Eccentric Flower talk:200908/Bits
From Eccentric Flower
Comments on Eccentric Flower:200908/Bits
I'm not thrilled about it either, but there comes a time when one can no longer ignore the eight-foot-high letters of fire.
-- 21:49, 17 August 2009 (BST)
Why is heath care so expensive? Several reasons, and I'm not saying these are the only reasons.
One, the number of doctors is artificially kept low by a guild system.
Two, part of this filter is the high cost of medical school, where a fresh graduate walking across the stage has an average of $150,000 student loan debt, and a further winnowing process called "residency" where prospective doctors are kept working 30+ hours straight for reasons that are lost on me, but I do think lead into reason three: medical malpractice insurance.
Last figures I found (from around 2002) showed that medical malpractice insurance runs from $20,000 to $70,000 per year per doctor (higher for clinics and hospitals). Part of this is (in my opinion) due to residency programs with half-zombie doctors making mistakes in hour 31 of their "working day", and the other, I'm sure, is the over-litigious nature of our society right now (which I am of two minds of, but I don't want to digress).
Four, health insurance itself. I was talking to a friend from Sweden, and he says that all he pays, regardless of medical service, is $10 (50 kroners---I'll leave the current currency exchange rate conversion to the reader). So he has no idea of the true cost of anything medical or healthcare related. He's not sensitive to the price point because it's other people's money that's taking care of the cost. So now doctors have a huge incentive to overcharge (hey, gotta pay that malpractice insurance, and those student loans) knowing that "the market" (which in this case, is the insurance companies) can pay. And if they counter back with a smaller fee, okay too, since the doctor may have been overcharging anyway (Bunny and I are not in agreement here about this; she says the insurance companies will not just pay any ol' amount, but I contend that we're not paying 1970 prices now, are we?). And hospitals have an incentive to overcharge since they can't charge for the emergency room and all those doctors and nurses have to get paid somehow (not to mention paying off all that high-tech equipment).
Five: speaking of high-tech equipment---that's not cheap either. Sure, I can get a computer that will blow the socks of anything I used in college for less than $1,000, but, being a programmer, there's no way in HELL I would want such a computer anywhere near me. I take that back, it's not the hardware I'm concerned about, but the software. Writing software is hard. And when lives are on the line, the cost of software goes up, due to compliance issues, insurance and bonding issues, testing, etc. (for comparison, the software on the Shuttle is the most tested, most understood and most debugged pieces of software on the planet; it's also THE most expensive software on the planet, probably followed by other avionics software and then medical software).
How would I initially cut costs in the health care industry? My first stab would be to make it cheaper to become a doctor (to increase supply), outlaw the current residency programs (to decrease mistakes made by overworked and underslept doctors) and mandate checklists (recent articles about the use of checklists in operating rooms showed they lower mistakes, which in turn would lower medical malpractice claims). I think those alone would be a decent first step.
-- 22:34, 17 August 2009 (BST)
In my defense, let me say that my own health insurance is a PPO system, whereby I can select any doctor I want to see, but if I use one on the list, my plan will pay more of the cost than if I use a non-plan provider. I can see from my Explanation of Benefits reports how much my doctors charge, versus how much my plan actually pays them. Sure, the doctor can charge whatever he believes the traffic will bear, but my plan has a pricing guideline of "usual, reasonable and customary" charges, and that's all they'll pay the provider, regardless of how much he bills. Assuming he has agreed to be one of their preferred providers, then he eats the balance, less my $20 co-pay. If he's not on the list, they pay 70% of what they consider usual, reasonable and customary, and I'm on the hook for the balance. So no, the insurance company will NOT pay any old price the doctors bills to them. If a doctor elects to opt out of any particular plan, including Medicare or Medicaid, because he doesn't feel they adequately reimburse him for his charges, then he's free to do so, but he will lose clients to other doctors who elect to participate. Free enterprise at work.
As for 1970 prices, no, we're paying more today for the same care, but we're paying more now for everything else, too. If you factor in inflation, we may be paying just about the same prices in today's dollars as we were back then. Malpractice insurance rates are abominable, and, as I've insisted before, doctors are people, too, and are entitled to put their kids through college and live in a reasonable neighborhood, just like other people. All of that costs more now than it did in 1970. They have to decide if it's worth it to them not to participate in health plans, and maybe lose clientele who cannot afford to employ their services, or to stay with the plan and make do with less reimbursement.
