My father practiced medicine for 40 years in Lexington, Kentucky. As recently as the early 1960s, he made a good living (NOT extravagant – I wore plenty of hand me down clothes and went to public schools) while charging very affordable prices for his services. When Medicare was enacted in 1965 he warned everyone that it was the beginning of the end of our great health care system.

My dad used to care for many poor people. He and the hospital where he worked never turned anyone away. Most of these people had no kind of health insurance. If they could not pay their (single page, very understandable) hospital bill when they were discharged they could just set up a payment plan. My dad got as little as $5 a month from some patients. Sometimes he even took farm products as payment. We always had lots of fresh vegetables and fruit, and once even got a side of beef! And often he would simply forgive the charges entirely and just take it as a tax write-off.

In the 1970s, two things happened that changed everything. One, he got sued for malpractice, and two, the IRS told him he could no longer write off unpaid bills unless he hired a collection agency and made at least three attempts to collect the payments. His malpractice insurance premium went from $10,000 to $90,000 a year in ONE year. The hospital told him he could not practice there without it. And he had to hire a full time secretary and a collection agency to try to collect the payments he used to forgive for his poor patients. The cost of his practice literally quadrupled in two years. He had no choice but to raise his rates substantially as a result.

Meanwhile, people started living longer and longer and having more and more health problems in old age. Malpractice suits and IRS rules forced doctors to increase rates. Doctors and hospitals started ordering more tests, using more expensive disposable products and new technology to cut down on lawsuits. At first, Meedicare paid for all of this for elderly patients. As prices rose and collections became more aggressive, younger people who formerly were able to pay medical bills as they arose couldn’t, and started demanding more health insurance from their employers. As third parties started to take over payments for medical care, nobody had any incentive to keep costs down.

Soon enough, some doctors hit on the idea that with all this cash going though the system they could make more money by owning hospitals than by practicing medicine. Thus the profit motive was introduced into health care. Previously non-proftit hospitals were bought by the Humanas of the world, and they started paying doctors more so they all moved to the for-profit hospitals. The non-profits could not keep pace without increasing their prices. Somebody else was paying the bills, so nobody cared. This led to a further price spiral as the new companies sought larger profits.

Then in the 1980s, Medicare costs really started to skyrocket, while the federal deficit became critical. The government responded by cutting reimbursements to doctors and hospitals. So the providers had to start charging even more to non-Medicare patients to make up for the lost income. They have had to cut their patient examination times, limit hospital admissions and shorten the length of stays, and do all sorts of other cost cutting which has continually worsened the patient experience.

This has continued to the point that the government now pays only about 20% of the actual cost of most procedures for Medicare patients. The Medicare reimbursement schedule is larger than the entire U.S. tax code. Bills are incomprehensible. Doctors have gamed the system by committing massive fraud, charging for procedures not performed and visits not made. The average patient can’t figure it out and doesn’t care anyway since he isn’t paying the bill. My dad goes crazy every time he has to have a procedure because of all the bullshit on the bill that he knows wasn’t done. He has turned in 5 doctors for fraud. Doctors used to be the most honest and trustworthy people in the world. Our government has turned them into crooks.

The entire reason your health care is so expensive and such a lousy experience now is because Medicare and Medicaid costs have spiraled to the point that the government has had to cut the reimbursements and you make up the difference.

NNtrancer on April 26, 2008 at 1:33 PM

Thanks for the clarifier. Basically, I agree with you, but homeschooling … is big, big, big in Arizona. We home school our three kids where they learn personal responsibility.

The embedded nanny state union won’t help. I think it’s our individual responsibility to educate our children. Not strangers. Look where that got us.

AZ_Redneck on April 26, 2008 at 1:05 PM

I didn’t say the schools should be run by the government, although it’s difficult to forsee any other option. But there’s always private and home schooling, although as a practical matter, they won’t engage large numbers of children even if the political will were there because of economic reasons.

By the way, I blame the left for destroying this country. And it comes down to three pernicious ideas they’ve sold to the citizenry:’

1. It’s not your fault. You’re a victim.
2. The world owes you a living.
3. If it feels good, do it.

A nation full of babies who can’t care for themsevles.

