HCR -- You Get What You Pay For

By John Ballard

A lot of my on-line time is spent cruising a hundred or more sites via Google Reader, many of which track various angles and opinions about health care reform. As most readers know Americans have the most expensive health care in the world per capita. Something like one out of every five dollars of the economy is tied to health care. So when I came across a post at The Health Care Blog headlined You Get What You Pay For I couldn't help myself. Before I knew what was happening a snarky little spit-wad formed in my keyboard and found its way into the comments thread.

The writer was advancing the idea that cancer outcomes in the US somehow justify the extravagant prices we pay for all the ancillary freight loaded on the health care train. The last paragraph says this:

We can agree that there is fat within every healthcare system, and the U.S. may have more fat than most. But it appears that when it comes to putting a nation�s healthcare system on a diet, one cannot cut out the fat without cutting too close to the bone. And in the case of cancer treatment, European nations appear anorexic.

I wanted to remind the writer about this grim one-liner

Q.  Why do coffins have nails?
A.   To keep out the oncologists.

Instead this is what I left...

When I saw the post title here are a few items that came to mind that we pay for.

�  TV ads � some of the most expensive air time for some of the most costly productions in the ad industry.

�  Mammoth executive bonuses and golden parachutes for both health care administrators and insurance companies

�  Facilities with manicured landscaping, marble floors, lived plants, flat-screen TVs in every room, and concierge food service

�  Elaborate accounting arrangements by which large so-called �not for profit� health care systems, often augmented by equally large, embedded insurance companies (BSBS comes to mind) launder bills mostly for the benefit of very profitable clinics, specialty practices and device manufacturers.

�  �Free scooters� advertised for Medicare beneficiaries. Sometimes comes with a free recipe book or lighted magnifier �just for making the call!�

�  Catered meals and other treats for hungry office staffs, compliments of your favorite drug or other supplies sales representative.

�  And speaking of sales, don�t forget the sales bonuses for high performers. The only people in America with no limit to how much they might earn are not in medicine or other specialties, but in sales. (Investment bankers are in the running, of course, but they are in fact limited by how much capital and/or credit they have. Enterprising sales people have only transportation, cosmetics and a few other expenses.

�  Don�t let�s leave out some red meat for the tort reform crowd � legal and accounting services, and a grey area often called �defensive medicine.�

With the exception of a dedicated group of community volunteers who provide a few ancillary goods and services, every dime of all that has but two sources:

1.) Medical bills
2.) Government grants for teaching hospitals and research by NIH. (taxes)

What am I missing?
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Yes, of course. I almost forgot � MEDICAL CARE!