Video: The Lasik reform for health care
posted at 10:55 am on December 2, 2009 by Ed Morrissey
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Personally, I think Reason.tv missed a great opportunity with its latest must-see video on health-care reform. Nick Gillespie looks at Lasik, the elective surgery that corrects vision through corneal laser treatments, as a model for real reform of the system. Instead of pursuing more third-party interventions, we should be removing third parties and reintroducing normal price signals for the health-care market. That would not only reduce costs, but it would also increase supply and make demand more rational:
I’ve made the same argument a few times on the blog, and Reason does an excellent job of presenting it. So why do I think they missed an opportunity? The same argument can be based on the cosmetic-surgery market, too. Most cosmetic surgery does not get covered by insurance, and as a result, providers compete for customers, customers get clear price signals, and providers rush into the market to fill demand, lowering cost and improving technology. Instead of showing eyeballs, Nick could have been showing — well, you can use your imagination.
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ObamaCare: Lots More of the Same
Rae on December 2, 2009 at 11:03 AM
Um, Ed, I tend to think that doing that would tend to discredit the message. Well, with most people, anyway.
I suppose someone else could go for the more dirty angle on there own…
Count to 10 on December 2, 2009 at 11:03 AM
For shame, Ed. This is a family blog!
Nah, you’re right, missed opportunity.
warrenmr on December 2, 2009 at 11:03 AM
Much better to have absolute control than a bunch of hayseed bubbas asking for the cost. The premise here is that only the government in healthcare can insure our best interest.
I had lasik and there was a 100% difference in prices, and ultimately found out that the surgeons were using the same machine at the surgical center. Of course this would now be banned under ObamaCare.
Starlink on December 2, 2009 at 11:03 AM
Supply and demand.
Johan Klaus on December 2, 2009 at 11:03 AM
Let The Individuals have a say in the pricing……..
hawkman on December 2, 2009 at 11:04 AM
You are correct, Ed; A discussion of price factors of boob jobs would be much more marketable as a video. ‘Enlarging the supply’??
michaelo on December 2, 2009 at 11:05 AM
Your point is well taken, Ed, but on the other hand perhaps this was not the best day for a cosmetic surgery analogy in view of the news of the Argentinian model’s death following butt enhancement surgery. Not that the one case invalidates any argument, but more people respond to emotion than to reason.
jwolf on December 2, 2009 at 11:05 AM
No way! My perfect eyes are way better than a boob job.
sammypants on December 2, 2009 at 11:12 AM
I love my Lasik
I had it after I had cataracts removed (at 35!!)
in Canada people are on a list to have cataracts removed
there is a GREAT interview on medical innovation and the dangers of killing it in the health care bill with a Venture Capitalist who funds innovation here
With Harry Rein Foundation Medical
best discussion I have seen anywhere of why the bill will hurt innovation
ginaswo on December 2, 2009 at 11:13 AM
Glad to see you’re keeping abreast of this situation.
rbj on December 2, 2009 at 11:14 AM
and frankly I do not consider this cosmetic!
same for contacts
when youo are legally blind and totally myopic it is Medical not cosmetic
I can even DRIVE now
depth perception and everything!
I mean I paid for it out of pocket but frankly people should be able to see farther than a foot in front of them
this is IMO nothing like getting beauitful
ginaswo on December 2, 2009 at 11:15 AM
There is an enormous problem with both Reason‘s and Ed’s ideas, so big I can’t believe they even saw the light of day: they’re about increasing the quality and decreasing the cost of health care. The Democrats have proven they’re not interested in that—in fact, they don’t care about it at all. Otherwise, Ed and Nick, good job. Just remember who you’re talking about…!
WesternActor on December 2, 2009 at 11:16 AM
Lasik is a beneficial surgery to correct a physical defect. It is the more appropriate example to make the point.
I had lasik and now need a redo. Great while it lasted, though.
ROCnPhilly on December 2, 2009 at 11:17 AM
One excellent point made was that all other basic necessities – food, shelter and clothing – are all left open to the free market. There really is no reason why the free market wouldn’t bring down the cost of health care drastically as well as the cost of catastrophic insurance. If most Americans were using an HSA we’d see a real revolution in health care reform.
gwelf on December 2, 2009 at 11:20 AM
Showing what? Joy Behar? I’ll stick with the eyeballs, thanks.
WesternActor on December 2, 2009 at 11:21 AM
Great video. As for the cosmetic surgery argument, the Lasix Doctor mentioned hair transplants so that topic was covered. But for the most part, when it comes to the best way to advance a serious argument,I think it helps to, er, focus on curative procedures like Lasix instead of of appealing to vanity.
