In general, the anti-worker, anti-human tone of Whole Foods C.E.O. John Mackey’s recent Wall Street Journal op-ed bashing Obama’s efforts on health care reform was deplorable…
Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?
Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That’s because there isn’t any. This “right” has never existed in America.
As Mackey certainly knows, this country provides plenty of services to all its citizens regardless of their ability to pay—primary education, fire departments, roads, police, prisons, parks, air traffic control, etc. To say nothing of food stamps.
And it’s almost amusing that Mackey’s mean-spirited list of suggestions for health care reform ends with this…
Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren’t covered by Medicare, Medicaid or the State Children’s Health Insurance Program.
Yeah, that will work.
But he does make one great suggestion…
Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor’s visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?
Urgent care is one thing, but learning the actual cost of your knee surgery or mammogram before it happens is both sensible and rare. Doctors charge wildly different amounts for the same procedures— individual doctors even charge hugely different amounts depending on the patient’s insurance plan.
It’s perfectly reasonable to ascertain how much your procedure costs in advance so you can shop around and/or decide whether or not it’s completely necessary. Think your doctor won’t prescribe anything that isn’t completely necessary? It’s all in the definition of “completely necessary.”
One example: my newborn son had a minor kidney defect that was picked up on pre-natal ultrasound. He seemed completely healthy but at 3 months the pediatric urologist wanted us to have a bunch of expensive and invasive tests to determine if the defect would pose a problem if he developed an urinary tract infection. We suggested waiting until he actually developed a UTI. The reaction we got was akin to as if we had revealed we were giving him beer in his bottles.
As long as doctors are paid by the procedure and most patients simply take what they say as a mandate—and why wouldn’t they when their insurance generally covers most of the cost?—there’s little incentive for controlling prescriptions, tests, and treatments.
In response to my post “Who Are These People?” someone asked if I believe that health care should be free. I don’t. But I do think it’s fair to know what you’re going to pay before the bill shows up. And I think many of the costs are out of whack.
Now it seems like much of the reform in the wavering health care plans wafting through Congress focuses on getting insurance and finding a way to fund it for the millions of Americans without coverage. But without instituting changes that will address the out-of-control American health care costs, pushing more people into the system will just bankrupt it faster. Though at least it’s a start.
I read (skimmed) the House health care bill, and most of it is great health care reform. It included reform that health care providers must provide actual costs before providing treatment, whenever reasonable.
Transparency of costs sounds great until you realize those consuming the goods and services are frequently in pain, unconscious, or not in their right minds, and have no background in being able to compare health care outcomes or risks – most people fail to understand the correlation of successful surgery has more to do with your anesthesiologist and the frequency your surgeon has in performing the operation than in anything else.
That’s why I don’t trust Obama on this. A few days ago he told a town hall meeting that Doctors don’t give adequate preventive care because while they make a “mere pittance” by providing preventive care, neglect a diabetic until she needs her foot amputated and the Doctor makes $30,000 or $50,000! Actually, Medicare reimburses about $750 to the Doctor for a foot amputation.
Not only does this prove he’s ignorant about the cost structure of the industry he’s set on meddling with, But it shows a general contempt for the back bone of the health care profession. Doctors. The way he talks about them you would think he thought that they were Lawyers… (and as slimy as he is (being a Lawyer himself)).
I agree that people don’t typically push back on costs and/or unnecessary procedures. But, I do think that medicine may be one of those areas where there’s such an imbalance of information between consumer/provider that it may not be possible for consumer-driven behaviors to reduce a meaningful amount of unnecessary costs.
As an example, a couple of years ago, my doctor said “you appear to have some growths on your thyroid.” She then ordered an expensive CT scan, and then an ultrasound, and then another test…. Something like $10,000 worth of tests total (covered by insurance), only to find out that I just have a naturally bumpy thyroid. I now think that there’s no way I needed to have all three of those tests done — but, at the time, with the specter of cancer in the background, am I supposed to say, no Doctor, I don’t think I need all those tests? I mean, she should know better than I do about what the signs of a real problem are, and it seems like there’s no way I could have all the information necessary to make those decisions about what tests are really necessary, without going to medical school.
