Lack of Freedom a Threat to Health

Periodically, somebody on the Left will throw in some anti-corporate rhetoric and sneer about the “free market.” Mark Patinkin’s column on the state’s difficulty attracting doctors provides yet another example illustrating that one can hardly point to our problems in condemnation of economic freedom:

I began by asking where he’d rank us nationally in fees paid for medical procedures.
“In many if not most areas,” he said, “it’s 49th or 50th in the country.”
The reasons are complicated, he said — one factor being restrictive laws.
What kind of laws?
He mentioned several typical procedures for which Medicare will pay a doctor around $300, almost below cost, he said. In some states, top doctors can charge an extra few hundred for patients happy to pay for their expertise. Here, as in Massachusetts, the law forbids that.
“In other businesses,” he said, “when you get seniority and experience, you raise your prices. I make the exact same fees as the doctor fresh out of residency. The only way I make more money than that doctor is by seeing more patients. I’m not allowed to charge more for procedures.”

Here’s a stunning bottom line for doctors:

He gave the real example of a 30-something cancer doctor who recently finished his training. His offer in Rhode Island was $125,000 with three weeks vacation and being on call every third night — being available for patient calls or going to the hospital. On the West Coast, The Doctor said, this same candidate was offered $250,000, eight weeks vacation and “call” every 10th night.

Rhode Island’s much touted (but selectively described) “quality of life” is surely threatened if our battle against the free market drives away high-end professionals.

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Mike
Mike
12 years ago

To be fair, whining about an entry level salary of “only” $125,000 smacks of the same chutzpah usually exhibited by our illegal aliens, welfare leeches and public-employee unions.

OldTimeLefty
12 years ago

Get ready for another sneer about the free market.
Forty-eight million people nationally have no or inadequate medical coverage. Tell them how the unseen benevolent hand of the “free market” works to their advantage….After we take care of that problem, then tell us about the poor RI doctors whose number, I would guess, is less than 48,000,000.
OldTimeLefty

joe bernstein
joe bernstein
12 years ago

Doctors take on a lot when they decide on that career.Years of training and evaluation to begin with.They do,in fact have a life and death reaponsibility.To compare lwayers and dcotors is ridiculous.Lawyers create the need for their existence to a large degree.Disease would be here with or without doctors.Accidental injuries also.I don’t believe doctors make too much money.
We pay pituitary freaks millions to dunk a basketball and drug soaked derelicts to croak out songs on “world tours”jsut as two examples.we make a little sprout like Hannah Montana a billion dollar property and spend millions on coverage of Britney Spears contaminating a car seat.And we’re supposed to begrudge a doctor a few hundred k a year?
If people think that way,the next time they have a heart attack,cancer,stroke,or hemmorhage they should call an athlete or entertainer.BTW,nurses are overworked and underpaid also.
Disclaimer:I am not related to any nurses or doctors.

Andrew
12 years ago

OTL,
If a free market existed in healthcare, I’d be able to buy insurance across state lines and my health coverage would be no more coupled to my employment than my purchase of an automobile.

rhody
rhody
12 years ago

Sounds like a sweet deal out West…until he tries to buy a house.

Anthony
Anthony
12 years ago

When you consider the amount of money that many doctors borrow to complete their schooling and the long hours of studying, I would hardly categorize a doctor complaining about a $125K salary as “whining”. Many doctors end up carrying debt equivalent to a mortgage by the time they graduate medical school.
As for lawyers, they gave us the Constitution and established the framework of our democracy. I have no problem with them making money.
Ultimately, the market dictates supply and demand. If RI hospitals don’t pay doctors enough, then they will move elsewhere. Eventually RI will have to make adjustments. If there are too many lawyers in RI and are they unable to make a living, then fewer people will end up enrolling in law school.
If people want to give their money to Brittany Spears or Hannah Montana, that is their choice, stupid though it might be.
My bigger problem is with those individuals who pay hundreds of dollars for concerts, entertainment, iPods, DVD players, etc. then complain that they don’t have money for health care coverage. Or with those people who blew off a free public education during their school years and then get upset about highly educated doctors making six figures.

Citizen Critic
Citizen Critic
12 years ago

You forgot to mention the incredibly high cost of medical malpractice insurance in RI. If someone has specific cost comparisons with other states, please post.
Your good doctors, educated professionals, business owners, intellectuals, wealthy class, they will all bail out sooner or later.
Rhode Island is economically unattractive in many ways. Professionals have been fleeing for a while. RI is simply not competitive with many others states.
However, if you are an illegal alien, welfare mother, political regressive, or union stooge.. then, it is one of the best places in the country.
For the rest of us.. hasta la vista, Baby!

