August 2012
28 posts
7 tags
Medical Third Party Payment Distortions
I thought it would be a good time to review the distortion in the health marketplace that third parties represent. First we’ll start with price distortions then we’ll review the effect of third parties on quality of delivered care.
Price:
Whenever third parties are inserted into the mix, the price of any service will rise. We have discussed before that the price of a roof repair or...
July 2012
27 posts
4 tags
"Keep your 'service' to yourself."
A health care legislative assistant that had looked at our online pricing told me that our listed prices were lower than what Medicare pays local Oklahoma hospitals for the same surgeries. I want to be clear. The combined bills of the surgeon, anesthesiologist and facility at our surgery center are less than what Medicare pays a local “not show a profit” hospital for the facility, alone.
He...
10 tags
The Real Health Care "Issues."
I’m writing this from Washington D.C., just having experienced the TSA experience many have come to know and love. The Association of American Physicians and Surgeons invited me to participate in a congressional briefing with Rep. Paul Broun, GA and I feel compelled to make a report.
Very few in power here have shunned the influence peddling that seems to go along with the job. Those who are...
6 tags
"Can you hear me now?"
Our price for a cochlear implant procedure is $8800. This price includes the facility, the surgeon and the anesthesia charges but does not include the price of the implant. I pay about $27000 for the implant. We’ll come back to this shortly.
A surgeon recently told me about a meeting where he was informed by a “not show a profit” hospital administrator that while the hospital...
3 tags
"What do you mean you don't want anything?"
I just returned from Washington, D.C. One thing I noticed. Some legislators suddenly (almost awkwardly) lost interest in what I had to say once they knew that I wanted nothing from them. A few were intensely intrigued with what I had to say once they knew that I wasn’t angling for a favor.
Why did the others lose interest? I figure that they realized that I wasn’t buying...
3 tags
And freedom and justice for some
I told someone the other day after Judge Robert’s ruling that I guess Al Qaeda hates us now because we used to be free. The guy with me said, “You had better get used to it. It’s the law!”
“What do you mean ‘it’s the law’,” I asked.
“It’s the law of the land,” he said.
“You mean the law of the land for...
3 tags
And you thought energy companies had money
I thought that this blog was worth re-posting, given my last comments about the hospitals. I also want to put this in perspective. The new Devon tower in Oklahoma City will cost about 800 million dollars once completed. This new building has re-defined the skyline of Oklahoma City, a magnificent architectural project and the tallest building in the entire state now.
800 million is a lot of...
6 tags
Bonnie and Clyde Hospital Economics
From now on, I am going to refer to “not for profit” hospitals as “not show a profit” hospitals. I believe that no other group deserves more blame for the disastrously expensive state of health care in this country than these big “not show a profit” hospitals. They, of course, have an incredibly powerful lobby, the American Hospital Association, which has bribed sufficient players in D.C. to...
6 tags
AAPS Schools Leviathan
Here is a video of part of my latest excursion to the swamp, our nation’s capital. There are a few good people up there, but not many. I begin about 20 minutes in to the video and answer a question at the end.
G. Keith Smith, M.D.
8 tags
Health Exchanges: Constructing Your Own Gallows
Several governors aren’t setting up the health exchanges mandated by the Unaffordable Care Act (UCA). Either they see this as constructing their own gallows, or see it as an unnecessary expense if the election goes the way of the GOP. Any honest governor knows that this is the tool that will be used to crush smaller competitors and stifle any innovation in the health insurance industry, both of...
6 tags
The "Chris Farley" Effect on Your Insurance...
I anesthetized a 208 pound, eleven-year-old female recently. Her parent’s combined weight was well over 700 pounds. Both parents were smokers. It occurred to me that the Unaffordable Care Act (UCA) guarantees that they will never be turned down for insurance. What does that mean for you and me?
If you think that including folks who engage in this level of self-abuse on your insurance plan...
“One of the most lucid analyses of the distinction between State and market was...”
– Murray Rothbard, Power & Market (via laliberty)
10 tags
The Business of Bankrupting the Sick and Dying
I anesthetized a man with laryngeal cancer the other day. Nice guy, no insurance. He will soon be bankrupt, but not because of any bill we sent him. Not because of any bill that his surgeon will send him.
He will be bankrupt because the system is corrupt. He ultimately will require chemotherapy and radiation, neither one of which is available to him without going to a big hospital. His...
5 tags
The state says,"What's yours is not yours, but...