People should push back and ask questions, certainly, but when it comes down to it, if my doctor says there’s a possibility of a problem, and the tests are covered by insurance, I’m probably going to have the tests. I think the key lies in figuring out how to make sure that doctors aren’t incented to order unnecessary tests to begin with…
people in comas
people throwing up due to chemo
people with stopped hearts
= not the most vigorous comparison shoppers.
“Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges.”
Doesn’t the government subsidize the entire farming industry? Does WF only sell food that is in no way affiliated with said subsidies? This guy’s an idiot if he thinks the availability and relative cost of food has nothing to do with “government interference.”
@5 for the win.
Anti-American unpatriotic Birther Tin Foil Brigade for the whine.
This debate makes me glad to live in Canada. Our system isn’t perfect, nor is it entirely free, but it’s very unlikely to go bankrupt from medical procedures!
We still need insurance to pay for prescriptions, get eyeglasses, physiotherapy and other stuff that probably won’t kill you soon. Where a person suddenly loses the use of their legs, say, usually their insurance won’t pay even half the costs of making your house livable for you. (As happened to a friend of mine.) So there are still costs to health care.
We do suffer from long wait times, although in my case I only had to wait minutes to get laser surgery for a retina tear, but most Canadians feel that’s what we’re taxed for, rightly or wrongly.
There’s no perfect system, but it seems like a good direction for public money.
I see many comments on here about the cost comparison statement in the article. The article does say “urgent care is one thing” which means your emergency room care, a situation where a person obviously won’t be able to look at a price list! And, the examples given are knee surgery and a mamogram, which are things you know are coming and can plan for in advance. Things like Chemo and illness, well, a person is in the middle of those, now aren’t they, and there can be no “before hand” review when a person is in the midst of it. I think comparing price as well as patient reviews and experience are all common sense things to review. Those are all things we look at when buying cars or day care, so why not medical expenditures?
The aim of the current plan is to undermine the group policy system by a) creating a non-group based alternative sponsored by the federal government (or a local co-op alternative that again would not be group-based) and b) legislating portability and transferability that would effectively undermine the group pricing structure by forcing insurers to broaden the actuarial base to remain solvent.
B) would have the side-effect of curbing the most prevelant form of competition that exists in the health-insurance business: offering or at least seeming to offer plans that cover a wide range of esoteric services.
That in turn would likely mean that insurance companies themselves would tighten up the indications they allow for relatively expensive procedures.
PC @ 5,
Well if someone’s in a coma, going through chemo or their heart stopped, then obviously it’s their own fault, right?
Where’s the PERSONAL RESPONSIBILITY???!!??
This would make perfect sense, if most people had the training to make informed decisions in health care. Or that the had access to the information they need to weigh the costs and risks.
Finding a decent mechanic who won’t rip you off on a brake job is hard enough.
For one thing people don’t have much incentive to shop for a better price for their health care because their insurance company takes care of it. Even if they are liable for 20% they are not likely to think about shopping around because they either think (rightly or wrongly) that they don’t have much control over it given that many insurance plans restrict which doctors you can see and be fully covered or they are much more concerned with finding the doctor who is most skilled in the procedure. For these reasons I don’t think more transparency is going to have much of an effect (still a good idea however). Far more important to have a heavyweight in the market (that is the federal government) that can put the squeeze on hospitals, doctors and pharmaceutical companies to keep costs down.
Not every health care cost is tied to emergency /life or death situations. It is weird how completely opaque health care costs often are, especially since there are different fees for the same procedure depending on who’s paying. Without apples to apples comparisons, how is “competition” going to benefit health care consumers?
On another note: I don’t see how Medicare is a great model. Lots of people have been saying Medicare is an example of government run health care succeeding. If it’s doing so well, why is it going to run out of money in 8 to 10 years?