OldTimeLefty
12 years ago

andrew,
You are playing dodge ball with the question. Are you saying that 48,000,000 people would be covered if only Medicare, Medicaid and the VA were eliminated? Or are you saying that, magically, with all public service health institutions eliminated, and only private medical care left that medical costs would be reduced so drastically that families below the poverty line would somehow have medical insurance within their economic reach?
Affordable coverage for all is the point. Perhaps you could buy coverage for you and yours, Forty-Eight million (48,000,000) of our citizens can’t afford to buy it and you’re saying, “Let them eat cake”
I do agree with you in that I think that medical coverage should be unlinked to the job. Are you thinking of Germany or Sweden for example?
OldTimeLefty

OldTimeLefty
12 years ago

andrew,
You are playing dodge ball with the question. Are you saying that 48,000,000 people would be covered if only Medicare, Medicaid and the VA were eliminated? Or are you saying that, magically, with all public service health institutions eliminated, and only private medical care left that medical costs would be reduced so drastically that families below the poverty line would somehow have medical insurance within their economic reach?
Affordable coverage for all is the point. Perhaps you could buy coverage for you and yours, Forty-Eight million (48,000,000) of our citizens can’t afford to buy it and you’re saying, “Let them eat cake”
I do agree with you in that I think that medical coverage should be unlinked from the workplace. Are you thinking of Germany or Sweden for example?
OldTimeLefty

Anthony
Anthony
12 years ago

Old Time Lefty, you’re right, affordable coverage should be the point.
But under our current system, state laws mandate that insurance carriers pay for procedures that are anything but life and death procedure. Doctors overbill insurers because they’re afraid they will only get back 50% of what they bill. Insurance carriers then react by passing along the additional expenses to the patient.
As convoluted and bureaucratic as the current situation is today, the US still has the best healthcare system in the world when it comes to cutting-edge research and treatments. A government-run healthcare solution would only hamper medical care and create more bureaucracy.
However, the system should not continue in its current form. There is a need for the government to play a role in facilitating reform within the private sector.

Tom W
Tom W
12 years ago

There is no longer a free market in health care, and thus the problem.
Between Medicare and Medicaid government is already a good one-half of health care in this country – and through regulations and mandates has its fingers deeply embedded in the rest.
Then there is what is called “cost shifting” (Medicare / Medicaid under-reimburse, and the differential is passed along to the “private” market).
HillaryCare or ObamaCare will force all of us into Medicare.
Costs will skyrocket even further, quality will decline, and shortages will occur (e.g., who’s going to incur the expense and time of going to medical school, only to come out and have the government set below market-level reimbursements, and thus have the government dictate one’s income)?
Whatever the euphemism – “single payer” or “universal” – having the government totally controlling health care will only make the problem worse.
NOTE THAT HEALTH CARE INFLATION WASN’T AN ISSUE UNTIL THE GOVERNMENT STARTED GETTING INVOLVED WITH THE ENACTMENT OF MEDICARE AND MEDICAID.

Justin Katz
12 years ago

OTL,
Andrew’s not playing dodge ball; you’re throwing around non sequiturs.
You blamed the free market for 48,000,000 supposedly un-or-under-insured people. His point was that there is no free market in healthcare for you to blame. Listing a handful of public-related aspects of the industry doesn’t address the fundamental point.
Step one is to un-inflate your numbers. Step two is to subtract people who opt not to carry health insurance (perhaps because they are young and healthy). Step three would be to figure out the effect of government-mandates and controls. Step four would be figure out how many people are hindered from acquiring health insurance by its joining with employment.
At that point, perhaps we could come to a reasonable estimate of the people who still lack inadequate health coverage and to address their problems. 48,000,000 people aren’t below the poverty level, and you can’t simply assert that it’s unreasonable to point to government tinkering in one’s explanation of the difficulties faced by the rest.

Justin Katz
12 years ago

Mike,
Watch the visceral myopia: whether the doctors are unjustly whining or not, it doesn’t serve Rhode Islanders to drive them into the arms of other states.

Monique
12 years ago

“You forgot to mention the incredibly high cost of medical malpractice insurance in RI.”
Around the country, actually. I couldn’t quickly find a comparison by state so cannot address Rhode Island’s cost, though Rhode Island’s need for tort reform cannot be helping. But as of 2007, the annual cost to a doctor of malpractice insurance ranged from $138,00 to $277,000, depending on the state and the location.
$138,000-$277,000. In addition to office rent, staffing, student loan payments, etc. At that point, the doctor hasn’t seen a single patient.
Now, do we assume that at $125,000/year, the hospital in RI is paying the doctor’s malpractice insurance? Otherwise, you’d have to be real bad at math or very committed to becoming a doctor to consider an offer that leaves you upside down.
Anthony, you can add Medicare to entities which are insufficiently reimbursing doctors. A doctor told me a couple of months ago that Medicare has dropped its reimbursement rate to the point that it is now only paying 33% of what is billed by the doctor.
http://www.protectpatientsnow.org/site/c.8oIDJLNnHlE/b.2913893/k.BB22/New_York_Doctors_Frustrated_Over_Malpractice_Insurance_Hike.htm