I wrote a piece early in my blogging days called “Give It Back.” This, I thought was a more honest phrase than the one that socialists use when they say “Giving Back,” as in “giving back to society.” Corporations and entrepreneurs have been successfully targeted for robbery with this guilt-ridden bullet, a very successful shake-down strategy. This phrase discounts the fact that entrepreneurial...
3 tags
Where Butterflies and Suicide are Free
News flash. You couldn’t make this stuff up if you had to.
Toronto——-“Canada’s justice minister says the federal government will appeal a British Columbia Supreme Court ruling saying that federal laws banning doctor-assisted suicide are unconstitutional. A British Columbia Supreme Court justice ruled last month that laws banning assisted suicide are invalid because they...
6 tags
"Please Waterboard Me!"
Here’s an interesting article. In it is a description of a man in a British hospital dying of thirst. Actually, he died of thirst. Not before he called the police asking for help from his hospital bed, though.
By passing on this description of hospital complications I in no way mean to suggest that hospitals in the U.S. can’t stand improvement. Followers of this blog know that I...
9 tags
"Don't Care What the Mugger Did With My Money."
I told someone on a radio show the other day that I chose liberty because I want to be free. I don’t choose liberty because it results in the best and most rational allocation of scarce resources. This is simply a bonus.
That’s the difference between the thought processes of the Austrian economists and those of other schools. The Austrians say in essence that they don’t care...
13 tags
Repeal and Replace? No thanks.
The socialist editorialist Clarence Page has called the GOP out, Mitch McConnell, in particular, for not having a replacement plan for Obamacare if they can manage to repeal it. This very short-lived interlude, void of any more health care ideas from Washington, is kind of nice. I’m sure the GOP will spoil the silence, though. Seriously, what on earth would lead someone to believe that...
5 tags
Does your physician work for you?
No anesthesia board examination is complete without encountering a “pushy surgeon” scenario. It goes something like this. ”Doctor, what are you going to do if the surgeon wants to proceed with the surgery before these critical lab results are back from the lab?” The young anesthesiologist responds with something like, “I’ll just tell him that he needs to...
9 tags
Health Insurance, Student Loans and Hail Damage
Call a roofer and tell them your roof needs to be replaced. “Who’s the insurance company,” they’ll ask. Tell them there’s no insurance. Compare that price to the one you get from another roofer who thinks insurance is involved.
Take your car in for repair of hail damage. “Who’s the insurance company,” they’ll ask. Once again, tell them...
7 tags
Vichy Capitalism
Crony. Vichy. What’s the difference? The difference is that a crony tries to keep quiet about their thieving relationship with their kept politicians. Vichy are cheerleaders for the winning team, even if Joe Stalin is running things. No shame. I call the guys that angle for the federal contracts and profit off of the taxpayer’s backs Vichy capitalists. Here’s one. He...
10 tags
Government = "Do it, or else."
No law is complete without an “or else” clause, as I like to call it. This is the last section of any law that spells out the punishment for non-compliance and the enforcement mechanism to carry out the punishment. That is the nature of the law then, isn’t it? To make us do what we wouldn’t normally do. Rather than serve its original purpose, the law, rather than...
9 tags
"The less you pay me, the more I make?"
One of the tragedies of the debate on health care that led up to the Unaffordable Care Act (UCA) was the lack of any serious discussion about the justification of the high cost of care. Hint: it isn’t justified. The careful avoidance of this topic was intentional, as any realization of the availability of high quality surgical care at 1/5th-1/10th of the price at a “not for...
6 tags
"Call Doctor Dolittle."
Many hospitals have a chaplain or priest on their staffs, either as employees or volunteers. I think this is a great idea. I think it is time, however, to consider bringing veterinarians into the mix. You see, no one knows more about, or has more experience in carrying out euthanasia than these guys. For those Uncle Sam has decreed too expensive to treat, I think the veterinarian’s...
4 tags
BFF (best friends forever)?
A new legislator in D.C. once told me that our government was run on relationships. He told me that he had coached himself to say, “I like you, but don’t like your bill,” when asked to sign on to theft, Washington-style. Stiff-arming legislative colleagues was much more difficult than shunning lobbyist’s bribes. Having said that, however, do you think the GOP is...
“It is the strangest dysmorphic transformation of any holiday in history. The day...”
– Jeff Tucker & Doug French - The Birth of Sedition (via laliberty)
10 tags
Global Warming and Obamacare
Recently, one of my sons facetiously suggested that we turn the air conditioner down to the lowest temperature and open the windows to cool it off outside. I made the comment that this would help with global warming. We all had a good laugh but then I started thinking. This is Keynesian economics. Just as my son’s suggestion discounted the heat contribution of the compressor and fan,...
