"I had a CT scan and they billed $3,255. If you go to a clinic and pay cash, you can get a CT scan for as little as $300."
FWIW, I went into Northwestern Memorial - Chicago's premiere medical institution - and had a chest CT scan last Friday for $120 - insurance didn't cover any of that.
I think that the major issue here is the financialization of our economy and the disconnect that forms in incentives when anyone can get rich playing spreadsheet jockey, instead of providing goods and services in actual demand. If we taxed private equity (and the other instantiations that get rich selling institutions for its pieces) higher, there'd be less (or negative) incentive to buy out a working non-profit hospital chain and chop it up to sell its parts (while likely saddling the acquired entity with the debt used to purchase it).
Until we get back to a world where using a welder is more rewarding than using Excel, don't expect us to get off this road to doom that we're currently barrelling down.
As for universities, force-ably divorce them from their professional sports teams*, and stop funding anything beyond education and research. And for the research that becomes lucrative, open-source that which was funded by public tax dollars.
Northwestern's president isn't getting paid millions to educate kids - he's getting paid that much to run an intellectual property generation machine with a couple of professional sports teams attached.
* If athletics are being discussed in the same sentences as unionization, it's no longer an amateur enterprise.[1]
You are lucky to be able to get medical services and treatment without insurance. Social Security recipients over age 65 do not generally have this option. And some providers (including doc-in-a-box) refuse Medicare patients.
That is likely true. You know, though, you've inadvertently stumbled into the Trump mob boss model. If the government gets a piece of the action on these, that can dampen the incentive. And by that I don't mean a tax, I mean an equity stake and a voice. Some would call that socialism, btw.
I don’t think the automation issue is going to be reversed, but we should try to increase domestic manufacturing where it makes sense from both a national security and comparative advantage perspective.
This is worse than you portray. We no longer have a chemical industry outside of a few commodity petrochemicals. Our specialty chemical industry now resides in China (mostly) and India. Not only does the physical equipment not exist here any longer, the knowledge base has eroded to essentially nothing over the past 40 years. Acetaminophen (Tylenol) is a simple molecule that can be made in three steps. We can’t even make this here. There is going to be a lot of headaches and pain if China cuts us off.
You forgot to mention one of the primary drivers of healthcare costs, defensive medicine. Malpractice lawsuits have become the modern-day get-rich-quick scheme for both malpractice attorneys and patients. My friend, a general/vascular surgeon, paid $200,000 per year in malpractice insurance in 2010, the year before he retired. He had never been sued. I don't know a single physician who is in private practice today. They are all employees of hospitals or groups, due to insurance costs. Many insurers won't even cover a physician in private practice. The 'employer' and the government also determine the number of patients the doc has to take, who he will take, and how he will deliver care. Add to that the $500,000 to $600,000 in education costs for surgeons, and the cost of healthcare becomes clearer.
True. This week I had my annual appointment with the vascular surgeon who keeps an eye on an aneurysm. I think I have reached critical mass with medical practitioners. This vascular surgeon orders imaging of areas covered by additional imaging ordered by two other physicians. I have mentioned this to all of them, but it seems coordination of appointments and imaging is too complicated even when they are members of the same physicians' group and use the same scheduling and communications software. Lucky I live only a mile or two from the imaging center.
I appreciate all of the physicians. Their education costs are very high but far more valuable than most of the degrees that cost half a much.
When I was taking management courses 40 or 50 years ago, the teachers (mostly at Auburn and Alabama) were predicting a service economy. They were also predicting a peace dividend with the end of USA combat in Vietnam. I believe the peace dividend focused us more toward a service economy.
The cost of insurance is no longer related to the cost of service. Obamacare caused some of that in the medical field when it created one class of patient whose insurance premiums were no longer determined by actuarial means. You can see the same type of hype in TV ads for auto repair insurance. The ads present "real" customers gushing about having any number of expensive claims filled with no premium increases. The insurers might be trying to attract customers who take care of their vehicles or who frequently purchase later models, but those customers will not get a bargain.
"I had a CT scan and they billed $3,255. If you go to a clinic and pay cash, you can get a CT scan for as little as $300."
FWIW, I went into Northwestern Memorial - Chicago's premiere medical institution - and had a chest CT scan last Friday for $120 - insurance didn't cover any of that.
