A blogpost from a friend up in the Fox Valley got me
thinking about how Big Pharma and Big Medicine and Big Insurance took over our
health care system without firing a shot.
Of course, it took the rental of several hundred politicians at no small
expense, but it began, I believe, when we stopped actually paying for things
involving our health care.
Centuries ago, when I was a young man in my twenties, I had
something almost none of my other friends had: health insurance. Blue Cross/Blue Shield, which I’ll call BC/BS
for the balance of this rant. I had it because my father was a prudent man and
insisted that I have it. I don’t recall
how much it cost.
This was in a time (the roaring 70’s) when outfits like
radio broadcasting companies didn’t offer health insurance as a “fringe benefit”
(that’s what such things used to be called).
Nor did most companies. If you
wanted health insurance, you purchased it.
It had nothing to do with your job,
just like car insurance. You just
bought it. Or you didn’t.
One night, playing softball with the radio station’s team (I
was a hard-hitting first baseman, sports fans) I fell on my arm. Pretty hard fall, and it came in a loss to
the County Sheriff’s Department’s softball team. After a couple beers following
the game, the arm still hurt like the dickens.
One of the deputies said “you oughtta have that looked at”, so I did.
In those days, there were no “urgent care centers”. If you hurt yourself after regular business
hours, you went to the hospital, which I did.
Before I could cross the threshold into the emergency treatment area to
be dealt with, I had to either produce proof of insurance or sign a bunch of
papers saying I understood I was responsible for ALL costs incurred in treating
me. So I produced the little paper card
with the BC/BS logo on it, and was ushered into a large treatment area.
Since my little BC/BS card said “X-Ray and Diagnostic Tests”
on it, there was no question about getting the arm X-rayed, and a short while
later the ER doc said “your regular doctor happens to be here in the hospital
making rounds of his patients; I’ve mentioned you’re here and he’ll be coming
to take a look at you shortly”. I said “but
doc, is my arm broken?” He said “no, it’s not.
Your doctor will be here shortly.”
Had I known what was going on, I would have said “you tell
old Doc FeelGood that I don’t want or need to see him – you’re my doc right
now, and if my arm’s not broken, I’m outta here; if it is, I want you to treat
me”. But I didn’t understand the system,
until several weeks later, when BC/BS sent me a statement indicating that both
the ER doc and my regular guy, Dr. FeelGood, had submitted an invoice for (I
believe it was $150 apiece) “examination and treatment”. My treatment, by the way, was a quick hello
from Dr. FeelGood, who confirmed that my arm was not broken and would probably
be sore for a few days, and I should take a couple aspirin to dull the pain. (This was long before the NSAIDs like
Ibuprofen were available to regular folks over the counter.) Total time of his “examination and treatment”
was approximately 60 seconds; total time of my contact with the ER doc was
probably about the same. Not a bad racket;
these boys bill out at a cool nine thousand bucks an hour (150 bucks a minute).
So, BC/BS, which was even back then in the roaring 70’s in
bed with the doctors and drug companies, coughed up the exorbitant payment to
BOTH docs.
Also, as a young man I was prone to sinus infections, and
Dr. FeelGood would from time to time prescribe antibiotics for me. Each course of antibiotics cost about
$28. I know that, because way back in
those days, whether you had insurance covering medications or not, you paid the
pharmacist when he or she dispensed the medication. If you had insurance, AFTER you paid the
pharmacist, you mailed the paid receipt to your insurance company, and they
reimbursed you for the cost (up to the limits of your policy). There was no “co-pay”; you just paid it.
The point of this needlessly long exposition is that back
before Big Pharma and Big Medicine and Big Insurance took over everything
related to our health care, we were connected in the sense that we knew what
things cost. We knew how much the doc
charged for an office visit, because we paid it, right then and there, to the
receptionist, before we got to see the doc.
We knew how much antibiotics cost because we paid for them, out of our
own pocket, before we could walk out of the pharmacy with the medication. Health insurance had nothing to do with your
employment (unless you worked for a huge union operation, like Ford Motors or
General Electric).
The cost of hospitalization back then? I really don’t know. That was covered by the part of BC/BS they
used to call “Major Medical”, and thank heaven I never needed that part of the
coverage back then.
When you have a direct connection to how much things cost,
you have a far better sense of control. That’s the way free market capitalism
is supposed to work, I think. If the
guy with the plow on the front of his pickup truck says he wants an additional ten
bucks a time more this year than last year to plow your road when it snows, you
have the option of simply paying him more, bargaining for a better deal, hiring
someone else, or buying your own plowing rig.
Your decision. You know what it
costs. When you go to the store to do
your grocery shopping, you know what things cost before you toss them into the
cart.
The beginning of the end of our control over health care was
when we stopped knowing how much things cost.
Now, we don’t care what it costs, as long as our insurance covers
it. And that, to me, is the biggest part
of the problem.
