Tag Archives: political economy

“Insurance” Costs

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My Medicare-aged wife broke her wrist, which necessitated surgery, and our health plan provider sent us an accounting of the costs involved.  Following are the high points of those costs.  It’s necessary to emphasize that the surgery is relatively routine following a wrist “fracture,” since the wrist is little different from a sack of pig’s knuckles, and where the arm bones, the ulna and radius join the wrist is more of an abutment than a joining.  The “fracture” was more of a slight jumbling of those pig’s knuckles and small breaks of the ends of the ulna and radius; the surgery was to rearrange the knuckles and repair the fractures with a plate and some bolts.  Really quite routine and minor (save the post-op pain and the long recovery time and discomfort); that emphasizes the nature of the costs.

The initial care was in the ER of a hospital not “in network;” the injury occurred, also, 100 miles from home.

ER Service Provider’s bill to the Plan Total cost
(Plan approved)		 Plan paid We paid
Wrist X-ray $342.31 $0 $0 $0
Apply splint $479.34 $0 $0 $0
ER Visit $764.99 $193.01 $115.65 $75.00
Totals $1,586.64 $193.01 $115.65 $75.00

 

Actual treatment:

Service Provider’s bill to the Plan Total cost
(Plan approved)		 Plan paid We paid
Wrist X-ray $33 $873 $8.56 $0
Surgery* $24,691 $1,021 $757 $264
New Office Outpatient $285 $166.51 $143.58 $20**
Follow-up X-ray $94 $30.74 $30.13 $0
Elbow X-ray $102 $27.04 26.50 $0
Long arm splint $132 $90.13 $88.13 $0
Cast supporting splint $125 $12.27 $12.27 $0
Totals $738 $326.69 $300.81 $20

*Two separate charges, for two separate actions in the wrist’s surgery. I’ve lumped them together here.
**Copay

Just summing those high points, here are the totals.

ER Service Provider’s bill to the Plan Total cost
(Plan approved)		 Plan paid We paid
Totals $27,316.64 $2,413.70 $1,182.02 $359

Notice that: the hospitals and the surgeon paid that vast majority of the costs of the provided health services.  Our health plan provider refused to pay them and the health providers were not allowed to bill us under the terms of their contract with the plan provider.  There’s no doubt, too, that the basic charges are inflated to cover those lost costs and the costs these entities incur when patients are uncovered or prove to be scofflaws.

Compare, in particular, the cost of similar surgery—nearly all inclusive—at a cash only (no health coverage plans) hospital in Oklahoma.  While the procedure listed isn’t exactly comparable to my wife’s situation, it’s close enough for this exposition.  The Surgery Center of Oklahoma’s price is $4,300; although the pre-op diagnostics like those initial X-rays are not included in the charge.

Keep in mind, too, that while Obamacare has made this situation far worse (and worsening), this sort of thing has been happening much longer than Obamacare’s existence.

One more thing.  A Medicare patient paying cash for a procedure in lieu of a Medicare plan’s coverage in order to get a lower total cost?  My GP tells me that it’s illegal for her to accept cash from a Medicare plan-covered patient.  I have to be uncovered altogether, beyond basic Medicare A, before she can accept legal tender.

It’s time we moved to a market-oriented system of health care and of health insurance.  See that Oklahoma hospital.

The Cynicism of the Left

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And it’s especially stark in the season.  The Wall Street Journal has taken note of the “charities” of the Left and their negative attitude toward the just enacted tax reform.

“The tax code is now poised to de-incentivize the heart of civic action in America,” Dan Cardinali, president of Independent Sector, a left-leaning lobby for philanthropic outfits, told the Washington Post. “It’s deeply disturbing.”

Cardinali is projecting. Most of us donate time and/or money because it’s the right thing to do and because it’s part of our Judeo-Christian obligation to help the least among us, not because we expect some sort of reward for doing so.

Or as one commenter on that op-ed put it,

They think middle class donors who are saving $25 by giving them $100 will stop because it no longer makes economic sense? If that were the case they could save $75 before the tax change.

Cardinali and his fellows of the Left know this full well.

Deficits as Cudgel?

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Gerald Seib says that’s what the Progressive-Democrats in Congress fear the Republicans will use them for.

Democrats worry that Republicans will simply use the rising deficits they are creating as an excuse to cut government spending on domestic programs important to Democrats—in the vernacular, that the tax bill will “starve the beast” of the federal government of the money it needs to keep spending at current levels.

I certainly hope those deficits will be used as the reason for cutting government spending.  The Federal government spends way too much of our money, and it does so without regard for whose money it is and without regard for the amount of revenue that taxes bring in—deficit spending is enthusiastically pursued regardless of tax rates or revenues.