EJDolbow on April 25, 2008 at 9:23 PM

We already have both.

Keemo on April 26, 2008 at 11:01 AM

I identify this as an “Intolerable Act”. One of many to add to the ever increasing mountainous pile.

The populace has been conditioned like so many rats to expect a handout if they pull the voting lever.
NNtrancer on April 26, 2008 at 12:48 PM

I agree with the premise, but disagree with the statement below.

It’s time that schools taught children what it takes to be functioning adults.

The embedded nanny state union won’t help. I think it’s our individual responsibility to educate our children. Not strangers. Look where that got us.

1> My parents work their entire lives in retail; paying into the system for some 58 years before retiring at the youthful age of 80 years old. My loving parents put away some decent money and continue to pay taxes on interest earned. My parents are now 86 and are facing the end of their wonderful lives. When God takes them, their will kicks in and myself and my brothers will get our inheritance minus this wonderful thing called the “death tax”, where the nanny state mafia will tax these funds that have already been taxed every year for the life of the funds!

2> I work my entire adult life, paying taxes and being a part of the system. I retire and start collecting my SS that I paid into for my entire adult life. Let’s just say that my wife and I get killed in a car accident; who gets the money both of us have paid into SS our entire working careers..Our kids? Relatives? NO; the government keeps our SS funds upon our deaths.

Screw this nanny state bullshit! Scam artists, everyone of them!

Same with gun control; its not about safety its about disarming the public to keep them from fighting back as was done during segregation against blacks in the south (by Democratic state governors and legislatures).

BTW, G.K. Chesterton makes his appearance four times in Goldberg’s book. Chesterton was against eugenics and suffered high society’s public scorn on that account. Thanks again for bringing Chesterton to our attention at HotAir.

For all of her good intentions, Hillary will ruin America “for the children”. She has leveled the playing field of life by defining children as citizens and citizens as children in order for the government to own children more absolutely than parental rights. From Hillary’s onset, her motive has been indisputably radical left-wing revolutionary repackaging of the progressive movement’s Social Gospel. The Clintons BOTH provide America with fascistic maternal “protection” via governmental “concern” for “the children” expressed and performed through programs; those programs serve Hillary “as an infallible index of progress”. (Goldberg p349 references Christopher Lasch, “Hillary Clinton, Child Saver.” Hillary (It Takes a Village) “argues for interventions on behalf of children from literally the moment they are born” (Goldberg, p350). Utilizing the fascist’s creation of crisis in order to manipulate the public’s assent, Clinton and cohorts equate childhood as a crisis situation that requires the “We the People” government to socially engineer the creation of the “new century’s ideal children” wherein traditional bourgeois standards are BAD, not good for children, and exlusive maternal attachment will seem dysfunctional. “By defining the intellectual status of children up, she is simultaneously defining down the authority and autonomy of adults. In a world where children are indistinguishable from grown-ups, how distinct can grown-ups be from children?” (Goldberg p353-354).

On REFLECTION, “some lawyers associated with a politics-of-meaning perspective [] envision a second stage of trials, in which the adversary system is supended and the focus is shifted to healing the problems and pain that the initial trial has uncovered in the community.” (Goldberg, 334 quoting Michael Lerner, The Politics of Meaning: Restoring Hope and Possibility in an Age of Cynicism.)…if there is ever a fascist takeover in America, it will come … with lawyers and social workers saying, “I’m from the government and I’m here to help.”

Today in Texas I shudder to see that Hillary’s mindset enjoys bipartisan practice as enforced today. How did 413 grow to 463 children removed at once from Eldorado homes, denied contact with mothers, forced by the state to be quarantined in centers for juvenile delinquents as the Governor boasts that his state is fully equipped to handle the crisis?

The arm of Hillary’s Big Brother and Big Sister is long, and the strength of the well intended hug suffocates the victims.

