Free does not mean available

A few weeks ago I went to a local computer store – they had advertised a free case of printing paper with the purchase of any two ink-jet printer cartridges.  I needed ink and paper, so I drove over.

I was at the store 90 minutes after they opened, and they were out of “free” paper.  Of course, the fine print says “while supplies last” and for all I know they had only one case of free paper.

I wasn’t pleased, but I left (without buying anything) and I had forgotten all about the incident.

Until I found this post, which I first think is extremely well-written –  but it also reminded me of the ink and the paper.

When considering government supplied health care it is important to keep in mind that “free” isn’t free and that “free” doesn’t equate to “available”.  Canada has a lack of supply and an abundance of demand.  Why?

There are probably a lot of reasons that I haven’t considered – but I do know that when I worked in the US healthcare system I worked with a LOT of Canadian Doctor’s and health care specialists.  I learned from them why they chose to practice medicine in the US instead of in Canada and it was mostly related to either salary/opportunity or availability of equipment, procedures and adequate infrastructure (lab technicians, X-Ray tech’s, etc).

In the years I spent in civilian medicine I actually met very few people that were in it strictly for the money.  Most were deeply caring people that honestly wanted to help others – and healthcare is a way they could do that and still feed their families.  We were always deeply disappointed if we couldn’t provide a patient with the best care because we didn’t have the right equipment/people.  It happened, but rarely.  And if we didn’t have the greatest new CT-Scanner then the chances were that another hospital in town did.  The patient rarely did without treatment due to lack of equipment/people.

I also worked in the US Military Healthcare System.  I worked at Navy Hospitals, Army Hospitals, an Air Force Hospital AND a Veteran’s Administration hospital.  I didn’t see much difference between the civilian and Military health care systems – with one exception: the Military Healthcare System is funded by tax dollars and was not expected to make a profit.  So no test was left undone; no serious concern was paid to the cost/benefit ratio and when in doubt (no matter how slim the doubt) a complete battery of tests was run.  Usually this was done by an intern or resident who didn’t want to chance missing something.

On the face of things, this sounds like the diligent thing to do.  In reality it is mostly wasteful.  Routinely these tests (and the associated expense) can be avoided by waiting and measuring.  Most civilian for-profit hospitals would have simply monitored the patient before ordering a bunch of “let’s rule this out” tests.  When money matters you run the tests that make sense.  When it doesn’t, you run everything.

So what’s wrong with running everything?  That sounds like a GREAT health care system!  Wrong – running everything takes time, and people and money.  Running everything means delays to get results back even for those patients that are really critical and need results ASAP.  Running everything creates a shortage of everything.  And a shortage of anything raises the cost, increases the delays and ultimately eliminates availability.

Not to mention that it is just extremely expensive.

When Social Security was designed, it was designed for the minority of Americans that were unable to care for themselves in their old age.  But since it was “free” everyone started to claim their benefits.  So the benefits go out to those who are truly impoverished, and to those who own 250 foot luxury yachts.  If you paid in, and you are of age, you can “claim what is yours”.  Do you think there is an abundance of Social Security money now?  How about in ten years?  Why is Social Security broken? Because everyone thinks it’s theirs – like a birthright.  People are taking far more out of Social Security than they ever put in – whether they really need it or not.  “Free” created a demand that cannot be met.  “Free” has virtually eliminated the availability of Social Security even to the truly needy – unless we cut “benefits” dramatically or increase taxes significantly.

Medicare is another example that illustrates this “free is not the same thing as available” argument.  Look at the current and projected costs of Medicare – either people will have to do with less (across the board) or we will all have to pay more.  Forget the fact that Medicare was also designed for the truly needy – it is being used even by people that are quite wealthy.

What makes anyone think that a “national healthcare” plan will work any differently?

And I haven’t even made arguments based on studies I was involved in where charging Active Duty Military even a very nominal fee to utilize their “free” Health Care reduced Emergency Room and Doctor’s Office visits dramatically (with no corresponding increase in mortality rates).

