Here in Oklahoma our Republican Governor and Legislature are in a tizzy, yea I say, a veritable plethora of tizzies, about health care, as in Obamacare they don’t want it. They want a FREE MARKET in health care!
There seems to be one very basic problem with all their emoting on the subject. Starting with the boss, Mary Queen of Lynch Mobs Fallin herself herself, and running on down the list to the lowliest member of the Most August Oklahoma Legislature (MAOL), I have yet to hear anything that even remotely resembles a free market in health care.
Consider this little detail. Suppose the system was set up so that Hispanics paid one price for a particular health care procedure, but Caucasians paid a different price, and African Americans paid a third price. I think most people would be outraged. Yet, discriminatory pricing in health care is the order of the day. There’s no such thing as a firm fixed price that everybody pays in health. What you pay is based on WHO you are and WHERE you sit in the social and economic order of things these days.
Those who pay cash for health care, for example, are always charged the highest prices.
When I had my little adventure with heart surgery last year, I received a very large bill, but thanks to my social and economic position as someone who has a job with health insurance, half of that bill was written off immediately. Where did it go? Who paid it? Nobody I guess, I didn’t pay it and the insurance company didn’t pay it. Where did those costs get shifted?
Maybe onto those who pay cash?
In the 1980s, I was an administrative assistant for a health care economists. I spent a lot of time doing research into medical economics in the journals at a major state university health care library (this was pre-internet) and compiling very large spreadsheets. One of the issues we looked at periodically was cost shifting, and it was apparent from the money that the people who pay cash for their health care always got stuck with the highest bills.
Now hopefully a person won’t have heart surgery more than once a lifetime, but this problem of discriminating against people who pay cash for their health care is particularly acute (as the doctors would say) for the lower priced but more commonly experienced, health problems. From the occasional ingrown toenail to vaccinations and on down the list to treatment for diabetes and allergies, every day people choose pain and suffering over treatment and healing because of the high price of cash medical care.
A second cost-shifting problem is that governments never appropriate enough money to fully fund Medicare and Medicaid. Most costs to shift elsewhere.
And make no mistake about this.
If others are paying less (those with privileged access to health care based on their economic and social condition) then others have to pay more. Costs don’t go away just because an insurance company used its pricing power to force doctors and hospitals who want to join its network to charge lower prices to its insureds.
And then there is the issue of transparency. When I had my heart problem, the only treatment alternatives presented to me were angioplasty or doing nothing and risking a full blown heart attack. Imagine my surprise, then, when after the surgery I found out that those were not the only two alternatives, there were other, less invasive and less expensive treatments that could be have been tried.
How often does that kind of cheating of patients go on in medical care? Thousands of times every day.
If we go beyond the practice of discriminatory price system and the lack of transparency in health care. . . well. . . don’t get me started. We could talk about credentialism and turf building, rent seeking medical professionals, abuse of the regulatory process to suppress alternative healing methodologies and so on and so forth.
It is a safe bet that the Republicans will never get to any of these actual free market issues, since their allegiance to the free and fair marketplace is strictly rhetorical. What they are actually doing is protecting and defending the rent seeking cartels that presently control medical care and which donate mucho big bucks to Republican campaigns.
The hypocrisy of our Republican politicians is nauseating.