Allow me to make a few random observations in pursuit of a larger truth.
First, Charles Murry recently wrote a book—By the People—a book that had a marvelous phrase in the subtitle, which was “liberty without permission.”
Secondly, and this might seem like a lurch, Nancy and I used to have a very good health insurance plan. We had one, in other words, until it got Obamafied. Once that happened, we couldn’t even find the pieces.
Third, having been liberated from our wonderful coverage by our betters in Washington, we decided to try Samaritan Ministries. A number of folks in our church had worked with them, and so it was that I had filled out many a pastoral recommendation. I was familiar, in other words.
And last, just before Christmas, I broke my right shoulder when I slipped on the ice. I had gone to help someone push a car out of a drift, and I had just gotten there. I hadn’t even tried anything yet, but was just scoping the situation out. I was just standing there, looking at the stuck car. I should perhaps add that I was standing there on the ice, looking at the stuck car, and judging from subsequent events, I gather that someone in the Council of El asked if Wilson needed to be thwapped on the ground, good and hard. The reply came in the affirmative, and so it was that an angel was dispatched. Again, judging from the event, I think the angel was the mighty angel found in Revelation 10:1.
Once the richly deserved thwapping was over, there were the bills—from the ER, the doctor, and now the physical therapy. We applied to Samaritan Ministries, the need was approved for publication, and the whole thing has been running like a recently oiled Singer sewing machine. We submit our bills, and we get checks from various saints around the country, along with encouraging notes from fellow believers who have prayed for us.
Now so what do all these things have in common?
We are living in a time of foment and transition. If you used to own an old-fashioned widget factory, and you figured out a way to up your production of widgets by 10%, the chances are excellent that the man from the government can keep up with you. In other words, if you owned a dinosaur and you figured out a way to make your dinosaur run a little faster, what you had was a slightly faster dinosaur.
But we are no longer living in a world of “slightly faster.” We are living in a world called “completely different.” What this means is that innovation can occur in an area that is completely unregulated. When something like that happens, the man from the government cannot keep up. They don’t even have a department responsible for that yet. I am talking about when Jeff Bezos builds his first Savings & Loan on the moon.
Consider first the Internet itself. Our government functionaries have been desperately trying to get a bit and bridle on that (and have only partially succeeded), but the whole thing still got away from them pretty quickly, and still has the potential to run clean down the road, laws or no laws.
Another example, a smaller one, would be what Uber did to the taxi cab industry. In other words, a certain kind of innovation can catch the old dinosaur industries completely flat-footed. They can catch the government completely unprepared. They can demonstrate their effectiveness before any commie in the House of Representatives can lie to the cameras about what the results will be. We already know the results. We live in a time when technological innovations can find the cracks in the decrepit walls.
Now I have a question. Is the health care industry a dinosaur? Is the health insurance business a dinosaur? And is it possible that such dinosaurs cannot fix their foundational structural problems by the mere window dressing of allowing you to fill in your forms online?
Imagine, as John Lennon taught us, but not the way he taught us. Imagine a host of cash-only medical clinics all over the country. Imagine cash-only mobile doctors who find the walls of the clinic too confining. They can just ride around on their motorcycle, doing good and helping people. Imagine a network of ministries like Samaritan Ministries that negotiate prices with hospitals and other entities still enmeshed in Insurance World. But because they have determined beforehand that all free market medical clinics are reflecting actual market prices, they would not try to renegotiate those prices. I mean, an antibiotic prescription is ten bucks, and that’s final. And in one of these cash-only medical clinics it would not be possible to buy a five dollar plastic cup of custard, even if you wanted to.
As Uber shows, along with Airbnb, and for the hell-bound, Tinder, one of the things our new technology knows how to do is match up and introduce people in real time. So you live in the Seattle area, and you have a stuffed head that would make a taxidermist wonder how they did it. “Where, oh, where could I find a doctor who wanted to write me a prescription for ten bucks? In the Seattle area? Why, look at this stuffed sinus icon on my phone!” And when that transaction is done, I have the serene feeling that there are ministry sharing networks that are predisposed to approve market solutions at market prices.
The cost of health care keeps rising because it is regulated. And regulated things have a tendency to swell and bloat, like a dead cow that has been in the Rio Grande for three days. We should ask ourselves if we have the wherewithal to start exercising a little health care liberty. Without permission.
First the Kirk took over the food co-op! Now you are taking over health insurance!