The original format that our government utilized against polygamy was to prosecute and directly remove only the men practicing plural marriage. THAT in and of itself motivated the majority to declare monogamy thereafter. The results of THAT are seen in modern Mormon strong families. True, only the most obstinate men refused to relinquish the brutal practice of polygamy, supplanted by the most obstinately “meek” subserviant women. But even Jesus blessed the meek to inherit the earth. So our “modern” government’s fascistic exercise of authority over the women and children of Eldorado does not really enjoy the moral high ground as the children AND the mothers are the easy prey of over-reaching governmental institutions and personalities in power. And what comfort does the public “home for children” spokeswoman give to those concerned that the children have been hijacked from home? “The children are resilient.” By that reasoning, the children’s resiliency would provide basis for them to remain (RETURN) home with their mothers while, if anyone must be arrested, the fathers be removed as the perpetrators of abuse.

Baby snatching is hardly what America’s Constitution was written to promote!

I just finished watching the excellent HBO series John Adams last Sunday. It tells the story of our nation’s birth and the sacrifice many of our founders made to create a free nation. They wanted a nation with government limited to just enough power to keep the peace and defend the nation. They didn’t conceive of the idea that a free people would trade their fortunes and freedom to create a government that would dictate choices to them in a manner far more egregious than George III.

Actually Ed, in Conscience of a Conservative, Goldwater opines that yes, the Fathers did predict such a thing (allthough perhaps not specifically a welfare system).

Hope some conservative blogs cover this as it may be our only hope.

yeap you hit the major points. good post. the government has done the same for college costs.

loganthompson on April 25, 2008 at 9:30 PM

Government has eliminated any concept of supply and demand or free market principles to the medical profession. Also as some others noted, there is no reason for people to look at bills anymore since they are just ‘taken care of’ by insurance.
For example, if a new dentist trying to get patients wanted to have a standing policy of charging only $25 he’d get screwed. They can offer ‘first time patient’ deals, but in most areas of the country he would be fined or worse for trying to get in a little cheaper.

Also, add in the mandatory malpractice coverage that is jacked up beyond belief adding to costs and the utter indifference to tort reform by anyone in the legislature which would bring prices WAAAAAY down if a pediatrician didn’t have to carry $40 million in insurance in case he accidentally prescribes an antibiotic that doesn’t work because of the utter willingness of the courts to award exorbitant awards for even the most minor of grievances.

Look no further than the 50′s and 60′s. If you had a minor surgery, it pretty much never cost you more than 1 weeks pay. You get your tonsils taken out now and it’s $20K easy. Government has priced people out of the game and priced the insurance racket in.

great reads and videos. this is where i send my friends that are socialist friendly, or just ignorant. of course they say i lack compassion for the uninsured.

Excuse me if I’m being stupid again, but I thought that freedom and opportunity go hand in hand as a means of possibly obtaining ones goals or needs – not a guarantee?

OldEnglish on April 26, 2008 at 1:01 AM

Not stupid, just old fashioned. Welcome to the New Way, where all of your needs will be provided for you in exchange for your freedom—-That is, until such time as you become accustomed to the yoke around your neck, when your needs will be traded for the privilege and luxury of those who control your reigns.

All hail the elite!

FloatingRock on April 26, 2008 at 2:01 AM

Oh, you mean Communism? Well, that’s cleared that up. As far as I’m concerned, they can go visit a taxidermist!

Medical care is so expensive because of gov’t involvement.

jgapinoy on April 25, 2008 at 9:13 PM

Excuse my niavete, but I hear this all the time and I’m pretty sure it’s true, I just don’t know the specifics of why. I’ve never really had it explained I guess. Anyone care to take on the challenge?

loganthompson on April 25, 2008 at 9:30 PM

Apologies in advance for beating a dead horse…

Medical care in the US is a government cluster-frak from top to bottom.

First, there is a government-sanctioned monopoly on health care — only doctors can prescribe drugs, holding oneself out to be a doctor without being one is illegal, etc. One could say that this serves a quality control function, except that….second, the government limits the supply, in that most medical programs at public universities turn away applicants by the score.

Third, the government has intervened in the drug market such that it costs millions to qualify new drugs with the FDA. This means that the payoff for any such concoction has to be evaluated against the barrier to entry.

