Category Archives: Ethics

The following links  compare our non-system of health care with the national health program of Canada.

It’s a stark contrast and  explains why so many American are forced into bankruptcy by health care expenses.

This talks a bit about the costs of having a baby in the U.S.  even if you have “good” insurance–several thousand dollars.

As opposed to Canada where the total medical cost of childbearing appears to be  $25.  The interviews in this article also highlight the satisfaction of Canadians with their system of health care.

In health care, we’ve developed a system of money making that’s unprecedented.  What once was a profession that at least gave lip service to patients and health care–remember the “sacred patient doctor relationship?” or the “ethical” pharmaceutical industry?–has evolved into a money grubbing borderline ethical business.

Gaming the billing system has become the norm.  When our local “non-profit” hospital (run by a Catholic hospital conglomerate) bought out medical practices in our area, costs dramatically increased.  Coding for visits moved to more expensive levels.  The hospital  billed an additional facility fee even while the practices remained in the same location as before.   Procedures previously done out of the hospital were moved into their facility.  Instead of finding ways to provide efficient economical care, providers (and suppliers) even so-called non-profits seek to maximize revenue.  This is happening at every level of our health care mess and is one of the major causes of our  ridiculous cost inflation over the past 20 years.

More on gaming our non-system here:

Between 2001 and 2010, doctors increasingly moved to higher-paying codes for billing Medicare for office visits while cutting back on lower-paying ones, according to a year-long examination of about 362 million claims. In 2001, the two highest codes were listed on about 25 percent of the doctor-visit claims; in 2010, they were on 40 percent.

This says it very clearly:

Justice Alito said that if he didn’t buy a Volt, the price of Volts would go up. Where did he learn that? Yale Law School? I hope not; I was there with him and I don’t remember learning that if demand falls, then prices go up. It’s the other way around: if customers won’t buy at a certain price, suppliers lower the price. It’s not that complicated — for most goods and services.

The same is true of vegetables, which is what Justice Scalia cared about. Better he should eat them than make a metaphor out of them.

But insurance is an exception to the normal rule of price being determined by supply and demand. That is because the price of insurance is determined by the risk pool, or in other words the likelihood of needing insurance among the group of purchasers of insurance. Insurers try to avoid selling to those who will actually need the insurance, and cause the insurer to make payments. They wish to deny insurance to those who will likely need it, or they want to charge more money for insurance to those who are likely to need it. (This was why part of Obamacare was to preclude insurers from denying insurance to those who are already sick.)

Read the rest of the article!

Medicynic:  I would have hoped that four of the five conservative justices were smarter than they demonstrated at the hearings on health reform  The fifth, Justice Thomas, is hopelessly compromised as his wife has publically opposed health care reform and the Thomas family has received income from the Liberty Lobby a group opposed to reform.  Amazingly unethical but not surprising that he chose to hear the case. 

Our non-system of health care causes many distortions.   Health care costs in the U.S. are the highest in the world, almost double that of other industrialized nations.

Because of escalating costs, lack of job provided coverage, and pre-existing illness over 50 million of our citizens have no health insurance.   Limits in insurance coverage, high deductibles and co-pays make health care increasingly unaffordable.

These costs have driven individuals and families to bankruptcy in increasing numbers as noted in this article which documented that 62% of those going bankrupt in 2007  were driven to it by health bills.

The author’s abstract notes:

Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001.

In 1981 only 8% of bankruptcies were related to medical expenses.   With the current lack of wage growth, the decreasing proportion of people with insurance and the exploding health care costs over the past 10 years (well over 100%) the findings in the article are not surprising. 

For 92% of the medically bankrupt, high medical bills directly contributed to their bankruptcy. Many families with continuous coverage found themselves under-insured, responsible for thousands of dollars in out-of-pocket costs. Others had private coverage but lost it when they became too sick to work.  Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness; another quarter do so within a year.  Income loss due to illness also was common, but nearly always coupled with high medical bills.

And the U.S. is exceptional:

Medical impoverishment, although common in poor nations,  is almost unheard of in wealthy countries other than the US.  Most provide a stronger safety net of disability income support. All have some form of national health insurance.

Medicynical Note: It’s bad enough that we have adopted an approach that does not have universal coverage and  that our health care costs are rising at an unsustainable rate and that our health insurance provides inadequate coverage. 

It is absolutely obscene however, that when a person gets sick and can’t work, his insurance can be cancelled or made unaffordable by raising the rate.  This is further aggravated by allowing insurers to then deny new coverage because of pre-existing illness.

American health care is set up to provide security and protection to everyone involved except the patient.  Quite an accomplishment if you ask me.

This graphic says it all.

Medicynical Note: What’s most striking are the poverty rates: 14% overall, 17% for children, 22% for the elderly and income inequality. Our comparative expenditures on pre-primary education and finally the health rating of our population are also not very encouraging. Exceptional yes, but in the wrong way.