If you figure out how to “free-market” your way around malicious gossips, you should be all set! ????
Does Peter Leithart have a position on “thwapping”?????
There’s already a mechanism in place to keep cash based medical services from happening. Its called malpractice litigation. It’s guaranteed to stomp that out instantly by people who are driven by envy and greed.
People tend to be less greedy when the alternative is spiralling costs for the most trivial of medical solutions. I bet that those who tried to rip off these private, cash-based doctors would very quickly find themselves without any real alternatives at all. Bad customers can be refused at the door.
“People tend to be less greedy when the alternative is spiralling costs for the most trivial of medical solutions.”
No, in the real world people do not tend to be less greedy. It only takes one cash based medical service provider to be sued to discourage more providers. Then you have liberals waiting for the opportunity to exploit a perceived crisis to expand and enforce regulations.
Voter imposed medical liability limits would choke back the weasel segment of the civil lawsuit community .
Except that cash-based medical services ARE happening. There are now physicians who are going entirely cash only. It’s a risk, but it’s happening.
http://selfpaypatient.com/category/cash-only-doctors/
I can see the benefit of these arrangements for sore throats and muscle spasms. But don’t people still need traditional coverage for serious illnesses? At my age, a trip to the doctor often involves something that needs an MRI or a CT scan followed by something colossally expensive like a hip replacement.
The cash only is for costs at the specific practice. If they send you for an expensive test or procedure, you use your insurance. They don’t require you to sign a blood oath that you will not use insurance for anything, it’s just that *they* don’t take insurance. MRIs and CTs and hip replacements (except for the surgeon’s fee) aren’t billed through physician practices anyway.
Cash based doctors still buy themselves malpractice insurance.
Cash-based doctors operating out of clinics that take passers-by get a lot of extra scrutiny from the FDA. My doctor told me there are constant sting operations to catch physicians who are handing out stimulants and opioids without a valid medical necessity. I don’t know what to think about that. Too much caution means people will suffer unnecessarily.
I know a lot of folks going down to Mexico.
And some American doctors with clinics there.
I know people who got their hip and knee replacements there. Tijuana has tons of American clinics. It is fine for people like me who can reach the border in a couple of hours, but it is difficult for arranging after care. Some American doctors here will not provide follow-up care for work you have done in Mexico.
I would like to propose a solution:
As of tomorrow, all lawyers, politicians, and employees of health insurance companies will have exactly the same health insurance the general public does.
I eagerly await the day after tomorrow.
Has anyone who uses the healthcare sharing option crunched the numbers to see if their taxes have gone up significantly? I understand your “share” contributions are not tax deductible–whereas insurance premiums are exempt from taxable income.
Amen to this post. Our family is just a little pile of collateral damage from Obamacare in every possible way, financial, emotional, spiritual, marital, even employment. I often work in health care but I recently took a leave. Just can’t handle the corruption anymore, the lack of patient centered care. We’re actually putting bar codes on people and scanning them like a bit of produce to see what kind of care the computer thinks they should have. People are dying, literally. I nearly started crying about the Uber cash for care idea! We used to have that where I live.… Read more »
Years ago I took my daughter to a place called “Healthcare Express,” which was the greatest misnomer I’ve every personally encountered. While I was filling out the six pages of forms, a woman came in with her kid and asked what was the cost to see the doctor if they didn’t have HC insurance…’cause they didn’t. $90, the clerk answered. I filed that figure away and completed my forms. It seems “a little steep” to charge 90 bucks for an office visit. Imagine my shock when my insurance company sent me a statement for $140 for OUR office visit, which… Read more »
Amen. I dream of the day the whole thing just comes tumbling down. Many people have no idea how much fraud is going on, how wealthy some people are getting off of other people’s misery.
I was talking to some nurses the other day. Ten years ago the biggest fear was needle sticks. Today it’s accidentally walking into some kind of organized crime thing you don’t even understand.
I love watching “period” shows, like “All Creatures Great and Small” or “Call the Midwife” because the HC providers make housecalls, carry everything they need in a bag…on a bicycle, and charge $10 for their time. And, they make relationships…they give meaning to the phrase “family doctor.” Now, either all these shows–there are hundreds–are collectively making up an alternate history, or they are providing poignant reminders of how things used to be…and therefore how they COULD be once again.
