The more our government has been involved with regulating and directing health care in the US the more expensive that care has become. New, expensive technology: hardware, pharmaceuticals, modes of treatment, are all aspects of modern medical care and wonderful because they keep people alive longer. Those are the results of expensive research and development. Just that matter of keeping people alive longer is expensive. Note I keep using the word “expensive”.

Time magazine’s Stephen Brill looks at current health care costs and pricing, the money-go-round, in “Bitter Pill: Why Medical Bills are Killing Us”. He asks,

Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.

Brill says we spend 20% of our GDP on healthcare. Of course, he also notes that “The Bureau of Labor Statistics projects that 10 of the 20 occupations that will grow the fastest in the U.S. by 2020 are related to health care.” Hence, we might conclude, health care is a growth industry in America. That’s not how Mr. Brill sees it. He says,

Employing all those people in the cause of curing the sick is, of course, not anything to be ashamed of. But the drag on our overall economy that comes with taxpayers, employers and consumers spending so much more than is spent in any other country for the same product is unsustainable. Health care is eating away at our economy and our treasury.

Growth industry, eating away… these things might be contradictory, except for how the system works. That is really big and Brill looks at that system from the point of view of people’s hospital bills, which they never look at with any care, and he does not look at offering any real insight. He is also looking at rates of payment for services and procedures; it is all very complicated which makes for a complicated set of complaints. Apparently, this is the biggest article in Time’s history, according to Holman Jenkins in his short piece in the Wall Street Journal. His main complaint against Brill’s point of view is this: “what he describes—big institutions dictating care and assigning prices in ways that make no sense to an outsider—is exactly what you get in a system that insulates consumers from the cost of their health care.”

As Brill notes, if we do look at our bills we find them incomprehensible and outrageous. Most people do not pay their own hospital bills or most of their hospital bills. According to Brill, poor people do and they don’t, which is another piece of complicated contradiction (read the article). For the most part, patients have no incentive to look through bills item by item and figure out what is real, what is unreal, what is reasonable or not reasonable in charges and fees. Yet,

The real issue isn’t whether we have a single payer or multiple payers. It’s whether whoever pays has a fair chance in a fair market. Congress has given Medicare that power when it comes to dealing with hospitals and doctors, and we have seen how that works to drive down the prices Medicare pays, just as we’ve seen what happens when Congress handcuffs Medicare when it comes to evaluating and buying drugs, medical devices and equipment. Stripping away what is now the sellers’ overwhelming leverage in dealing with Medicare in those areas and with private payers in all aspects of the market would inject fairness into the market. We don’t have to scrap our system and aren’t likely to. But we can reduce the $750 billion that we overspend on health care in the U.S. in part by acknowledging what other countries have: because the health care market deals in a life-or-death product, it cannot be left to its own devices.

Fair market? We are not talking about a free market, not at all, as that ended a long time ago. Medicare began in 1965 with a premium of $3 for anyone 65 years old or older. Old people had medical bills three times that of the young, and Medicare was intended to correct that problem, lift that burden. Life expectancy was 67 years for men and 73 years for women. Today, if I am reading this CDC chart correctly, if a person lives to age 65, he can expect to live another 19-20 years after that on average. Life expectancy at birth has not improved all that much in the US, mostly because of crime and accidents. However, if you can make it to 65, you have the great chance of living a very long time. That’s modern medicine for you. I can find no direct correlative statistic, since seniors do not have medical expenses in the same way, but reading statistics from the CDC and the USDHH, generally medical expenses for those over the age of 65 are half of what is spent on medical care in the US. If we really wanted to cap medical expenses in the US, then the kind of cap that would make the best sense in a “Modest Proposal” way would be to execute everyone who comes into the hospital with a major health problem who is over the age of 65 years. Nip it in the bud, that problem of extending life through medical means.* Who can afford it?

If the Brill piece is too long, too anecdote-laden for you, Chris Conover at Forbes has Five Take-Aways from the Brill article. His first is my favorite, that “Healthcare is a Cesspool of Crony Capitalism” and he notes from Brill:

According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.

Part of that might just be lobbying for favorable treatment of drugs being vetted by the FDA, but I also suggest that what is happening in Washington with Medicare and Obamacare is not without the influence and guidance of the “health-care-industrial complex”. Why does Brill and why do others think that more government in the health-care “industry” will bring down costs? In his conclusions, when he says “When you follow the money, you see the choices we’ve made, knowingly or unknowingly,” who could disagree? He deplores that, but what he proposes will actually bring us more of the same.

*Note: I spent part of yesterday at the bedside of a dear friend who is dying of cancer at the age of 100 years old. She says that no one should live that long; it is too hard. No, neither does she see an alternative. “It wasn’t my choice.” She does not blame her doctors. Who would make you die when they can help you live? Looking at modern medicine from her perspective, in a hospice bed, with a sharp mind in an impossibly withered body, it is a wonderful horror what modern medicine can do. That’s another story.

Coming home from our two day visit with my son, Owen and his lovely wife, Margaret, tired of driving on the Pennsylvania turnpike, my husband and I stopped at a rest area. As I came out of the ladies’ room, I saw said husband, Tom, in the Starbucks line. He never wants to stop at Starbucks, but I always do and I was ready for tea. Did I mention there was a line?

