Wednesday, April 11, 2012

The copay for stitches...

So Monday evening I'm playing basketball with my oldest and his buddies... My right eyelid collides with the opposing point guard's skull - splitting it wide open... A little more than an hour later (I know, that was pretty quick) I'm on the table getting stitched up... Of course I never waste an opportunity, so I say "Doc, what are your thoughts on health care reform?" His reply was your standard right-wing "we need to do something, but we live in a country where some work hard and earn what they get, while others prefer not to work but demand all the benefits that would come from hard work"... It was the old "who's gonna pay for it?" line...

He went on to describe how certain areas of medicine, specialists for example, still make a ton of money... He said that they'll (he works at an urgent care unit of a local medical group) receive "a couple hundred bucks" for my visit... But if I went to a plastic surgeon, it'd probably be a couple thousand... And the hospital emergency room would cost a great deal more as well... That was interesting because on the way there Nick and I discussed the who-should-do-it question... Being that it was my face, were there such a being as an emergency plastic surgeon, it'd be a (pardon the pun) slam-dunk decision... And as a consumer with health insurance, I wasn't thinking in the least about cost...

Now were I, to a consequential degree, on the hook financially for the decision as to how much of a scar I'll be seeing in the mirror the remainder of my days, presuming a plastic surgeon was available, I'd have had a financial as well as a facial decision on my hands... And I suspect that in a system where it's in the consumer's immediate interest to, himself (as opposed to a bureaucrat), assess the cost of a given service, competition would influence its price (not to mention quality)...

Clearly the current (heavily regulated) system is fundamentally flawed... The question is are we moving any closer to a market under the Affordable Care Act?


  1. We need something. It is long over due. The politicians need to stop arguing over if we need it and just get on with putting the best program together. It is a travesty that we are the richest country in the world but still don't have good healthcare for everyone.


  2. Affordable Healthcare for everyone is along overdue. The politicians need to stop worrying about that and get on with creating it. Being the richest country in the world it is a travesty that we cannot take care of out own citizens.

  3. The Affordable Care Act is a big ball of garbage. It actually rewards big corporations to default on health care and pay the penalty (saving corporations lots of money), which in turn hands over the majority of health care services to the government. We all know what happens when government takes over a sector. Any one who has been in the DMV line knows what I'm talking about. And once you get to the counter you will rarely see a happy face or quality service. America will be in big trouble if we can't get rid of this socialistic system not to mention that will cost us trillions of dollars and bankrupt our country and perhaps our entrepreneurial souls.

  4. Marty, you fail to recognize that the majority of over-utilizers of healthcare services could care less about financial consequences. As a local healthcare provider I can tell you we are paid appx. 29% of gross charges and only 11% of our patients have private insurance. Of our claims, only 6% are paid in full. The solution is not letting market forces dictate healthcare because we have so many un/underfunded mandates on providers. And since we don't want people dieing in the streets, those mandates won't be going away anytime soon.

    The sad reality is that much of our healthcare system is funded off the backs of private insurance... which as you know is typically an employer sponsored benefit.

    Sadly, unless you are intimately involved with healthcare finance (and I'm not talking about our elected officials), you really can't understand the challenges of balancing services and reimbursement.

  5. Martin L. MazorraApril 12, 2012 at 2:43 AM

    Of course a "free market" can't exist in the presence of "mandates"... So you're saying that, without mandates, we'd allow people to die in the streets?? Did we - prior to these un/underfunded mandates?? I agree, our elected officials "really can't understand the challenges", and therefore cannot be relied upon to provide the solutiions...

  6. Your Comments: Yesterday I was at the State Capital, the Assembly got togehter to discuss the new State Run Health Care Program. What was told to us is that they want to pass this bill but they don't have any idea how it will be funded. Sound familar? Also all State, Federal and Unions will be exempt from this program. That leaves you and I to pay for this NEW PLAN. Wonderful! Currently in the State of Cal. 30% of ER's have closed. Why, because of the cost of services for those uninsured or covered under the current health options provided by the State of California does not cover the reinbursment cost of care. EVERYONE IN THE US IS COVERED! The privite sector pays for it one way or another through taxes. This "NEW" plan will not shift the cost. NO ONE should be EXEMPT!