Buy Danish on December 2, 2009 at 11:25 AM
Ed just wanted to see boobies.
lorien1973 on December 2, 2009 at 11:26 AM
I know what direction you were going but all I can think of is somebody pricing out Pelosi’s face based on third-party pricing and what the same face would cost under Obamacare.
highhopes on December 2, 2009 at 11:33 AM
John Stossel made the same point about veterinary care in Canada. Unlike care for humans, the veterinary care is quick, friendly, high-tech, and affordable, because if you’re not happy with how your pet is being treated, or think you’re getting ripped off, you’ll go down the street to the competitor.
RBMN on December 2, 2009 at 11:34 AM
Hair implants?
TexasDan on December 2, 2009 at 11:35 AM
Great video, Ed. And with CVS as well as Wal-Mart getting into the routine clinic business, the free market approach has never looked better!
Webutante on December 2, 2009 at 11:37 AM
Or another excuse to post a picture of Nancy Pelosi.
gwelf on December 2, 2009 at 11:37 AM
Now. Now. I’m sure Ed was talking about nose jobs and tummy tucks. Right, Ed?
tims472 on December 2, 2009 at 11:37 AM
Are we thinking here that oncologists and cardiologists will start taking out newspaper ads and bidding against each other? “Buy one round of chemo, get the second round free”?
Lasik and boob jobs are optional surgery where people have all the time in the world to shop around. The most costly portions of medical care are not and so the market is very different.
“Wait Mr. EMT! Don’t take me to Providence Hospital! I hear they’re having a special on gunshot wounds at GW!”
Bleeds Blue on December 2, 2009 at 11:44 AM
Ed,
This is a great video. Going to show to my liberal friends.
To prove this point even more look at the health care in Argentina (the land of the beautiful people). They not only include cosmetic surgery in health care but the government actually gives money to encourage it. Compare the costs of Argentinian cosmetic surgery with that of the U.S. Unless patients do get to choose for themselves rather than the government I bet there is an expected difference.
shick on December 2, 2009 at 11:47 AM
In the days before everybody’s employer was their insurer, people paid for the small stuff (e.g. setting a broken bone) out of their savings, and had “hospitalization” insurance for big operations not related to a car accident, which you had different insurance for. So, people did shop around for family doctors, partly based on price, and mostly by word of mouth.
RBMN on December 2, 2009 at 11:54 AM
in the interview with Harry Rein I linked above, he explains the entire basis for the Orrszag plan is misplaced
Orszag is focusing on FIRST COSTS which Rein points out is backwards
first costs are always high, innovation at first is expensive, like a walkman in 85
then the cost comes down as usage is expanded
by forcusing on cutting FIRST COSTS Orszag is basically eliminating innovation
ginaswo on December 2, 2009 at 11:55 AM
That would be fine. But the small stuff is not what’s driving costs these days.
Bleeds Blue on December 2, 2009 at 11:56 AM
actually if we knew what the charges were I think we would all haggle for a better price
as a medical claims adjuster even WE did not know the costs
they are coded by contracted rates by CPT (procedure) codes
so an initial office visit 99205 could be 120.00 UCR (Uusual, reasonable, customary rates) and out of network the insurer would allow what the UCR was for that zip code
so an Upper East Side MD is gonna get more than an MD in Mesa AZ for example
BUT the key is the UCR Db are all propietary info the consumer cant see and is established by surveys by who? yeah the same insurers
Andy Cuomo and Eric DiNallo the NYS Insurance COmmish recently settled a lawsuit against the insurers on this data
ginaswo on December 2, 2009 at 11:58 AM
bleedsblue
lol!! I used to tell my buddies when we were teenagers ‘if something happens dont let them take me to Jamaica Hospital’
cuz even as kids we knew the service there was awful
ginaswo on December 2, 2009 at 11:59 AM
The problem is, when you’re not paying yourself, and the doctor knows that someone else is paying your bill, there is no “small stuff.” Everything costs a fortune now. Also, blame the ambulance chasers. That’s the other big problem.
RBMN on December 2, 2009 at 12:02 PM
I’m actually OK with reasonable tort reform (though I think the benefits would be less than a lot of people expect).
I think another big problem is fee for service. Were there a way — as some hospitals and medical systems are exploring — to basically put doctors on (an appropriately high) salary rather than paying them for piecework, you’d derive some of the same benefits that tort reform is expected to deliver.
As a side note, I think that if McConnell told Reid: OK, you’re going to get this bill through anyway, I’ll give you four RINOs for political cover if you give me tort reform” Reid (and Obama) would take the deal in a minute.
Bleeds Blue on December 2, 2009 at 12:13 PM
I’ve argued this point for years. It’s simple common sense. Health care is expensive for the same reason housing and higher education is expensive. When someone else is subsidizing the cost — be it a bank, an insurance company, or the government — the cost goes up. When individual are responsible for the bottom line, the cost goes down because people start paying attention. It’s so simple that it’s mystifying that the left can’t grasp the concept.