Aubrey, you have allowed the right wing noise machine to frame your perception. If “knowing the cost” of health care has any corrolation to the actual cost of said care, why is care less expensive under every single payer system? People in France, Canada, Japan, et al do not receive itemized bills and make decisions based on which treatment is the cheapest. They consult with trained professionals to get the care they need – and those countries spend far less than the American system.
Kinda shuts down your whole thesis, don’t you think?
LOL @ “anti-human.” What is he, a Zerg? A Romulan?
So because some people are incapable of making medical decisions, no one should have the option to see costs and shop around? How on Earth does that make sense?
I recently went to a new doctor, who told me that with new patients it was standard practice for them to run the full gamut of cholesterol, blood, and urine tests, including a full STD screening (even though I’m healthy, in my mid twenties, and in a stable relationship with no symptoms of STDs.) I thought nothing of it until I received a $400 lab bill (after insurance)! Had I known this going in, I would have been a bit more selective of the tests I allowed them to process.
Mackey’s premise that health care is like food or shelter is just dead wrong.
The heart of the problem is that different people’s minimum health care needs are not generally equivalent, or even in the same ballpark. A lucky person can live to 90 and never see a doctor their whole life. A less lucky person develops juvenile diabetes early on, and needs expensive supplies and treatment to manage the disease through the rest of their life.
I think it’s illuminating that Mackey boils it all down to the question of whether there is any such thing as a “right” to health care.
That’s a keen question. Thought experiment: let’s ask a representative sample of new parents if they think their children should grow up in a country that has no “right” to health care, where a person’s financial security can be imperiled by the development of a chronic disease, or their life simply ended because they develop an acute condition whose treatment they can’t afford?
@16,
Because people are living longer and because all health costs are increasing way above inflation every year thanks to our incredibly inefficient system. The government can control some Medicare costs, but it can’t yet do that much about health care costs going up 30 percent every year.
@3,
Medicare pays 80 percent of health care charges, so either an amputation costs $937.50 or you’re a liar.
Why isn’t the democratization of basic diagnosis included in the healthcare reform conversation?
I am fairly certain I have strep-throat, but will go without because GroupHealth charges $180+ to diagnose using a rapid test (I have a high-deductable catastrophic plan). It took four phone calls over the course of an hour to get an estimate for the care. ‘Could be more,’ they warned me.
The manufacturer of this test proudly proclaims that their unit cost is less than $0.50 and can be administered by untrained personnel. Ugh. I should be able to pick one up for $5.00 at RiteAid.
I think there are two different issues here in terms of how to reduce our overall health care spend.
One is knowing the costs before you get a non-emergency procedure done, so you can either shop around, or try to figure out whether it’s essential or not (if it’s screening-type tests like @19 describes). I think this is a good thing — my dentist always gives me a statement that says how much any work will cost before it’s done. And, I would assume, any doctor’s office would be able to the same, if you just asked.
But, the second is that, for many doctors in the US, there’s an incentive to order tests — both a monetary incentive, and a fear of malpractice incentive (which is, ultimately, a monetary incentive, I guess). In this case, unless the incentive problem is solved I don’t see how consumers can significantly reduce the number of unnecessary tests/procedures that are done. Because, ultimately, it’s going to come down to the fact that the consumers don’t really know whether something is necessary or not, and so must really on their doctor for that information.
Tort reform would solve a few of the issues…as #23 suggested. In #4’s case. if those tests werent ordered and the doctor decided based on one test that you were ok would you then file a lawsuit stating the doctor should have known? Doctors order many tests in order to cover themselves for fear of being sued if a year down the road a bigger problem comes up. If the government has control of what tests can and cant be ordered, who is left liable in case something comes up that could have been detected with the order of another test? I would rather pay a few extra bucks and be sure. Healthcare is not something that should be rationed. We can come up with a better way then a government take over.
Here’s why health care must be available to all regardless of their ability to pay. It saves lives and money.