SeanO
SeanO
12 years ago

Tom W hits the nail on the head. In 1960 more than 60 cents out of every health care dollar came directly from the consumer’s pocket. Such a connection between the consumer and provider is optimal in delivering “value” ( lowest price with best quality of product or service ). As Medicare and Medicaid were introduced in the 1960’s and have expanded greatly; we now have about 14 cents out of every heatlhcare dollar coming directly from the consumer’s pocket. The result is skyrocketing cost. This is predictable if you recognize human nature. This is the real reason that people often decide NOT to purchase healthcare insurance. Another is that government ( especially in Rhode Island ) loads Mandate after Mandate into healthcare plans thereby raising premium prices further. Add significent over regulating in the healthcare insurance business and you are left with only 2 players in the insurance game. The Left has created the following irony in America. We are underinsured because we are overinsured. What we need is a little Milton Friedman.

Citizen Critic
Citizen Critic
12 years ago

Tom W. is correct, as usual.
The free market is the best way to regulate health care.
Government screws up everything it touches. How could more government possibly be a good thing?
Old Time Lefty is wrong again, as usual. His entitlement mentality symbolizes what is killing our country. Nobody is entitled to taxpayer funded health care, or to being coddled by the government their whole lives. People need to take personal responsibility. And government needs to get out of the way and give the proper incentives.

joe bernstein
joe bernstein
12 years ago

Here is an idea for helping people to afford health care:
Make all medical and dental expenses,including costs for drugs and insurance premiums an adjustmant to income,rather than a deduction,which is subject to a percentage of income limitation and is available only to those who itemize.
An adjustment to income,like moving expenses,is available to anyone filing a tax return and therefore could be utilized by lower income people.
People at the very lowest income levels arer getting subsidized health care,so this tax savings could be used by middle class and working class Americans to help pay insurance premiums.
this solution is by no means a cure all,but it would help.And no bureaucracy would be created.It would just be part of the already existing tax return.The savings could be substantial for many individuals-and the basis for this adjustment is very evenhanded-the people with the highest out of pocket medical expenses would be the major beneficiaries.What could be more fair than that?

Anthony
Anthony
12 years ago

I agree with most of what Tom W. has to say–especially when he states that having the government totally control healthcare will only make the system worse. But I think it’s simplistic to blame government for all of the current problems with healthcare. There are several problems with healthcare in the private sector that would have occurred naturally whether or not their was a Medicare/Medicaid program. For example, there will always be tension between innovation and medical care in healthcare. In the U.S., patients subsidize not only medical care, but research into new procedures, medicines, etc. Some of the inflation in healthcare is due to the fact that private sector companies are trying to develop new research and technologies that will improve patient care. In itself, inflation resulting from efforts to improve patient care are not necessarily a bad thing, if those who need catastrophic coverage can still afford it. State-run medical systems in other countries often give quality medical care–provided you happen to have a common illness or need routine surgery. They fail miserably at treating illnesses that fall “outside the box” or in developing new procedures. So, you can bet that if the US turned to a state-run system, medical progress would slow down considerably. On the other hand, an unfettered market would leave several people behind. The healthcare system needs to be focused on the patient, not the provider, the carrier, the hospital or the government. So what can government do? Here are a few examples– 1. Pass laws that allow the interstate purchase of insurance, creating a more competitive marketplace for patients. 2. Provide patients with incentives to use HSA’s. 3. Allow at least one barebones “catastrophic” type of insurance policy in every state that is free from mandates not related to saving a patient’s life… Read more »

OldTimeLefty
12 years ago

Justin, Speaking for Andrew (Was he out of his depth. Was it your judgment that he needed help?) you said that “his point was that there is no free market in health-care for you to blame. Listing a handful of public-related aspects of the industry doesn’t address the fundamental point.” If we don’t have a free market we certainly do not have a socialized one. What we have is a national health care problem. I’m sure that you agree with that. When we compare ourselves with other Western Democracies we see that we are derelict in covering the majority of our citizens. Do you agree that this is a problem? I certainly believe it is. Your idea to fix the problem seems to be to argue that the 48,000,000 number may be exaggerated. Let’s grant you a 10% error, which would leave roughly 43 or 44 million people un or under insured. The point is to cover them, nicht whar? How are you proposing to do this? Next you want to gauge the effect of government-mandates and controls. How do you do that? What government- mandates are keeping these 43-44,000,000 people from obtaining adequate government coverage? Please expose those mandates so that we may get rid of them and cover our 43-48 million uninsured. Finally, you want to figure out how many people are hindered from acquiring health insurance by its being joined with employment. We have no argument here. Health insurance should not be joined to employment. It should be a right. If it’s not a right, do you think it’s a worthwhile endeavor to establish program or programs to cover them all? What program to do this are you espousing? I ask the question again; how do you propose to cover this army of uninsured? OldTimeLefty P.S. Andrew… Read more »

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