Fourth, public health care has been warped from an emphasis on prevention to an emphasis on crisis management. Prevention just isn’t “sexy” enough to fund when there are alternatives like bridges to nowhere or office buildings with legislators’ names on them.

Fifth, medicare has led a generation to believe that health care is not their problem once they reach a certain age. Food is. Housing is. Health care is not. Go figure.

Sixth, by giving employer-provided health care a special status in the tax code, combined with significant marginal tax rates on the middle class, the government has forced everyone to look at health care as an employment issue disconnected from their core behaviors. You can drink and smoke and shoot up and play nasty games with infected people in between your extreme sports….but as long as you drag your carcass in for the ol’ 9-to-5, any health issue you have is someone else’s problem.

Seventh, by allowing anyone who suffers or dies for any reason to successfully assert negligence by the medical community, the government has put their massive thumb on the scales of medical judgment. If you get the sniffles, expect a blood workup, CAT scan, MRI, and three visits to specialists.

Eighth — Y’know, this is getting old. In the US, there’s bandaids on bandaids on bandaids on bandaids, of failed or failing government policies. Fundamentally, you should be able to go to a medical help facility and know how much you’ll pay and for what — not have it hidden in payroll withholdings or income taxes paid, inflated by mandated administration costs….and you should have enough knowledge of the doctor’s reputation to be able to assess the likelihood of negligence.

From a Dailykos poll of commenters -

Would you support or oppose a law requiring a nationwide ban on semi-automatic handguns?

Strongly support 1216 votes – 54 %
Somewhat support 255 votes – 11 %
Somewhat opposed 279 votes – 12 %
Strongly opposed 416 votes – 18 %
No opinion 45 votes – 2 %

Occasionally, over the last three and a half years or so, my mother has had to use oxygen. She doesn’t need it constantly, just once or twice a month for a couple of hours.

Medicare (that is, the taxpayers) has been picking up the tab for her oxygen concentrator until a month ago when I bought her own machine. They (Medicare) have been paying $435 a month for a machine that retails for less than $800 new, and under $500 used/re-certified for medical use, and two hundred bucks or so off eBay, not certified, but completely functional and safe…
So, so far the taxpayers of America have paid over $14,000 for her occasional use of a machine that could have been purchased in quantity for about what they pay for one month’s use.

Then there is her medication. She has a lot of chronic but not life-threatening problems, and the taxpayers are paying for 8 prescriptions; Let me just tell you about the newest medication: An anti-psychotic prescribed just because of one kind of odd episode that upset the people at her nursing home: (she is back home now with me providing full time care) Medicare paid $600 last month for some pills that I can purchase at my local pharmacy for cash for $218.00. I haven’t been able to get a precise breakdown on all of her medication, but I’d estimate you suckers are paying about ten thousand dollars a month for pills that would actually cost about a thousand dollars a month if I paid cash for them.

And you morons want government to take over ALL health care for everyone, ‘cradle to grave’???

Doesn’t the fact that socialistic medical care costs ten times as much money and provides 1/4 the level of service bother you just a bit?

I mean, really, our medical care administrative system is definitely broken, but do you, as a taxpayer, really want to have your tax rates doubled or tripled to add another level or two of government bureaucracy to take care of people you don’t know or even particularly care about in any personal way???

Excuse me if I’m being stupid again, but I thought that freedom and opportunity go hand in hand as a means of possibly obtaining ones goals or needs – not a guarantee?

OldEnglish on April 26, 2008 at 1:01 AM

Not stupid, just old fashioned. Welcome to the New Way, where all of your needs will be provided for you in exchange for your freedom—-That is, until such time as you become accustomed to the yoke around your neck, when your needs will be traded for the privilege and luxury of those who control your reigns.

All hail the elite!

Medical care is so expensive because of gov’t involvement.

jgapinoy on April 25, 2008 at 9:13 PM

Medical care is so expensive because of liberal litigation.
Like 30-40% more.

The man who prefers his country before any other duty shows the same spirit as the man who surrenders every right to the state. They both deny that right is superior to authority.
Lord Acton

“Government is not reason, it is not eloquence, it is force; like fire, a troublesome servant and a fearful master. Never for a moment should it be left to irresponsible action.” —George Washington