This was a good piece from Reason. I think they will catch flack for not offering a solution for people who have pre-existing conditions tho. To me, this is one of the discrete problems in otherwise sound system that needs to be addressed as opposed to overhauling the entire thing. Other than that, it was all spot on. I am esp. supportive of the call to make extend favorable tax treatment to those who are in the individual market (like me) and not getting coverage through an employer.
NoLeftTurn on December 2, 2009 at 12:21 PM
Why wouldn’t you shop around for oncology or cardiology treatment? Your emergency care example with a gunshot wound is has nothing to to with either of those.
I know often people are limited by which carecenter can offer the treatment, we ran into that ourselves last year with heart surgery. But baring that, why not? I would.
Also, much of what Obama rails against is elective surgery such as the total hip replacement story he tells.
jhffmn on December 2, 2009 at 12:36 PM
I believe the Mayo Clinic is putting doctors on salaries to good effect.
Regardless, this “public option” thing continues to be a sticking point. It’s just a bad idea.
TheUnrepentantGeek on December 2, 2009 at 12:41 PM
Boobs, Ed? Why would we want to see more Democrats…I don’t get it.
DakRoland on December 2, 2009 at 12:41 PM
So, I’m going to take my non-existent medical training and evaluate my oncologist based on price? “This guy’s survival rate is 5% higher, but he costs 40% more, so I’m going to go with the other guy.” I don’t think so.
How am I qualified to judge the effectiveness of my oncologist. It’s not like I can go on a test drive and any stats are going to be unclear to the layman at best.
And, aren’t you just talking about rationing?
Bleeds Blue on December 2, 2009 at 12:45 PM
This is too rational.
The politicians support Obamacare because it gives them more power. The people who support those politicians support them because they want someone else to pay for their care and would rather spend their money on a new TV. To either group, it’s not about lowering costs.
johnmackeygreene on December 2, 2009 at 12:53 PM
No, rationing is the government telling you you can’t have it and that’s that.
This is your wallet telling you that you can’t have it right now but you can in the future if you can afford it, so you go shopping and find some way to afford it.
Go make that silly dishonest conflation somewhere else, like, ummmmm, I don’t know, an economics class.
johnmackeygreene on December 2, 2009 at 12:56 PM
Do you have anyway to evaluate your oncologist now?
Also, am I talking about rationing? Not in the least. I’m just pointing out that Obama blames elective (unessesary as he calls it) surgery for the cost of healthcare increases. This thread is arguing that lasik offers a model for controlling the price of elective surgery.
Not I believe this debate has anything to do with actually lowering the cost of healthcare as evidenced by the Obamacare bill’s failure to include any real strategy to lower the cost of healthcare.
jhffmn on December 2, 2009 at 1:02 PM
Speaking of ‘boobs’. When Obama sez at the end of the vid: ‘…consumers do better when there’s choice and competition.‘, Nancy Pelosi jumps to her feet in applause to lead the standing ovation of hypocrites. What a boob that woman is!
.
martywd on December 2, 2009 at 1:03 PM
I did too, and I also needed a redo. Which is why I paid a little bit more per eye for the lifetime warranty. If I ever need an adjustment I just set the appointment and get it done free of charge.(so to speak)
exsanguine on December 2, 2009 at 1:08 PM
Nick wanted you to remember something about the topic:
“I saw this great Reason video about healthcare. It said…um…uh…something…
Great video though.”
eeyore on December 2, 2009 at 1:14 PM
“Unnecessary” surgery and “elective” surgery are entirely different animals. “Unnecessary” is when a doctor takes out your tonsils when they’re inflamed not because they won’t clear up on their own but because he’s padding his bill, he’s covering his butt, or he decided that it was easier than listening to you whine.
But, on the rationing.
The only way to make people shop for medical services is to increase the cost to them. We all agree on this, right?
Now, if a millionaire decides to have hip replacement surgery and gets it, while you’re old granny who worked hard all her life can’t get it, because she’s on a fixed income and might need the thirty grand, that’s the market at work.
But if we socialize medicine, the millionaire gets his hip replacement, and granny gets her hip replacement but has to wait six months, you call that “rationing.”
What’s the effective difference (except that in once case granny actually gets her hip)?
Bleeds Blue on December 2, 2009 at 1:18 PM
Perhaps not the newspaper ads, but otherwise, indeed yes. If you shop around to find the the cost of the same treatment is considerably less from one doctor over the other, which will you choose? Despite the seriousness of their profession, doctors are service-providers like any other–no different from the guy who cuts my grass or the ladies that clean my floors, a plumber, a lawyer, whatever. I shop around for the features I want at the price I want to pay, and I hire that person for the job. Why should medicine be any different?
