A website reader writes in: “I’m 64 and disabled. I’ve had two major surgeries to my back and hip performed by the VA in the past two years, and am satisfied with the care, other than purchases of medical ‘supplies’ I have made. My questions are non-ideological; why do medical items cost so much, beyond any normal rationale? Why do I pay $64 for 6 $.10 C-Pap filters? Why does a $4 plastic sitzbath cost $24 at the drugstore? Why does an $8 donut cushion cost $35? Why does a pair of slipper socks issued in the hospital show up at $17 on the invoice? Medicare and Medicaid are the current big players and payers in this game. Why are these absurd charges tolerated? Who approves them? WHY IS THERE NO END USER VETO OR APPEAL OPTION? How many major procedures would the aggregate of these small items fund? If a washcloth costs $20, how inflated is a heart surgery? WHO’S DOING ANYTHING ABOUT IT?”
Dr. Hurd replies: The answer to all of your questions is simple: Medical care is not a free market. In a free market, supply and demand determine prices. Under socialized medicine, which the VA certainly is, there are no laws of supply and demand; there are only arbitrary government regulations. Because some of what takes place in medical care and technology occurs in a marketplace, albeit a heavily regulated one, there still exists a notion of prices. But the interplay between government and market results in the type of thing you describe: $35 for $17 items, and the like. This is because government, as an entity, is not responsible for cost containment and other rational consumer choices that an individual consumer is. As for veto or appeal options, those do not exist in a command-and-control government system. The only way for options to exist, and be maximized, is for there to be a free and unregulated market. When I say “unregulated” I mean exactly that: No regulations except for outright fraud, which of course can always be tried and prosecuted. Beyond that, it’s up to the individual consumer and the marketplace, and the individual patient and doctor within the marketplace. I am sick of the “free market” getting the blame for all that goes wrong when government regulates or takes over the free market. Among the many lies being perpetrated by today’s politicians, one of the worst is the myth that we have a free market in medicine and it must be corrected.
What we have is government regulation of medicine bordering on total control.
The VA totally controls medicine for its beneficiaries, and Medicare just about controls medicine, including the setting of prices, for the elderly. The costs of Medicare, along with the costs of regulations imposed on health insurance plans to make them more uniform for everyone, have driven up the cost of health insurance for those in the non-Medicare, non-VA “private market.” Now our government seeks to correct this problem by essentially putting everyone on Medicare. They don’t have the nerve to do this outright. Instead, they’ll impose restrictions on what’s left of the private companies that are so outrageous that everyone will be forced to go onto “Medicare for all” within a few years’ time. Totally evaded in this package is the reality that Medicare will go bankrupt in its current form, only covering the elderly; so how can Medicare sustain itself when it covers essentially everyone? How low can doctors’ reimbursement rates go before many of them quit — and all of them become even more tired and indifferent than many of them are now? And I’m not even commenting on the cost of irrational malpractice claims, which the government will do nothing about. Just think: All of this to avoid the “risk” and “pain” of a free marketplace — something that has never even existed in the age of modern medicine.
I know this was a “nonideological” question. But ideology matters. Whether your ideal is one of socialized medicine or a free market has enormous, real-life and daily consequences. There are no policies without underlying ideas; and all ideas lead to policies, in practice. Ideology is not optional. It’s implicit in everything.