“Free” is too easy to abuse.  If you think your local Emergency Room is busy now – wait until that visit is “free”.  We will quickly overburden our health care system and “free” will eliminate “available”.  And then everyone loses.

You’ll have completely free access to non-existent services – or by the time your turn comes up it will be too late.

Comments

  1. ike said, “…the current system is “broken” because no one knows what the hell anything costs, therefore price doesn’t matter.”

    Here’s a story which took place, quite a few years ago, in California. A friend of mine who has a variety of long term health issues was recommended to try regular treatment in a hyperbaric chamber. These chambers are used to treat decompression sickness and athletic injuries, among other things, and each treatment in a hospital (at the time the story took place) cost about $700. Most of that cost was dictated by insurance companies and lawyers, who insisted that a number of specialists be physically available during each session, even though each of them might only be needed in less than 1% of cases, and those cases could rightfully be assumed to represent those most ill, near death, etc.

    The friend found a co-op, which she joined. The members of it agreed in writing to limit (not waive) litigation recourse. The co-op bought their own chamber, opened and operated their own facility with medical staff, and the members paid (to the best of my recollection) approximately $200 per session. The entire thing was financed based on the members’ requirements which equated to a fully subscribed daily use of the chamber.

    I believe that the typical US hospital cost of these sessions today is over $1000. Per session. Per patient.

  2. I think we’ve seen what happens when the government runs health care by looking to Medicare as an example. Look how long the Part D prescription plan has been in place and there are still major problems with it.

    All I hear now days is how much people pay in premiums for their health insurance. This guy pays $600 a month for his family, that girl pays $700, and so on. Some of the reasons these premiums are so high are the the continuing raise in health care costs. I don’t know the last time anyone has been in the hospital, but I was in overnight three years ago for a surgery and and for that overnight stay my hospital bill alone was over $16,000. Granted insurance companies negotiate rates, and if you are smart enough to use a participating hospital you will benefit from those negotiations, but still these costs contribute. Another thing that contributes is how sick the people at your work are. That’s putting it in extreme layman’s terms, but as my sister once said- “Man, we had three hysterectomies and a lady with cancer this year our premiums are going to sky rocket”. In a sense, you pay for what you use. No different really than car insurance. You have a wreck, your car insurance goes up.

    To address the issue of things being denied like prescription drugs. I’m guessing MissM’s son’s medication may of been denied as Experimental/Investigational. I could be wrong, but from the description she gave, that’s what it sounds like. Often times doctors try to prescribe medications that are over the manufactures recommended dosage limits. It’s not illegal for pharmacies to fill it, but if the manufacturer doesn’t recommend a dosage that high or that frequent, then it’s not proven to work and in most cases insurance companies aren’t going to pay for it. People get mad at their Insurance and say they are trying to practice medicine when in fact sometimes people should be questioning their doctors a little more thoroughly. As far as birth control pills not being covered but Viagra is…There are always condoms…

    Here’s something I’ve always wondered. We never hear people asking our auto insurance to cover our new tires or our new transmission. Why are we expecting our health insurance to cover things that are clearly excluded?

  3. MissM, I’m sorry you’re dealing with a crappy hand. The answer isn’t to limit freedom.

    The fallacy with UHC is that somehow the dreaded evil “profit motive” is responsible for jacking up prices, and if we eliminate “profit” we’ll all hold hands and sing kumbaya.

    In reality, the current system is “broken” because no one knows what the hell anything costs, therefore price doesn’t matter. Under the common perception of private healthcare, you aren’t paying for treatment, the company is. That could not be further from the truth. YOU never got the see the bill, so you just ASSUME the insurance company and the primary care physicians settled at a fair rate. Just like most people are numb to the amount they pay in taxes, because the vast majority are either excised before “take-home pay,” or are embedded in the prices we pay at the end.

    Free markets work when individuals have access to actual information, costs and benefits, risks and downsides. You’re assuming that taking Insurance out of the equation will somehow “liberate” the price information that is now hidden from consumers.

