You can't take it with you (Or why dying people aren't smart consumers)
by digby
From the annals of bad punditry, I bring you an excerpt of This Week with George Stephanopoulos:
BRILL: Well, if you put Medicare in the context of the larger health care system, and this is something that everybody at this table is going to think that I should go to a mental hospital when I get finished saying this, the government and all of us would actually save money if you lowered -- I said lowered the age for Medicare. If the Medicare age were 60 instead of 65, the economy and the taxpayers would actually save money. And George, please don't look at me like that.
RATTNER: You're potentially right. And part of the argument -- you're taking people out of the Medicare age to 67 is you're taking people out of the Medicare system.
BRILL: Right. And what you would be doing, is you would be putting the most efficient player, which is Medicare -- Medicare spends 80 or 90 cents to process a claim and the health insurance companies spend $18 or $20 or $25 to process a claim. Health insurance companies pay two, three, four times what Medicare pays for various services. So if you lowered the age, you would put more people into the bucket of much more efficient health care.
And the worst part about it is, the reforms that we have now, with the president's plan, are actually going to raise the costs because all of the people who are 60, or 62, or 63, who can't afford the premiums that they're going to have now, are going to be subsidized by the taxpayer.
STEPHANOPOULOS: George, well that becomes an argument for a single payer system.
WILL: That is one argument.Here's an argument against that, for a different kind of reform, all the big numbers, billions and trillions, 12 cents is the most important number. 12 cents is the portion of every health care dollar paid by the person receiving the health care. Someone else is paying the rest. It was 47 cents 50 years ago when Jack Kennedy was president.
Now, let me ask the five of you a question, you go to the doctor and he or she says they say I want to give you the following test? How many of you five say, how much does that going to cost?
BRILL: Give me two.
WILL: Don't bother, because the doctor can't tell you anyway.
BRILL: George, you're completely wrong. We have tried that experiment with 30 million to 50 million Americans who don't have health insurance and have to pay 100 percent right now. And they have no choice, they are powerless consumers. If you go to an emergency room and a doctor says you need a CA Scan, and the doctor may not even say it, they may just do it, you're not sitting there as a consumer saying, gee, I wonder if this is the most efficient emergency room. I wonder if I really need that CAT scan.
STRASSEL: No, we haven't, because we only have a small group of Americans who are doing that. We have a much larger group of Americans, like George says, who are getting their health care through their companies and it's largely paid for them and they have no skin in the game.
The important part about your piece was that you mentioned that this is a seller's market. There's no transparency in the market. There's no competition. There's no ability for consumers to look around. We spend hours deciding which toaster we're going to buy. We put no such thought or work into where we're going to get our health care. And you have had companies like Safeway who worked with their employees to introduce some transparency. And you've seen a big reduction in health care costs.
BRILL: There's a difference between buying a toaster and buying a CAT scan.
RATTNER: This is a huge moral question for the country, because I agree with George, that right now, most Americans do not see price in deciding whether to use health care. You see price in toasters, you see price in cars and homes, everything else. In health care, you don't see price. And therefore, I have to believe, and I think your piece eluded to this, that when people go on Medicare, they really don't see price, they tend to consume more than they otherwise would.
26 percent of all Medicare spending is last year of life. We don't know how much of that is really efficacious spending. These are really tough moral questions for the country. But we're going to have to deal with them if we're really going to get health care under control.
First of all, let's make note of the sad fact that Stephen Brill feels it necessary to note that people at the table will want to send him to a mental hospital for suggesting that we ought to lower the medicare age. What a sad comment on our time.
But get a load of George Will's argument. He truly believes that patients are consumers in exactly the same way as toaster shoppers. Why, if only we had a list of prices we could shop around for the cheapest deal on our heart surgery. (Personally, I tend to wait until things come on sale so I sure hope I don't drop dead before I at least get a coupon!)
I had thought we had already had this debate and most of the right wingers had realized they lost the argument. But that was far too optimistic. Apparently, it will never go away: they think the problem with our health care system is that people aren't paying enough for it. If they paid more, they wouldn't use it so much and costs would shrink. I'm not sure how you deal with the problem of people not having enough money to pay but I'm going to guess that Will believes this is the natural way of things and the great Invisible Hand of God will intervene if someone really deserves to live. The most important thing is to rein in all that superfluous medical spending that people are using just because it's so much fun to have tests and procedures we don't need. I do love a good colonoscopy but if I had to pay for it in cash, I might think twice about getting them done more than once every five years. Fingers crossed!
But as dumb as George Will's solution is, it pales in comparison to Steven Rattner's:
This is a huge moral question for the country, because I agree with George, that right now, most Americans do not see price in deciding whether to use health care. You see price in toasters, you see price in cars and homes, everything else. In health care, you don't see price. And therefore, I have to believe, and I think your piece eluded to this, that when people go on Medicare, they really don't see price, they tend to consume more than they otherwise would.
26 percent of all Medicare spending is last year of life. We don't know how much of that is really efficacious spending. These are really tough moral questions for the country. But we're going to have to deal with them if we're really going to get health care under control.
Apparently, Rattner not only thinks that we all should be paying more for health care, he thinks that dying people should be shopping around for cheaper procedures. After all, everyone knows they waste a lot of money on that last year. If they knew how much their dying was costing, surely they'd shop for something less expensive. Because saving money is a very high priority when you're dying.
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