It Isn’t A System, It’s Market Manipulation

Everyone likes to complain that healthcare costs too much, and then complains about the “healthcare system” as if it is some sort of unified national entity that is controlled from the top. It isn’t. What we call healthcare in this country is a marketplace made up of hundreds of thousands of companies, each reacting on an individual basis to market conditions.

The largest of these changing conditions is CMS, the Centers for Medicare and Medicaid Services. They set the conditions under which they will pay for medical services. For example, if a person comes into the hospital with signs of sepsis, that person must receive a blood test for lactic acid levels. If that level is greater than two, the person must be tested again within 6 hours, or the hospital doesn’t get paid. This is repeated all over the entire field of payments from CMS. They regulate everything.

They tell hospitals what procedures must be done, how they will be done, and what each provider can charge for all of those procedures and tests. They also dictate that CMS has to be charged the same amount as every other patient. With CMS directly controlling 32% of all healthcare spending in the US, and indirectly controlling another 40% of medical spending by dictating policies to insurance companies, they are the 800 pound gorilla in the room.

If a provider doesn’t play ball, they don’t get paid, and can be added to the national list of “CMS doesn’t let this person be involved in medical payments” blacklist that effectively ruins your career by making sure that 72% of patients can’t use insurance, Medicare, or Medicaid to pay for your services. No one will hire you. It’s even a question on hospital job applications- “Are you on the CMS naughty list?”

So the market responds to that by doing what they are told to do by the Feds.

Then there are the patients themselves. I can’t tell you the number of times that a patient comes into the hospital every day with COPD but is still smoking. There are the diabetics who come in complaining of numbness in their feet, blurry vision, and stomach pain with a blood glucose level over 500 and an A1C of 12, but will lie and tell you that they are watching their diet and taking their medication. There are the drug addicts who come in twice a week because they overdosed, and the drug seekers who come in nearly every day looking for a pain med fix. (We have one woman who has already been in the ED 14 times this month, and it’s only 17 days into December.) The person having a stroke who has a history of high blood pressure, but doesn’t take their medication. Yes, each of these were patients I saw during the last week, and each of them blamed doctors for not fixing their problems in an hour or less, even though their problems were entirely self created.

There is an endless parade of patients who come in with cannabinoid hyperemesis syndrome who won’t stop smoking weed, or STIs because they won’t stop mating with every person who will take their clothes off, Mental health patients, homeless who want free sandwiches, and illegal immigrants who use us as their primary care.

All of these people get seen under a law called EMTALA, which mandates that hospitals have them evaluated whether or not they can pay. Once they are evaluated, those CMS rules we talked about earlier dictate that they have to be treated. Then the entire thing gets paid for by your taxes.

Then after all of that, people then sue the practitioners, workers, hospitals, and drug makers who followed all of those rules and win millions of dollars in payouts.

The problem isn’t healthcare- we as a nation have the best healthcare in the world. What is screwing things up is market manipulation by the government. Imagine for a moment that the Feds were doing the same with the “restaurant system.” That is, 72% of all food was paid for by the government, who set standards on what everyone could eat, how much they could eat, how that food must be prepared, and under what conditions grocery stores and restaurants would be paid. Then they also dictated that anyone who went to a restaurant that had a drive through would have to be served whether or not they could pay for it, but then reimbursed the restaurant for the meal cost. All of this regulated to the point that there are hundreds of thousands of rules, each of which must be followed to the letter. What would a restaurant look like, and how much would a meal cost?

I don’t think most people have a problem with the care they are getting, and those who do frequently misunderstand why they got what care they did get. Most people are upset at the cost, and that cost is directly related to the government distorting the market, and the market’s entirely rational response to that manipulation.

What makes me laugh the most is that everyone then blames the doctors and other facilities, then demands that the government step in to fix the problems that the government created. That’s true whether you want more regulation, single payer, or some other government intervention.