique, are no longer satisfied with ruining other business, they've decided they need to take Ma and Pa's retirement money - ergo derivatives.

The ONLY thing that can stop these predatory parasites is harsh government regulations. 

The ideal system would be one where everyone had ENOUGH. As it is now the only way to keep score is money. And getting obscene amounts of money in a closed system such as ours means taking from others. Capitalism promotes that. Anyone who thinks that there would be no incentive for people to innovate and make the world a better place without screwing over others and acquiring obscene wealth has simply drunk the capitalists cool-aid. I understand that. Hell, almost HALF the population is willing to vote against their own best interests because the corporates tell them God is on their side.

". . .which were the result of committees"

Oh, I forgot. Capitalists don't have committees.

" it's not clear that capitalism works there"

I think it's VERY clear it DOESN'T work there.

The cost, at the time of writing the check is bad enough. The REAL cost is spending your lives wondering, even with your "good" coverage, what will and will not be covered when you need it.

Since I moved to Christchurch from Chicago 35 years ago, I haven't spend ONE MINUTE wondering if my health events/conditions will be treated. I've had a wide variety of hospital procedures - compound tibia fracture, hip replacement, 8 stents in my heart and, most recently, a bypass. Total cost? I have no idea. I've never seen any kind of bill. The subject of money has never arisen. When comparing our tax rates, please include your insurance premiums and whatever excess you pay over and above that. Also include the cost of your personal liability insurance. I cover that below.

My care has been outstanding.

Surprisingly the health insurance industry in NZ is thriving. There are lots of people who "need" a private room (there are 4-6 beds per room in public hospital - my only comment about that is that means the nurses are closer). Some people want their boils removed NOW. Health insurance would cover that and I HIGHLY doubt that you would pay $200 in excess. A Boil, like my hip replacement, is, essentially, elective surgery in that failure to provide medical intervention would not usually be life-threatening. If it IS life-threatening you're on the operating table in minutes.

Waiting Lists - That's the MAIN complaint people have against health systems like NZ's. Placed on the scale beside NEVER having to worry, and the answer (to me) is clear.

A few months ago I went in for an angiogram (in preparation for the bypass). I was ON THE OPERATING TABLE, and they came in, "sorry - urgent problem", and took me back to the ward to wait another hour. Big F#ng deal. 

Two major things make the US system intolerably expensive; profit and liability. If I asked for an aspirin, the nurse would check my chart, go get me an aspirin, and update my chart. In the US they have to charge, what?? $30. Actually the administrative cost of recording each aspirin and paper clip to recoup costs (and generate profit upon)  is probably, in many cases, higher than the cost or the good or service provided. NZ has solved the liability problem, too. We have the ACC (Accident Compensation Corporation) (the Government) . When I broke my tibia, they paid 80% of my salary for the three weeks I was off work (they would pay that 80% for LIFE, if necessary) and then paid my taxi fare to and from work for the months where I was in a cast and couldn't drive. In the end they compensated me $3000 (even though I didn't really have any permanent disability). Here's the important bit. I am NOT ALLOWED to sue the dude who backed out of his drive without looking. In The States he would have been sued for what?? at least $500,000? Who pays for this?

The US health system is truly ill - even after ACA - and will continue to be broken until you stop paying 80% to insurance companies and lawyers, neither of whom actually provide ANY health care.


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