Federal spending needs to be cut back drastically, not just on domestic programs important to Progressive-Democrats, but on all domestic programs (other than defense, which already is so low that our military cannot reliably win a war against a regional power like Russia, much less a rapidly expanding one like the People’s Republic of China.  We’ve even had to abandon our Cold War mission of being able to fight and win two separate wars simultaneously).  A good start would be a 10% across the board cut on all extant programs, and then begin cutting seriously from there.

And yes, that includes privatizing Social Security and Medicare and block granting Medicaid transfer payments to the States without strings—they know better than the Feds how to spend those funds State-domestically, anyway.  After conversion, the Feds then should reduce those Year Zero block grants by [10%] per year after that until there are no more Federal Medicaid transfers.

An additional step for Federal spending curtailment is to consolidate all current Federal transfers into a single block grant for each State and then reducing the size of that grant along the schedule above.  In this way, States like New York, California, and the rest of the dozen or so States that send more of their citizens’ tax money to the Federal government than they get back could keep all of their citizens’ money and spend it within their State in accordance with those citizens’ imperatives.  Surely even Progressive-Democrats could get behind a program that lets their constituents keep their money local—that’s more for the local Progressive-Democrats to spend.

Net recipient States would be able to keep all of their citizens’ tax money, also, reducing the alleged “need” for Federal transfers.

Additional cost saving: the middle-man bureaucracies, with their inherent costs, would be eliminated, too.

The only deviation from eliminating such knee-jerk routine transfers should be in times of declared State or regional emergency.

The Disappointing Joe Manchin

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Senator Joe Manchin (D, WV) seemed, initially, like a center-left Democrat and a man who was capable of bipartisan work when he came on the scene a few short years ago.  Recall, for instance, his firm support of our 2nd Amendment and his opposition to much of Obamacare and to then-President Barack Obama’s (D) war on coal.

Now, though, he’s a proud member of the Progressive-Democratic Party’s caucus in the Senate, and the conflict between his claimed values and his voting against the just passed tax reform bill is showing.

“There’s some good in this bill. I acknowledge that,” Manchin said, when West Virginia radio talk show host Hoppy Kercheval asked the senator why he opposed legislation that will benefit the “vast majority” of taxpayers and businesses in the state.

“The things that you mention are correct. Initially people will benefit and see some changes in their taxes[.]”

But

Manchin blamed his opposition on projections from some analysts that the tax overhaul would increase the national debt, and that cuts directed at individuals and married couples is temporary and sunset in 2025 without further action from Congress, versus the corporate cuts, which are permanent.

And

Why did the permanency have to go on the big end, and not on the individuals who really got left behind?

He’s carefully eliding a number of things, though, with his rationalization.  One is that if he’s truly concerned about the national debt, he should get out of the way of Congressional efforts to cut Federal spending.  But he’s a Party man.  And the only way those temporary cuts actually will expire is if he and his fellow Progressive-Democrats go against Party tenets and prevent their extension or being made permanent rather than demanding the tax increases expiration would create.  But he’s a Party man; so are Progressive-Democrats all, all Party men.

Further, businesses plan—must plan—farther into the future than do us individual citizens.  They are far less agile than we can be; their costs for things like production supplies and for labor, to name just two factors, have to be planned for far in advance.  Businesses need the stability of permanence far more than we do; eight years is close enough to permanent for us.  Manchin knows this, or he’s too economically ignorant for national office.

And

He [Manchin] also complained of a coming increase in health care costs because the legislation repealed Obamacare’s individual mandate to purchase insurance.

He’s eliding another fact here, too.  Health coverage (not care) costs have been skyrocketing under Obamacare since the first months after it was enacted.  All that repealing the penalty for disobeying the Individual Mandate is doing is freeing up 13 million Americans—especially those at the lower end of the economic scale—from having to buy an Obamacare plan they can’t afford or that the rest of us can’t afford to subsidize.  Those health care costs have been sky-high all along—due to the lack of a free market in that particular industry; Obamacare only exacerbated this.  Manchin knows—or should know—this, as well.

Keep this in mind as this Progressive-Democrat runs for reelection in West Virginia next fall.

Ex-Im Bank Nominee Confirmation

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The Senate Banking Committee rejected Scott Garrett, President Donald Trump’s nominee to head the Export-Import Bank.  The Wall Street Journal is casting that as “a win for crony capitalism” on the grounds that as a New Jersey Congressman, Garrett had twice voted against renewing the Ex-Im charter.

It’s not the end of the world, though; far from it. Confirming the nomination of a guy who doesn’t like the Ex-Im would have been better, but absent a quorum, which this refusal to confirm extends, the bank is unable to approve financing arrangements over $10 million.  This not a bad outcome; Ex-Im is well hamstrung, and that’s a good interim condition.