I think that the major issue here is the financialization of our economy and the disconnect that forms in incentives when anyone can get rich playing spreadsheet jockey, instead of providing goods and services in actual demand. If we taxed private equity (and the other instantiations that get rich selling institutions for its pieces) higher, there'd be less (or negative) incentive to buy out a working non-profit hospital chain and chop it up to sell its parts (while likely saddling the acquired entity with the debt used to purchase it).
Until we get back to a world where using a welder is more rewarding than using Excel, don't expect us to get off this road to doom that we're currently barrelling down.
As for universities, force-ably divorce them from their professional sports teams*, and stop funding anything beyond education and research. And for the research that becomes lucrative, open-source that which was funded by public tax dollars.
Northwestern's president isn't getting paid millions to educate kids - he's getting paid that much to run an intellectual property generation machine with a couple of professional sports teams attached.
* If athletics are being discussed in the same sentences as unionization, it's no longer an amateur enterprise.[1]
[1] https://www.collegeathletespa.org/
You are lucky to be able to get medical services and treatment without insurance. Social Security recipients over age 65 do not generally have this option. And some providers (including doc-in-a-box) refuse Medicare patients.
https://www.medicalnewstoday.com/articles/can-i-get-social-security-without-medicare
I have insurance - that particular procedure just wasn't covered.
That is likely true. You know, though, you've inadvertently stumbled into the Trump mob boss model. If the government gets a piece of the action on these, that can dampen the incentive. And by that I don't mean a tax, I mean an equity stake and a voice. Some would call that socialism, btw.
To take a little issue, US manufacturing output is relatively stable (https://fred.stlouisfed.org/series/OUTMS) as is overall consumer manufacturing (https://fred.stlouisfed.org/series/PRMNCG01USA661N), but manufacturing is a smaller share of the growing economy and employs fewer people as automation helps us make more with fewer workers.
I don’t think the automation issue is going to be reversed, but we should try to increase domestic manufacturing where it makes sense from both a national security and comparative advantage perspective.
This is worse than you portray. We no longer have a chemical industry outside of a few commodity petrochemicals. Our specialty chemical industry now resides in China (mostly) and India. Not only does the physical equipment not exist here any longer, the knowledge base has eroded to essentially nothing over the past 40 years. Acetaminophen (Tylenol) is a simple molecule that can be made in three steps. We can’t even make this here. There is going to be a lot of headaches and pain if China cuts us off.
Especially as we've alienated our alternatives to China, rather than strengthening ties.
Important note: the majority of public employment is under state and local government, not Federal.
You forgot to mention one of the primary drivers of healthcare costs, defensive medicine. Malpractice lawsuits have become the modern-day get-rich-quick scheme for both malpractice attorneys and patients. My friend, a general/vascular surgeon, paid $200,000 per year in malpractice insurance in 2010, the year before he retired. He had never been sued. I don't know a single physician who is in private practice today. They are all employees of hospitals or groups, due to insurance costs. Many insurers won't even cover a physician in private practice. The 'employer' and the government also determine the number of patients the doc has to take, who he will take, and how he will deliver care. Add to that the $500,000 to $600,000 in education costs for surgeons, and the cost of healthcare becomes clearer.
True. This week I had my annual appointment with the vascular surgeon who keeps an eye on an aneurysm. I think I have reached critical mass with medical practitioners. This vascular surgeon orders imaging of areas covered by additional imaging ordered by two other physicians. I have mentioned this to all of them, but it seems coordination of appointments and imaging is too complicated even when they are members of the same physicians' group and use the same scheduling and communications software. Lucky I live only a mile or two from the imaging center.
I appreciate all of the physicians. Their education costs are very high but far more valuable than most of the degrees that cost half a much.
When I was taking management courses 40 or 50 years ago, the teachers (mostly at Auburn and Alabama) were predicting a service economy. They were also predicting a peace dividend with the end of USA combat in Vietnam. I believe the peace dividend focused us more toward a service economy.
The cost of insurance is no longer related to the cost of service. Obamacare caused some of that in the medical field when it created one class of patient whose insurance premiums were no longer determined by actuarial means. You can see the same type of hype in TV ads for auto repair insurance. The ads present "real" customers gushing about having any number of expensive claims filled with no premium increases. The insurers might be trying to attract customers who take care of their vehicles or who frequently purchase later models, but those customers will not get a bargain.