Chatting as we waited, he told me what he was planning to get. I gave him the wifely fishy eye, but said nothing. When it was his turn with the barrista, (that’s the Starbucks term for the counter help, if female) he said, “I’ll have a tall double java mocha espresso double latte, please.” The girl looked at him coldly, but with an eye to the line behind us, and with a gesture said, “Our drinks are on the board.” He looked up in some confusion because he’d thought he had named a drink he had heard of; certainly he had expressed what he wanted to drink. I said, “He needs to be awake.” So, a little grimly, she suggested one of the hot mocha drinks with a double shot of espresso in it. He said, “OK!” Then I asked for my favorite, brewed chai, “In a really big cup, whatever it is called” and got another foul look and the sad information that I could either have another kind of tea or the spiced “milk” product they call Chai Latte. I chose a real tea, which is a pain in the neck for them, but at least they make tea rightly enough, putting the bag(s) in the cup before adding water. No other restaurant does that, since no one drinks tea nor has any waitress (apparently) ever read Orwell.

Just to top our awfulness as Starbucks customers, I pulled out the three cards I currently have and we used up the remnants of two $5 gift card ones. I have a nearly full one that I bought at the local, but cannot tell the cards apart. The now-seriously-simmering barrista had to swipe all three cards to get the correct total to cover our bill.

The best part of the experience, actually, was the look on Tom’s face when he stopped at the side bar where you get sugar, cream, napkins, and after pulling out two packets of Splenda, took the lid of his not very tall drink and saw the inch of whipped cream on top. I didn’t laugh. I did say, “You might want to taste that before adding sweetener,” and pointed to the wood stirs so he could at least poke holes down to his beverage. After a vigorous stirring, he did taste the drink and said, “Yeah” and abandoned the Splenda packets. Then he abandoned me for long enough to get himself a five hour energy drink from a machine, apparently having no faith in his Starbucks coffee.

I must give credit or blame for this post to Robert Cheeks, who is my now friend on Facebook. He saw that I had written about this there and responded with “Blog this!”.

I simply couldn’t bring myself to listen to the president last night. I honor the office, or want to. Honor implies some sort of trust and I cannot find that in myself any longer. I did not listen last night because I cannot stand to hear the president of our nation offer full whoppers about the state of the union. It makes me cry.

This morning, of course, the news is full of commentary on the speech. What I read in the more conservative press was bound to be very negative, so I didn’t read that. The straight news offered me absurdities like the president talking about creating jobs while raising the minimum wage. Doesn’t that mean that jobs are bound to be fewer, with employment dollars spread even more thinly? On top of that, isn’t Obamacare bound to cause a hidden increase in the cost of employing anyone? I’ve heard that each employee will carry about $3 per employee hour just to pay for the new healthcare coverage that we absolutely have to have. Who can afford to hire anyone? What I have read about raising the minimum wage is that eventually the economy absorbs the increase with the inevitable result of making products and services cost more. The dollar adjusts and is worth less. This will have the happy result of making the national debt and the deficit feel lighter. Please, someone tell me I am wrong.

I was giving myself a headache reading the news. I’ll listen to the radio, I thought. I have housework to do. During busy work I often listen to National Public Radio. Good, I thought. They will give me a positive spin on the president’s speech. I did hear plenty of highlights of the president and the news was about the various promises President Obama was making. The female voices of the Morning Edition positively chirped. Despite their cheer, the pattern of my thought as I listened was this: “How is this going to work, if that is true?” For example, how can the president promise this and that benefit while claiming to reduce the deficit? Foreign policy has the same kind of pattern. Of course, I could not stop listening.

Ah! Finally came the NPR Morning Edition analysis of the speech. That was what I was waiting for, a positive spin on anything President Obama says that pretends to be intelligent. Steve Inskeep and NPR reporters are bound to offer the silver lining to the clouds I see going forward. (I do get to feeling like Eeyore on a gloomy day.) Today, no, they do not. Even those guys seemed stunned by the — I want to say bald-faced lies, but they used much softer words. The pattern of their thought was also, “How is this going to work, if that is true?” and worse, “That is not true and this seems unlikely to work, as a result.”

Hopeless. I am left hopeless. Maybe it will take a couple of days for the spin on the State of the Union speech to work around to something positive. I will probably only hear or read that secondhand. Unless this proves the rare occasion in politics when both the Left and the Right agree that the president has worked the union into such a state that only in lying about it can he make any public statement about it. I should be watching for that agreement as an agreeable development. Can I stand to listen?

Note: while washing the dishes and listening to the news, I grabbed a knife by the wrong end. The cut on my finger has not stopped bleeding and I now notice that I have blood all over my keyboard. I note that, as it seems somehow apropos. This is what writing feels like lately, bleeding on the keyboard. And it seems to me that conservative postmodernism eschews bandaids.

Ross Douthat effectively discusses what we should all be reading, mostly in periodicals, in 2013.  He calls it “How to Read in 2013″ and is suggesting we could all effectively read more of what the rest of the political spectrum has to say.  That necessitates what to read, and First Things is on his list.  He has suggestions I have never heard of and perhaps some you haven’t read, either.  “And whenever you’re tempted to hurl away an article in disgust, that’s exactly when you should turn the page or swipe the screen and keep on reading, to see what else the other side might have to say.”

I do read many of Douthat’s suggestions, though the reading of the far Left I had never heard of before.  Maybe if I dug a little further into what the Left says I could understand things like how eating the rich would enrich us all, or why Obama is a great statesman, or any of the other political stands of liberals that I find incomprehensible.

How would you expand Douthat’s list?  What is required reading for 2013?