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Quite the World, Isn't It?

The high cost of health care, and the ruin of a society

Time magazine has a lengthy and significant (at least the section I read; too long for one sitting on a busy day) article by Steven Brill on the absurd economics of the modern American health care, from eye-boggling markups on over-the-counter painkillers delivered in an emergency room to the massively inflated salaries of top executives (not to mention doctors). It’s an issue Los Angeles Times columnist Steve Lopez tackled last year, but it needs tackling again. And again. Until we are finally moved to do something about the indefensible pricing practices within health care.

This is the biggest force behind our crisis over access to health care; the cost of medical delivery drives up the costs of insurance (not to mention the rapacious nature of the insurance companies). Yet the power of the health care lobby makes any sort of reform or control politically difficult. Add to that the mystery of the profession; we tend to exalt doctors to a near-religious extreme, and take it for granted that after years of study they are entitled to wage levels exceeded only by CEOs.

We need to fix this. We could start by requiring medical providers cough up a price list before medical care begins. I rejected knee surgery last year in large part because the surgeon’s office would not respond to my requests for information on how much the elective procedure would cost me and my insurance company. They assumed I would just give them carte blanche to charge whatever they felt like.

In what other business, or service, is it not common practice to know the cost up front? And to be able to shop around, thus introducing to the system the thing free-market zealots love most, competition? Yet managed care rules jack up the costs if you try to shop around for doctors outside your insurance system. While the managed-care groups negotiate lower rates, many of us know too well that we often get bills from our doctors for costs above the negotiated rate. And we pay it.

I’ve long believed that by focusing on affordable health care insurance, we have missed the real issue: The cost of health care itself. It is morally reprehensible that in a society as large and vibrant as ours, people who fall ill risk financial ruin to get healthy. In fact, medical bills are the leading cause of personal bankruptcies. How is that healthy for a society, or an economy, let alone an individual?

Even more reprehensible is the immoral practice of holding health, and life, hostage to a profit margin. We are a society of people, not corporations. We should act like it.
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