Gaming the Gamble
We're all gamblers here, right? OK, joke is over. We play at gambling for the most part. Those who go beyond that are either very clever or crooked. Well, there are a few that have made it their sickness. But most of us are playing without a lot of nuts and bolts knowledge to maximize in the system provided.
Take a look at Doyle. Interesting ol Geezer. But, if you consider sitting down at his table you'll get the cut throat side. That is something that few of us can overcome. Now get up from that table and sit down in the real world. Here you don't have a game choice and that game is stacked. They have their own Doyles.
Otis bemoans this in a blog of his. Here the subject is health care. Health care is a terrifying subject. It affects ones ability to continue on this moral coil. We are like players with scared money in front of them. Pot odds? We don't have a clue.
Now the idea is for the government to step in and save us by adding a near 2-trillion dollar overlay to the game. And they'll do it with our money. That is supposed to resolve the issue that few really understand and that includes most in Washington.
Healthcare is no different from your utility bill. They are regulated industries. Ma Bell was another in my youth. It was the courts that stopped that and not the legislative branch.
Regulated industries operate on a cost plus model. They are the casino. The more play the bigger the rake. The house always has the edge. With cost plus the way to increase the plus (profit) is to increase the cost. And these folks are inventive. If you don't believe me, ask the wife who lives and breathes regulation and has an overview of medical practices.
If you read down the comments in Otis' blog you hit this one:
Speaking with my sis, a 2nd year resident, she tells me that a huge part of her job is making sure that she writes up the tests that she is ordering in “just the right language” in order to ensure that she gets paid by her patients’ insurance. This is something that her administration is constantly training their doctors in doing. Forget quality health care. If hospitals can make more money by ordering a strep test instead of sending someone home with orders for lots of fluids and rest, then they will instruct their physicians to order the test.
That is it in a nutshell. Hospital have to cover overhead. To do that they are happy to create added cost that their staff can game into the system. The system is not health care. The system is actuarial (table odds) coupled to economist and accountants. This is the basis for regulated industries. Health care become the vehicle and not the reason.
In the 80's our local utility was your typical utility. My grandparents own the stock. It was a conservative play that garnered a bit more than bonds. They hired a new president. He didn't want to move to our rust belt town so they rented the nicest house in the nicest gated community for him. Each weekend a private jet whisked him back east in a private jet. He was cost plus. Each dollar they spent earned them a few extra pennies because of the cost plus nature that regulation provided. BTW, he was worth it. He grew and acquired and the stock jumped along with the utility bills and they were finally acquired by a bigger one for a nice premium. Stock holder benefit and utility bills jumped.
If you look at the news on all this, the fear is that we end up with the lower cost system held in Canada. They give examples of people who didn't get the surgery or chemo they needed in a timely fashion. Yet, a couple of those Canadians showed up in Otis' comment happy as pig's in shit. No system run by man is perfect. Theirs isn't either. It is just a shit pot cheaper.
We are reforming a system without recognize what caused the system. Good luck!
P.S. G-Rob waiting for your intellect to take me to task.
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The Canadian system has problems, too. There are longer waits for testing, including in my specialty of radiology. Canadians are still coming south of the border for a CT scan or an MRI.
It’s an ugly problem with no easy solution. I just hope that cuts are fair across the board. Unfortunately they won’t be. Big Pharma just spent $40 million lobbying congress to make sure their money is preserved.
-DrC
An old bridge partner of mine (back in the 90s) is a physician. He told me once of a mother who brought her son to the ER who had a headache. Before he left, the admitted him and did a CT scan.
I said kids get headaches all the time, the boy had one. Why did they do this.
His answer was they are afraid of being sued and they were covering their ass.
Something is srsly wrong here, folks.