Yes and no. Think of the poor doctor trying to carry an EKG machine and a portable lab around with him. We have to remember that a lot of people died from things that can be treated today, but not with the kind of equipment that fits into a doctor’s bag. I remember when leukemia was a death sentence, and now most children survive it. But the treatments that save lives tend to be massively expensive. I think that’s one of the problems we have to deal with in trying to sort out the health insurance mess. But I do… Read more »
“Think of the poor doctor trying to carry an EKG machine and a portable lab around with him.”
Could probably do with a big van, or a semi truck…
With a trailer for the MRI machine!
See?! You’re being inventive already!!
I find it hard to imagine that there’s not an app for that…
Well, I don’t think anyone’s saying that a doctor should be limited to what’s in his bag. Certainly you could have MRI clinics and whatnot for those times it’s needed. Skeldale House had a surgery, after all, and when something was more complicated, they called in more experienced men, sent things to the lab, etc. But the day to day stuff, and even more serious stuff that lent itself to simple diagnosis, could be handled that way. Merely moving flu and strep and routine physicals and followup appointments and your quarterly blood pressure and blood sugar checks and all that… Read more »
What I think would be even better would be allowing nurse practitioners with special training to handle many of those kinds of cases. Strep can’t be diagnosed except with a swab which the nurse administers anyway. How often does the physician actually take blood pressure and hook you up to the EKG in the first place? I think some states have gone much further than others in allowing this.
Yes, in a lot of places this is already happening. I think in Pennsylvania CNPs got the right to prescribe from a limited formulary within the last few years. Actually I’m not sure if that passed, or if it’s still in contention. Around here you will often see a CNP if you make a sick appointment for a minor illness, or the kind of monitoring/followup things we’ve been discussing. However, it’s still done in the context of the vast machinery of an established medical practice with all of its overhead.
When I worked for a small company, I spent some time with a similar group, called Christian Healthcare Ministries. It struck me as morbidly obscene that the small company could obtain healthcare insurance for $1500/month for my healthy family, which was more than they could afford to pay for their employees. So my choice was to pay the premium myself or shop elsewhere…which I did. CHM cost us–top dollar–$450/month, and there are less expensive options. Now that I work for a monolithic company, they pay the lion’s share of the premiums for me, which makes my share less than the… Read more »
You are paying for this ‘insurance’ with lost income.
Your idea is a nice thought, but it’s rather incomplete. There are plenty of loony behaviours the American medical industry has accumulated that could be fixed in time, but you’re going to have to cope with two insurmountable issues eventually: * Medical care doesn’t respond to market forces in the same way as widget stores or restaurants, because sick/injured people aren’t inclined to shop around, and doctors won’t turn away indigent patients. * White Americans have very different usage patterns for medical services from Blacks and Hispanics. (Ply your friendly local EMS responder with enough drink to loosen his tongue… Read more »
“Medical care doesn’t respond to market forces in the same way as widget stores or restaurants, because sick/injured people aren’t inclined to shop around, and doctors won’t turn away indigent patients.”
Since FDR got his hands in it, health care hasn’t been a competitive field that responds to market forces and price discovery. It’s extremely regulated, convoluted and filled with 3rd parties. But it’s not because medical care itself is different from other goods or services.
Look at less regulated areas of health care. The price of Lasik has gone down. This clinic also has a very interesting model: https://surgerycenterok.com/
I’m not convinced “market forces” ever applied in the same way to medical services, though I agree the tying of medical payments to employment has been overall negative.
Lasik is not really a counterexample because it’s both an elective procedure and an alternative to other forms of remedy; the only real similarity is that practitioners went to medical school. (I agree that some other elective procedures could benefit from the same situation Lasik is in.)
The point is that Lasik isn’t nearly as regulated as more standard procedures where the Gov’t/Insurance/Hospital Industrial Complex gets involved.
Regulation increases costs. But it is definitely not the whole story. Look up cost disease and you will see a number of things with little regulation that at increasing in cost just as quickly (a good analog may be veterinarian care). “* Medical care doesn’t respond to market forces in the same way as widget stores or restaurants, because sick/injured people aren’t inclined to shop around, and doctors won’t turn away indigent patients.” This is dead on. Medical care is nothing like buying a car. You have very little intrinsic sense of the value of the service, it isn’t aspirational,… Read more »
How much do those systems rely on the good will of the people using them? I know that some of the nasty things insurance companies do is intended to prevent doctors from gaming them – driving up bills with unnecessary extra charges/services. Do the co-ops have protections against those things, or work on the good faith of their users and providers? I rather like the idea and think it could be a model for not only medical insurance, but a lot of services. Just interested to know if there are protections from abuse or if accepting some level of abuse… Read more »
Samaritan Ministries is basically a catastrophic insurance plan. Those will be cheaper because a: you’re just not covering as many things, b: you get away from the requirement to cover pre-existing conditions, and c: there is no assumed liability. In addition, hospitals and doctors are often willing to reduce prices for cash payers, but if paying cash ever became the norm this wouldn’t happen anymore.
