The Annoyed Man wrote:
It would be interesting to see how that might play out from the standpoint of market forces. It could almost go either way. In regard to healthcare, public option proponents would argue that removing government from competing with private insurers has guaranteed that insurance prices would go up... ...and they have. OTH, realists with a smattering of business sense would argue that prices have gone up because costs have not been contained, and those increased costs are being passed through to the consumer instead of being taken out of the insurance companies' profits. — hence the playing of the "tort reform card." Personally, I favor the latter explanation.
Actually, the more accurate (IMHO, of course) explanation for why "costs" or "prices" have gone up for health services is the exact same reason income taxes, property taxes, and that sort of thing have gone up in cost. It's simply because the consumer of the services is not the one paying the bill at the point of purchase (which I outlined in my blog post
http://conformityfeared.blogspot.com/20 ... eform.html" onclick="window.open(this.href);return false;).
There is no containing of any costs if the person making the decision to buy or not to buy, or to what extent to buy, is not made aware of the cost at the time of purchase.
If health care services were not covered under health insurance, then what are the odds that when you go to the doctor with a cold, you are going to pay for a blood test "just in case"? Maybe the 15 minutes of the doctor's time would have cost you $50 for the visit, but the lab work costs $200 and then the "just in case" round of antibiotics that do absolutely nothing to treat a cold cost you another $100 so now you have paid
SEVEN TIMES the price you would have paid if you actually were aware of the cost at the time of purchase of the service. You paid $350 for what should have cost $50 (you go to the doctor, he says "it's a cold, and there is no treatment for a cold, stay home and rest, take OTC cold remedies for the symptoms and it'll go away in a week"), and wasted lab resources and prescription medications to diagnose and treat what you might have rather than what you do have.
Even with health insurance in the picture, if your employer did not pay for your health insurance directly without your intervention, I think the odds are slim you would choose to buy it. When I was at my previous job (12.5 years for a big technology leader) they paid $1400/month for my health insurance benefits, and my portion was about $120/month. So the only amount I could choose not to pay was $120. If they had just paid me the extra $1400/month, given that I am reasonably young, healthy, have a healthy and young family, and we are very low-risk, I would likely have chosen to keep the majority of that $1400/month and instead buy a major-medical policy at 1/4 of that price and pay for routine doctor visits and prescription drugs as needed out of my own pocket. But since I was unable to make the
choice as the actual consumer, then I also was unable to control the cost.
Here's a specific example. I went to the doctor once about ten years ago with severe knee pain. I was referred to an orthopedic surgeon. He ordered an MRI before even seeing me. The average price of an MRI is about $1600. He didn't even LOOK at my knee before ordering this MRI. The MRI was inconclusive. It showed a fluid cyst in my knee which could be felt by hand and was visible under the skin and required no special equipment to see. But nevertheless, the surgeon figured that I needed knee surgery to fix a likely cartilage tear that was not shown in the MRI. So he was going to do arthroscopic surgery in order to
find a cartilage tear that
might be there, which bills the insurance company over $10,000. Had I gone through with this round of treatment, I would have spent about $12,000 total for a solution that was in search of a problem. Needless to say I elected not to have the surgery, and my knee got better on its own. Exactly a year later I had the same problem in the other knee, I could feel the same fluid cyst and the pain was exactly the same. My doctor again referred me to the very same orthopedic surgeon who by routine ordered an MRI before even seeing me. Then when I got there to actually see him he tried to book surgery to do the same hunting on my other knee and didn't even bother to check and see whether I got surgery on my previous injured knee and whether this was in fact the correct solution to the problem. In reality, if the doctor I saw the first time had not referred me to a specialist, and had identified the fluid cyst, then I would have paid $50 for one doctor visit and the treatment of "rest and ice" would have been prescribed, but because of the habit of Americans with expensive health insurance to pay huge sums of money for treatment rather than diagnosis if I had done what the doctor recommended I would have likely racked up $25,000 to $50,000 in bills.
Now, the fact that I saved the insurance company 99.5% of the cost they were intending to pay did not affect my own health care cost one single penny. So there was nothing in it for me except fewer scars on my knees and less time lost at work for surgery and recovery. Since there is normally no benefit for the consumer to contain the costs, then there is no reason for them to contain the costs.
So the reason that health care costs are out of control is because the user of health care services is not allowed to control those costs at all.
And the current health care (insurance) "reform" plan just drives this problem further in the wrong direction. Incidentally, this is just as much about liberty and freedom as it is about health care. I want the freedom to choose whether to get an MRI and make an informed decision, and
I want the right to keep the money that I save by not doing the MRI. But the way we are going, you pay for it whether you use it or not, just like with public schools and all other things government.
So while the majority of Americans with the entitlement mentality think that health insurance should be provided at someone else's expense, and that someone else should be the evil, greedy company they work for or the all-loving government, who can take money from the evil, greedy rich to pay for it, this is the opposite of liberty. It results from the past two or three decades of transition from health insurance being a luxurious perk that people got from a small number of large employers to an expectation that everyone down to the bagger at HEB gets no matter what. This is fed from class envy where employees think that the employer is abundantly rich and greedy to keep all these profits and the employee is owed something. This thought is the result of emotion and no knowledge or education of how business actually works. Frankly I want the company I work for now to be successful, because if they are successful, I am successful. And it erodes their profit for them to pay for health insurance that is overpriced and pays for services that are not needed for the majority of their workforce. That eroded profit puts my employment at risk and affects my bottom line in the end. So I wish my company did not offer health insurance at all to anyone and would instead just pay actual real money to the employees in full and let us all make our own choices about health care. But Americans today are not about choice. They are conditioned to have their money confiscated before they even know they have it to buy things that they wouldn't otherwise buy "for their own good", such as social security, public schools, health insurance, government-run charities (welfare, ACORN anyone?), etc., and they know that if given the choice to spend their own money however they see fit, they will make stupid choices. Then they will blame the government for not taking away their money or someone else's to save them from their own foolish choices.
Indeed, for the good of us all, need education, even if just in our own selfish interest. 
