by Patrick Nohrden
Since this article first published in September 2008, world political and financial situations have changed. Some things never change.
Health care has suddenly become the battle cry on both sides of the aisle. A political hot potato, the issue of health care has taken on the reverberations of a natural right. A pundit cannot talk about the rights of the oppressed, the loss of jobs, a ruination of our economy, without slipping something in about health care. And the doctors and insurance companies are saying nothing about it and are simply content to wait for the carnage to end, like the lions waited in the Coliseum for their next meal of Christians. No matter what happens with health care, the insurance companies and doctors will get richer.
There was a time when the family doctor made house calls for $10 when a kid had chicken pox. Nobody had “health care” then. If catastrophic injuries or illnesses occurred, charitable organizations stepped in to help out or the patient went on a payment plan. Prices were reasonable, because there was no health care.
Despite what appears to be staggering medical costs, the prices have not changed that much, especially when you consider the increase in actual medical charges against inflation. For those of you lucky enough to have a medical insurance plan offered through your employer, take a look at the explanation of benefits paid statement next time you get one following a doctor’s office visit. The doctor may have charged $450.00 for whatever it was that he did for you in his office, and submitted the bill to your insurance company after you paid your $20.00 co-pay. The insurance company paid a discounted amount, perhaps $50.00, and your doctor wrote off the rest. The doctor received only $80.00 for your $450.00 visit and was content.
Meanwhile, your insurance company earned about $3,600.00 from you in insurance premiums last year. Maybe you are sick a lot and you go to the doctor once a month. You will pay $240.00 in co-pays plus your insurance premiums for a total of $3,840.00. Meanwhile, your doctor will have received about $840.00 for what looks like $5,400.00 in medical services. The insurance company justifies its premiums to the state insurance commissioner by claiming that it paid claims totaling $5,400.00, despite having only paid $600.00. If every policy holder paying $3,600.00 per year in medical premiums made the same 12 visits to the doctor every year, the insurance company will request that the state insurance commissioner allow it to increase the premiums to $5,500.00 per year. And the insurance commissioner will approve it.
The popular politispeak for today’s candidates has some nebulous plan for form of socialized medicine. That way, insurance companies are guaranteed their existence beyond the graves of our grandchildren and doctors never again need worry about operating their business in a competitive market. Did I say competitive market? For doctors? That just is not right, some will say. Medical providers should not have to compete like regular businesses to attract customers. Baloney! If doctors have to compete, they will charge less money. Those that are better can charge more. More likely, those that are good and cheap will have the most business. Those are the doctors that deserve the multi-million dollar houses, not the ones who know how to bill insurance companies $450.00 for a patient’s ten-minute office visit. That it how the competitive market works.
I have lived in a country that had socialized medicine. People die there in alarming numbers. Shortly after my arrival in Jinzhou in Northeast China, it became necessary to convert my tourist visa to a “foreign expert” visa, which required the issuance of a “foreign expert certificate.” That could only be accomplished with submission of the right documents and a physical examination. Therefore, the Foreign Affairs Office arranged for my physical. I took my physical with two Japanese students who were attending Bohai University.
The first procedure was to check our body temperature. The nurse placed an electronic thermometer into the ear of one of the Japanese girls, obtained a reading, and then gestured for me to make my ear available. However, the nurse did not change the disposable plastic sheath over the reading end of the device. I demanded that she replace it, but the nurse only laughed at me. She did not think that I was serious. When I again demanded a replacement sheath, she knew I was serious. I could tell by the puzzled look on her face. She truly did not know why I had asked for the simple sanitary device to be replaced. Finally, she explained that it could not be changed, as the clinic did not have any more of the disposable sheaths. As a result, they gave me the old-time oral thermometer which, thankfully, had been sitting in alcohol. Because of the highly socialized state of medicine in China, it was not cost effective to purchase the disposable sheaths for the electronic thermometers.
One cold day in the middle of winter I had to see a doctor for an ear infection. I had to go to a hospital to see one. That is where they keep them. In most of China, doctors work in hospitals, not in medical office centers. What a scary experience.
In the hospital’s lobby, a young lady wearing a heavy coat was standing at a podium. The hospital was not heated. I went into the ear doctor’s office, and there were two desks back to back near the back of the room and an examining table along the left wall. The rest of the room was just open space, which occupied about two-thirds of the room. The doctor was talking to a child patient and his father, so we were told to just wait, which we did while standing in the middle of the room.
When it was my turn, the doctor examined my ear, and then cleaned some of the gook and blood out, throwing the debris into a tray that already had debris from prior patients. While I was being examined, other people came into the room for their turn with the doctor. Like me, they had nothing to do but stand and stare at the patient currently being examined, which happened to be me. This was made doubly awkward by the fact that I was a westerner, so they naturally had to talk about me having my ear examined, that and the fact that I was a westerner.
The doctor made her recommendations, gave instructions on the use of some medicine, and wrote me out a couple of prescriptions. Then we went to another doctor’s office to have a bump looked at near my spine at the top of my back. His office was even colder, and the doctor was wearing a long overcoat, which he seemed to keep from his days in the Army many years ago. I never saw a single wheel chair anywhere, although I went through several parts of the hospital. I did see a man walking down a corridor who was carrying what looked to be his mother on his back.
You could say that it is not fair to draw a comparison between China and the United States. After all, China is a developing country. It is socialist. But is that not the point? Its system of medicine is socialist, and despite all the modern aspects of China, the great wealth of technology it now possesses thanks to the Clinton administration, and the staggering growth in its gross domestic product, it cannot keep up to the United States in the quality of health care. But it cannot. Its system of medicine is socialist.
But even in its socialist form of medicine, entrepreneurial medical provides are always looking for a way to make a buck. There was one instance in Yiwu, Zhejiang Province, in the heartland of Chinese cheap-goods manufacturing country, when I saw one such medical center manager saving money. He was washing out I.V. tubes on the sidewalk with tap water. This is bad enough when you consider this primitive form of cleaning medical supplies, but when you consider the fact that the water in Yiwu is too dangerous to drink even after boiling, you have to wonder what the consequences could be. A reader might think that such a thing would never happen in America, but that reader knows nothing of the Endoscopy Center of Nevada’s debacle early this year. I do not see much difference.
The point is, when business competes, the consumer wins. When doctors compete, the consumer wins again. Any “health care” program initiated by those we elect in Washington will only spell disaster and take the United States down the rut-ridden road of medicine in socialist countries. We do not need it. We do not want it. Perhaps the only sure cure to the nation’s health care dilemma is to simply outlaw medical insurance except for catastrophic illness and injuries. Not only will we save money, but doctors will learn to provide care cheaply, honestly, and expertly. Doctors will have more reason to encourage repeat business by improving their expertise and keeping their costs down.
Patrick Nohrden 