Heres why it can’t be treated as just another product in the market place. If you go to a doctor for an expensive treatment and he fails to cure you, you don’t get a refund. There is no warranty, gaurantee. Only suffering and death.
You know what?
We need tort reform.
We need to take all the America-hating Talibangelists and stuff torts into their mouths until they croak.
That will reform them.
(you do realize I’m not serious half the time I post, don’t you?)
I am whole-heartedly in favor of health care reform, but we must go into it eyes wide open, and must be aware of how it will effect all people, employed or not, sick or not, young and old. I don’t find Mackey’s letter that deplorable, really. He’s no Gandhi, but he’s correct in what he says about rights to health care….we don’t really have them, do we. So, we have to make sure that we make good choices, sustainable choices in a reform plan and make sure that we can pay for these choices, without bankrupting all of the social services we already depend on. I’m just saying, I don’t think Mackey is one of the bad guys.
@21 people living longer adds to Medicare costs–OK no argument there. But I just don’t buy that inefficiency is the only reason HC goes up 30% higher than the rest of inflation. There has to be more at work here.
And even if you could eliminate the 30% differential with publicly funded HC, that’s not going to lay a finger on the demographic pressures of the aging baby boomers. You’re going to end up with a public entitlement at the very same time you have fewer actively earning taxpayers to cover the cost.
I don’t get why there’s so much fire around the “pull the plug on grandma” meme when there’s plenty to argue about how to pay for it all. And you’re not going to get there socking it to the top 1%. Once your mom and dad retire, you’re going to be paying A LOT of taxes to cover their medical bills.
The last time I needed an elective procedure I made sure to find out it was covered by my insurance. Then I asked the provider how much it would cost. He shrugged his shoulders and said “Why? Your insurance is covering it.” I said I was curious. He mumbled something about not knowing until after it was over and then it became clear to me – he had no idea and didn’t care.
We’re not reinventing the wheel, here. The rest of the developed world has what the Greedy Old Pukes have prevented us from getting – a rational, compassionate health care system. Decade after decade, the insurance giants have reaped indecent profits off of human misery in this country. All of this propaganda insists that the quality of life in Sweden, Denmark, Norway, Holland, etc. must be terrible, since it’s their system that we progressives are trying to establish. That’s completely absurd. It’s time to take the insurance establishment and big pharma down. Go Bama! He can do it, he’s our man, if he can’t do it, nobody can!
“A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter.”
From the Preamble to the Constitution:
“We, the people of the United States, in order to form a more perfect Union, establish justice, insure domestic tranquility, provide for the common defence, promote the GENERAL WELFARE, and secure the blessings of liberty …”
jesus fucking christ. What the hell does GENERAL WELFARE mean if not food, shelter and health? It’s at the very beginning of the damn document!
@31 – yeah, but they printed that on Hemp.
Awww, if you make healthcare free, everybody’s gonna go out and get a urinary tract infection for their infant!
Insurance companies and doctors aren’t the only one driving up the cost of health care. Don’t forget the drug companies. They spend more of their budgets on advertising than R&D. (Lot’s of R&D is done at universities funded at the taxpayers expense.) They push expensive, trendy designer drugs by advertising it endlessly on TV & offering doctors “incentives” to prescribe them over cheap generics that do the same or better. Do you know how they determine pricing? They keep jacking up the price until doctors stop prescribing it….and doctors don’t generally consider cost of meds when they prescribe. I hope the health care reform addresses Big Pharma’s rampant greed too.