Bob's Kid on December 2, 2009 at 1:26 PM
Except in the future, there will be a whole lot less millionaires to pay for any of your utopian social programs. People will do without in what looks to me to be a very dark future if the world keeps on this track.
hawkdriver on December 2, 2009 at 1:30 PM
Actually rationing would be, after calculating granny’s QALY it’s determined not to be cost effective to give her a hip replacement. Maybe she only has a few months to live, or a few years, or she is just too old then no hip replacement for her.
That’s healthcare rationing.
jhffmn on December 2, 2009 at 1:32 PM
Kaiser does too, as well as taking care if the whole malpractice issue–which is huge.
I belong to Kaiser and am presently undergoing cancer treatment for the second time in two years. Last time, the hospital nearest me didn’t have the sort of nuclear medicine facilities that I needed, so I went to a hospital across town. I had a choice of going up to Sacramento or out to Roseville, I chose the closest one. This time there’s a nuke med department at the hospital nearest me, so I’m going there–but I could have gone back up to Sacramento, out to Roseville, or even down to Stockton if I wasn’t happy with my other choices. If Kaiser didn’t do this type of treatment at all, they would have sent me out of system without any additional cost to me. I’ve always had plenty of choice in my health care decisions, so it’s a good model for making things simpler and less expensive.
With that said, many people do not like Kaiser–fine. They should be able to shop around for the type of health care they do like and can afford. But they should be able to choose, not a government bureaucrat. If they want to be treated by a doc at the Mayo Clinic who is salaried, great. If they want to be treated by an NP, that’s great too. One size definitely does NOT fit all.
Bob's Kid on December 2, 2009 at 1:42 PM
I’m not a mechanic, far from it. I haven’t a clue. Or a veterinarian, or a lawyer, or a contractor. But I certainly am able to do a little research to find one that suits my needs. I’m guessing you’re smart enough to do that too.
When dealing with the human body, averages and percentages mean little when it comes down to you personally. A doctor’s stats don’t mean anything because your body is not going to necessarily react predictably to treatment. And to be honest? Most ailments don’t even need a doctor to administer them because there is well-defined standard protocol for–well, for most everything–that almost all doctors follow as best practice. Even a caveman could do it. It’s what everyone does first no matter how they practice. The head-scratching might come in later, but with a little bit of practice, most diagnoses aren’t rocket science.
Bob's Kid on December 2, 2009 at 1:53 PM
That’s the trouble with a hypothetical question. It’s divorced from reality. In socialized medicine, granny is a lot less likely to get her hip replacement, 6 month wait or not. Under the current system, there are other ways to work it.
I could just as easily say that granny gets her hip replacement because a doctor agrees to write off the rest of her bill after health insurance pays. It’s no less likely than granny waiting 6 months for a hip replacement under socialized medicine.
tom on December 2, 2009 at 2:08 PM
You are exactly right Ed. Too bad congress is so far removed from market dynamics that they are getting ready to drive the economy off a cliff.
There are a lot of good ideas for reforming health care. Nancy Pelosi has none of them.
dedalus on December 2, 2009 at 2:27 PM
So, I’m going to take my non-existent medical training and evaluate my oncologist based on price? “This guy’s survival rate is 5% higher, but he costs 40% more, so I’m going to go with the other guy.” I don’t think so.
How am I qualified to judge the effectiveness of my oncologist. It’s not like I can go on a test drive and any stats are going to be unclear to the layman at best.
And, aren’t you just talking about rationing?
Bleeds Blue on December 2, 2009 at 12:45 PM
No silly, you don’t need to know everything, you just need to have friends- you ask around! You do research on the Internet. We needed an autism doc. We could go local and so so or drive to Florida, pay thru the nose, and get the best in the country. Autism is another good example of this- regular insurance doesn’t cover the treatments that work, so families decide how much treatment they want for their kids. We chose the spendy, Floirda doc and got superb treatment. Others choose to do nothing. It is up to the individual to choose.
Kristamatic on December 2, 2009 at 3:47 PM
To use a favorite expression of Obama’s: they have no skin in the game. Obama and the legislators voting on the health care bill will never use the medical system they are trying to create. They have insured that there is a high quality system of care for themselves. Thus they feel no need to worry about the quality of the health care the bill will provide. I doubt that very many of them even intend to be in government by the time major and widespread backlash for their legislative incompetence materializes.
snaggletoothie on December 2, 2009 at 4:02 PM
Ed rules! Glad you filled the void after Brian departed…
MechEng5by5 on December 2, 2009 at 4:30 PM
Why do we need ins. for ingrown toenails or flu shots? Do we have car ins. for oil changes? Ins. should be for catastrophes.
jgapinoy on December 2, 2009 at 5:21 PM