I like the idea of Samaritan Ministries, and I’m glad they are operating in the healthcare realm. However, I was pretty disappointed when a friend of mine who uses the service had a child diagnosed with a catastrophic chronic condition and they said they would cover treatment for six months and it was a good idea to apply for Medicaid. This service limitation was not made clear in up front documentation.
Relevant: http://slatestarcodex.com/2015/06/06/against-tulip-subsidies/
I think there are some good points in there, but I wonder if he exaggerates the effect. I know a lot of doctors, and none of them struggle to pay the bills in any serious way. And the doctors who aren’t worrying about those college debts anymore, or who never had to, don’t seem any better at avoiding the greed train than those who are. And for one counter example, my sister became a P.A. with a ton of college debt from seven years of school without any parental help. She chose to work in a low-income neighborhood, low-paying position,… Read more »
You likely had a different take away than I did because you are everything through “those greedy bastards” glasses. The most interesting part to me is that those who have the power to reduce the price and increase the throughput of doctor training have no incentive. “I want to be able to say people have noticed the Irish/American discrepancy and are thinking hard about it. I can say that. Just not in the way I would like. Many of the elder doctors I talked to in Ireland wanted to switch to the American system. Not because they thought it would… Read more »
I wouldn’t call it “those greedy bastards” glasses. Just a clear recognition of the pervasive existence of greed in this country.
Look at the Mike Pence thread – is everyone reading that through “those lustful bastards!” glasses? No, yet they are assuming that even church men and women shouldn’t be in a situation where lust has the slightest chance to do harm. Yet we’re much more accepting of giving room for greed to do its work, even when greed is even more pervasive than lust and with less penalty for bad behavior.
“even when greed is even more pervasive than lust”
I’m not sure about that one at all. There are countless people who have become content with their boring middle-class lifestyles. As long as they have porn or other internet addictions to give them constant dopamine hits, they’re not particularly greedy or seeking additional wealth. Welcome to “lives of quiet desperation,” 21st Century style.
Internet pornography and social media are new enough that I can’t say for sure one way or another whether they’ve shifted the equation like you are describing. But when I look at longer-term trends (house size, car size, phone cost), the apparent onward march of ultra-excessive materialism, and even recent events (such as Trump’s election being heavily supported by working-class and middle-class people who still felt they didn’t “have enough” and were passionate about getting ahead before someone else did – be they immigrant or foreigner or another race or whatever), it still looks to me like greed drives the… Read more »
Every time I read political polls that indicate The Economy is the number one concern on voter’s radar, I’m not quite sure what the pollsters or the polled have in mind. What I mean is, that is such a broad category. Jobs? Cost of goods? Availability of goods? When we talk in such broad terms, what aspect of the economy worries most people, and why? Your point about the general prosperity we all enjoy is well made. I don’t know about how much we feel dis-satisfied or insecure compared to our parents and grandparents. One of the reasons we’ve come… Read more »
I wonder how much of it is necessary. Friends/relatives who have gone through med, veterinary and other schools talk about memorizing huge amounts of things they’ll never use or they can easily look up. Like knowing fine details about every possible parasite…even ones only found in remote parts of the world. It’s all a short-term memory dump they forget by the next test. I’m all for tough admission standards, but the “weed out” process should mostly be in undergrad or entrance exams…and real-world applications (working in the ER, etc.). What’s more is that with all of the learning, they barely… Read more »
I agree–there’s nothing the students can do…and I’ve known some who wanted to do things like mobile clinics/vans right out of school. I was just stating that neither the cost nor number of years in school need to be as large as they are.
Ben Shapiro makes the comparison between LASIK vs other health care services. LASIK is typically not covered by insurance and thereby far less regulated, which has meant the price of LASIK today compared to 15 years ago is astounding in the exact opposite way that all other healthcare costs are astounding compared to 15 years ago.