@31 – Ha ha ha. That was good… I also fail to see how education makes the cut as a “right”, but not health care. Aren’t both in the best interests of the general welfare of society? From a strictly capitalistic perspective, we want our workers to be able to be productive, and education and health care are pretty important in accomplishing that…
I have dual citizenship with America and Australia, where they have a single payer system with private insurance for elective surgery. Really folks, it’s not rocket science. The quality of life AND general health of the residents in Australia is much higher than it is in America. I didn’t have to wait in any lines for anything…all of the things that people throw up as reasons NOT to reform health care are just made up. PLEASE somebody tell me – which of you has experienced this crap, because I’ve had heart surgery in Australia and brain surgery in America…What you got? In both cases, I had to contribute very little, relatively speaking that is, to the total costs…however, I knew exactly what I was getting in Australia. Who my doctors were, what was going to happen and how much my costs would be. In America, they just set up everything up and sent me the bills afterwards. Almost ok, except I had a bill for $3k from someone who didn’t take my health insurance, which I would have liked to have been informed about PRIOR to the surgery, especially if it was that b*tch I had to deal with in the recovery room. There’s no reason why this information should NOT have been given to me in advance and the only reason I can see is what #29 said. My lead doctor, who assembled the team had no idea…and could’ve cared less. WTF?! This from the country that supposed to be leading the world. Please. We can do better.
not to mention, when i first returned to america, it was winter, i caught a cold, went to a doctors office – WHERE NO DOCTOR WOULD SEE ME – because i didn’t have health insurance. are u kidding me?! it’s not like i didn’t have money! what is up with that? it was a respectable office, linked to jefferson university hospital in phila. well needless to say, i wouldn’t leave – somebody was going to see me. finally a nurse practitioner agreed to see me. but jeez. i am educated, travelled the world, middle-class & wtf – can’t get a doctor to see me for friggin cold symptoms in america – simply b/c i don’t have health insurance. what kind of bs is that? needless to say, i have never gone without since, but if that’s not being held hostage to the insurance companies, i don’t know what the hell is.
UW shows some transparency in terms of how much they pay for your health insurance each month along side the premium you pay. Employers pay a staggering amount for the health insurance many get through them. The $25 I paid for Group Health value coverage (which has deductibles and a ton of coinsurance fine print) costs UW $660 a month to provide this half-assed coverage to me. I can only imagine what they would pay each month if I elected to pay ~$100 for more comprehensive coverage.
Universal coverage would cost much, much more than most of you could possibly fathom. And the market’s not going to correct to the tune of the 50-75% cost reduction it would take to make comprehensive coverage affordable to all of us (which is what many of you think UHC would give us).
It goes back to fixing the health care system is general, and the costs associated with insurance only make up a minor fraction of that problem.
While I think in theory this is a great idea, sometimes it’s just not practical. I went in for an emergency appendectomy in January of this year and had no choice of anything except which hospital I went to (I chose the ER that usually has the shortest waiting time here in SF). The surgeon was assigned to me because he was on call that weekend, and everything else just sort of happened to me while I was in a fair amount of pain and/or drugged up on morphine.
The final bill for the hospital itself (including the ER) was $28,000. Of that, it was divided into three sections one of which was reduced by 95% by the insurance company (United Healthcare through hubby’s employer Gap, Inc.) Why? I have no idea.
The end result is that my out of pocket cost is about 10% of the total procedure. It’s going to take a lot of months to pay this off. I ended up paying roughly that for the surgeon’s bill as well.
In the end I don’t think I could’ve changed much about what happened, so I think your suggestion about transparency only goes so far…perhaps for surgery planned in advance (like a knee or hip replacement) it would be a lot easier to do this.
In the end the amount of the bill means absolutely nothing, because it’s constantly being massaged by agreements between institutions and insurance companies.
@21
The difference between $750 and $937.50 is immaterial but the difference between $937.50 and $50,000 still proves my point.
Careful, your (lack of) intellect is showing…
Or are you stupid enough to believe that Obama was not talking only about the portion of the disbursement that went directly to the Doctor (which it was clear he was)? But the entire cost of the procedure including hospitalization etc. (which wouldn’t even make sense)?
Are you really stupid enough to think that Obama believes that Primary Care Physicians are colluding with Hospitals for the huge pay off of $750 (assuming that the PCP would be the Surgeon, which is beyond unlikely)… instead of the “pittance” they would receive for providing proper preventative care?
Wow!
You (and Obama) just further illustrate the fact that Democrats can’t even be trusted to understand the issue much less fix it.