[et_pb_section bb_built=”1″ admin_label=”section”][et_pb_row admin_label=”row” parallax_method_1=”off” parallax_method_2=”off” allow_player_pause=”off” parallax=”off” parallax_method=”on” parallax_1=”off” parallax_2=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” use_custom_gutter=”off” make_equal=”off” custom_margin=”||0px|” custom_padding=”||0px|”][et_pb_column type=”1_3″][et_pb_image admin_label=”Image” src=”https:\/\/piteo.com\/wp-content\/uploads\/2017\/05\/Fee-Bill1.jpg” title_text=”Ration Card” \/][\/et_pb_column][et_pb_column type=”2_3″][et_pb_text admin_label=”Text”]<\/p>\n
In case you haven\u2019t noticed, it is no longer your great grandfather\u2019s healthcare system.\u00a0 In fact, your great grandfather did not have a healthcare system at all.\u00a0 Your great grandfather barely had a doctor, let alone an entire system.<\/span><\/p>\n In 1930, my father was pinned between the coal truck he was unloading and\u00a0the house\u2019s foundation.\u00a0 The\u00a0vehicle\u2019s rear bumper snagged his hip cracking his pelvis above the ball joint.\u00a0 After freeing himself from the clutches of the coal truck, and with the help of a passerby, he made his way home.<\/span><\/p>\n Did he call and ambulance, no.\u00a0 Did he go to the emergency clinic, no.\u00a0 Did he call or visit a doctor, no.\u00a0 Did he get a CAT scan, an MRI, an x-ray, an ultrasound, a blood test, or a psychiatric review to insure he was properly medicated for PTSD \u2013 no.\u00a0 What did he do?\u00a0 He went home to seek the skill and\u00a0ministrations of his eldest sister who was standing in for his recently deceased mother.<\/span><\/p>\n Aside from the demonstration of the very real tenaciousness and innate self-reliance of our ancestors, what\u2019s the point of his story?\u00a0 Simply this: 50 years ago, 100 years ago medical assistance was not an ordinary event.\u00a0 Suffice it to say that in the early part of the 20th century an individual\u00a0saw a doctor less than once a year and expected to be in a hospital once or twice in his lifetime.\u00a0 In 1850\u00a0to 2017, using anecdotal evidence, an individual\u2019s use of formalized medical care has soared from\u00a0one or two events every ten years to dozens of events per\u00a0year, a 100-fold increase<\/span><\/strong>.<\/span><\/p>\n This increase is driven by the explosive advance of medical technology.\u00a0 In 1848, a published schedule of doctor\u2019s fees contained some 45 procedures including medications.\u00a0 Today, the modern version of the simple illustration below is the Healthcare Common Procedure Coding System (HCPCS).\u00a0 Today\u2019s HCPCS contains millions of procedures, in fact, the latest\u00a0HCPCS contains 6000 categories, let alone specific procedures.\u00a0 In 150 years, the number of health-related products available to an individual has grown\u00a0by over\u00a0a million times<\/span><\/strong> (source: cms.gov<\/span><\/a>).<\/span><\/p>\n On the other hand, the relative cost of healthcare has grown much more modestly.\u00a0 A tonsillectomy in 1848 cost $10.00 which is equivalent to $5,020 in today\u2019s dollars using relative share per capita GDP (source: Relative Share<\/span><\/a>). Generally speaking, a modern tonsillectomy costs $5,442 (source: health.costhelper.com<\/span><\/a>),\u00a0an increase of around 10%.\u00a0 One is left to conclude that people spend a great more on healthcare today, not because of the item cost of the products, but rather, the sheer number of products people can or feel they must purchase.<\/span><\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=”Row” allow_player_pause=”off” parallax=”off” parallax_method=”on” parallax_1=”off” parallax_method_1=”off” parallax_2=”off” parallax_method_2=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” use_custom_gutter=”off” make_equal=”off” custom_margin=”||0px|” custom_padding=”||0px|”][et_pb_column type=”1_3″][et_pb_image admin_label=”Image” src=”https:\/\/piteo.com\/wp-content\/uploads\/2017\/05\/cab417111b337983b55c45f49210439a.jpg” title_text=”Ration Card” \/][\/et_pb_column][et_pb_column type=”2_3″][et_pb_text admin_label=”Text” inline_fonts=”Droid Sans”]<\/p>\n So why is this important?