Sean's right about residents and those ungodly hours. Does anybody know why they do that? Or how many needless errors occur due to exhaustion of hospital personnel? There's got to be another side to this situation.
It seems to me that all college educations are more expensive today, the better the quality, the higher the price. Since student loans at very low interest rates are already available, I'm not sure I see how we can lower the cost of an M.D. degree by very much. I'd love to see it happen, but don't see a solution.
One other aspect we were tossing around is Sean's contention, and I'm sure he's probably right, that people with insurance tend to use it for less catastrophic things, see their doctors for a headache, when a couple of aspirins and a nap might have solved the problem. On the other hand, people with no insurance don't even get minimal preventive care such as chest xrays, cholesterol and sugar screenings, etc. because they can't afford them. Ultimately, their health problems may well become more of a burden on public assistance, because by the time they experience symptoms, their illness may have advanced beyond the point where simple measures could have prevented the problem altogether. I'm thinking maybe some sort of ceiling for the number and/or kinds of routine procedures and tests might be another aspect to consider. For example, my dental coverage allows two cleanings per year. If I want more, I have to pay. If there were a way to make them cheaper, then I could even see not having them covered at all, much the same as routine car maintenance (oil and tires and belts, that sort of thing) isn't covered under warranty insurance. In the long run, a certain amount of preventive health maintenance will cost taxpayers less than the consequences of blowing off checkups because you can't afford them.
And, lastly, we all have a responsibility to do what we can to keep ourselves well. It's a no-brainer that we should get exercise and eat a proper diet, because it will help to keep health care costs down. Passing up all those double cheeseburgers is something we ourselves can do to contribute to the common good. Even so, I'd balk at seeing something like that legislated. It should be something we just do, because we can. Wouldn't that be great? There, you see? I really Do sort of understand your wanting the wealthy to give back to the community, just because they can. Where we differ is, I don't want to see it mandated.
-- 00:10, 18 August 2009 (BST)
Obviously I'm biased, but I'm speaking as a reader of film criticism here, not as a former critic. (I'm out the game now, and have no stake left in it.) Podhoretz's remark that "deprofessionalization is probably the best thing that could have happened to the field" strikes me as silly with a dash of crazy. I have spent a lot of time reading pro film critics and a lot of time reading unpaid film bloggers, and I have never encountered a non-pro film blogger who came within miles of the best pro critics. I'm not saying you can't find brilliant film criticism from amateurs, but it's rare as hell. When I think of film bloggers, I think of Harry Knowles types. Fanboys. That's the type who is going to bother to blog regularly about film for free, some geek who is really horny for the next James Cameron movie. Really skilled, smart writers probably aren't going to regularly write about film for free, because they'll figure if they're gonna write purely for the love of it, they may as well try to finish that novel.
I tend to think that as the old media collapses, we'll see the rise of stuff on the order of Salon or Nerve, circa 1998. Websites that are essentially print magazines that update constantly. They've both fallen off quite a bit over the years, but I think that model is the future. There will still be people who want Real News, and Real Commentary. They'll want content they can count on, instead of having to sift through a bunch of blogs every day.
-- 04:00, 18 August 2009 (BST)
Actually, Ursula, I am seeing an increasing number of professional film critics who are now writing about film for free, like Glenn Kenny (formerly of Premiere). And the website The House Next Door has some of the most thoughtful film/TV criticism you'll find, with unpaid writers. With the career path folding, good writers still want to write about film, and equating "unpaid" with "fanboy" is not accurate. Besides, Harry Knowles isn't writing for free, not anymore, not by a long shot.
Not to mention that a film writer who thinks he/she might get paid work again is likely to publish unpaid, just to keep in practice and to have current writing samples out there in public.
-- 16:51, 18 August 2009 (BST)
Man, I just realized that talking about the change/possible decline of film criticism is way less stressful and upsetting to me than talking about health-care reform, which makes me want to shout and shake people.
-- 17:56, 18 August 2009 (BST)
Jette:
Thank you for reminding me that the only kind of writing I both like AND am good at, is no longer a sustainable career option. Grmph.
-- 20:36, 17 August 2009 (BST)