    And I don’t know what kind of crappy plan you have that doesn’t pick up birth control. That’s been included in everything I’ve been a part of for more than a dozen years. (And I used to work in teevee news, and they routinely have crappy and cheapass coverage.)

    Which actually segues to another point: you’re complaining about a system that is TOO restrictive, and wanting to replace it with one that is UNIVERSALLY so. You have a crappy insurer, and if the rules allowed for more freedom, you’d be able to freely shop for a plan that fit your comfort level. Health insurance wasn’t always tied to employment – that came about with WWII, when FDR imposed a wage freeze. Companies were forced to compete for an already smaller worker pool, and since they couldn’t offer more money instead offered “benefits.”

    Our system is broken, because of one well-meaning decision after another, ALL of them removing freedoms instead of improving them. The answer isn’t to continue in that direction.

  4. @ MissM –

    “Government big enough to supply everything you need is big enough to take everything you have” – Thomas Jefferson

    I assume you can afford your child’s medication and that you have purchased the required prescription. Otherwise it would be very wrong for you to be spending money to access the Internet while neglecting the health care needs of your son.

    So you are not being denied access to any care or required medication.

    You can always buy better insurance – cancel the Internet and cable and pay more for an insurance plan that covers your medication needs.

    See – you have that choice. You have the choice to access the health care you need.

    My argument is that if it is run by the government that choice will be removed from you – and from me. I would rather have the choice.

    Besides – why should I pay for your son’s prescription? You CAN pay for it, so why should I?

    And if we get government supplied health care you will be paying for all of that Viagra. Why should you?

  5. Have you used your health insurance lately? Mine turned down a prescription written by a neurologist for my son, because the levels are a bit high. All my son’s records had to be copied and the neurologist had to write a letter explaining why the medication was needed, yet they STILL deny it. The denial letter says that my insurance no longer covers it, but they have filled multiple prescriptions for this same drug at different levels. This is bizarre. Its for an anti-depressant, for god’s sake.
    The recent UAW strike against GM was about retiree health benefits mostly. Cost PER CAR for health benefits is $1500! Universal health care removes the profit motive and third party profits from the equation. I was spending $600+ per month for insurance, privately, now I work part time for a company that gives part timers health insurance, but I believe that they are compensated based on what they turn down.
    I don’t believe that universal health care will be perfect, but the cost to industry, employees and consumers is outrageous. If there is universal health care, we all pay for it. And if there isn’t universal health care, we pay for it, in different ways.
    (I’m not gonna even get into the fact that viagra is covered but birth control isn’t)

  6. @Ike – GREAT analogies – and I know through my own experience that those analogies are true. I see it even in very simple ways, like Food Stamps. Once you get accustomed to having someone else buy your groceries there is little incentive to be frugal, or to do anything that stops the flow of those groceries.

    The Food Stamp program is raising people that expect to be cared for and that have little reason to change things – because as long as they demonstrate the need, the care is never-ending. There is little incentive to get off of food stamps, and almost every reason (except personal pride) to stay on food stamps.

    We can’t create a society where everyone expects “the government” to take care of them. The government has no money that did not come from us – and nothing is free. And eventually there will be too many people taking, and not enough to carry them all.

    Of course many people are quite happy with this approach. I am not one of them. 🙂

  7. PJ O’Rourke had a great take on this, based on Milton and Rose Friedman’s “Free to Choose”:

    When you spend your OWN money on YOURSELF, you buy a used set of Pings at the second-hand golf shop.

    When you spend your OWN money on SOMEONE ELSE, you get them a greeting card or something trivial that was on sale.

    When you spend SOMEONE ELSE’S money on YOURSELF, you get the most expensive brand new space-age clubs on the market.

    And when you spend SOMEONE ELSE’S money on SOMEONE ELSE – you end up getting diamond-encrusted wheelchairs for Olympic athletes, and subsidies for fur-bearing trout farms. It doesn’t matter what it is, how useful it is, or what the **** it costs!

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