\u00a0 It is important because the goal of\u00a0\u201caffordable healthcare\u201d will have less to do with cheaper MRI visits or drug costs and much more to do with\u00a0limitations on products and procedures available to the public.\u00a0 And since technology keeps exploding the possible number of products and procedures and shows no inclination to slow down, control of healthcare costs will demand either voluntary or mandated restraint on what people have access too.<\/span><\/p>\n In the 1980\u2019s, the Soviet Union was filled with supermarkets \u2014 empty supermarkets. They were empty not because bread was too expensive; the supermarkets were\u00a0empty because the government was forced to ration supply to control the demand.\u00a0 Given the\u00a0compound problem of no incentives to increase production and no disincentive to purchase items that were subsidized by the State, forced rationing was the consequence.\u00a0 That is, the lack of a free market crushed the idea that socialism could\u00a0provide a \u201cfree lunch\u201d to its citizens without dictating what and when the comrades got to eat.<\/span><\/p>\n Government provided\u00a0healthcare, or a single-payer system<\/span><\/em> as it is sometimes euphemistically referred, is impossible for the same reasons.\u00a0 Consumer demand MUST be controlled in any system with virtually limitless choices.\u00a0 The only outcome of liberal visions for universal healthcare is a landscape of gray hospital buildings without doctors, drugs, or equipment and a bureaucrat gatekeeper checking your ration card, and proclaiming: \u201csorry comrade, you already had a broken arm this year.\u201d<\/span><\/p>\n I met a young man the other day, let\u2019s call him \u201cHenry.\u201d\u00a0 Henry had just come home from the hospital where he underwent\u00a0bariatric surgery to reduce the size of his stomach.\u00a0 The procedure itself cost over $12,000, and the total cost of the entire process exceeded $25,000 all of which was covered by his insurance.\u00a0 While many people might consider bariatric surgery (e.g. gastric bypass) an elective or even cosmetic surgery, not Henry.\u00a0 He\u2019s just divorced and back in the dating pool, but it wasn\u2019t his appearance that troubled Henry, he\u00a0was desperately concerned about the possibility that his overweight condition might cause him to become diabetic or even succumb to heart disease.<\/span><\/p>\n Since Henry\u2019s insurance would not pay for elective surgery, the solution was simple.\u00a0 His doctor just recorded the diagnosis as\u00a0\u201cEarly Onset Diabetes Mellitus\u201d, and magically the insurance company forked over the $25k.\u00a0 Henry is not a bad man, not in the cosmic sense.\u00a0\u00a0It\u2019s just easier for Henry to defraud the insurance industry than to\u00a0put down his\u00a0fork.\u00a0 Henry is venal.\u00a0 He is awash in a\u00a0system that is just chock full of\u00a0product and procedures. \u00a0He\u2019s a consumer and Henry has a catalog of unbelievable variety in front of him.<\/span><\/p>\n It is true, that my father would have looked at Henry as if he were a burglar who had just crept into his house and stolen his paycheck.\u00a0 In 1930, there was no global feeling of entitlement, there was no cornucopia of products, and there was no expectation that your neighbor had a responsibility to\u00a0help you pay for whatever you wanted.\u00a0 In 1930, you expected to pay for what you received, whether it was a loaf of bread, or a new car, or a cast for your broken leg.\u00a0 But that was 1930 \u2014 not\u00a02017.\u00a0 Today, Henry\u2019s action is simply seen as normal behavior without\u00a0judgment.\u00a0 Henry probably does not even consider the fact that his trimmer body was paid for by his fellow citizens.<\/span><\/p>\n So then, here we have the Paradox of\u00a0Healthcare:\u00a0\u00a0a\u00a0free healthcare system\u00a0that results in\u00a0the most expensive kind of healthcare\u00a0even though specific products and procedures get cheaper.<\/p><\/blockquote>\n