I have waited a bit till the dust settled on the Supreme Court decision of last month to ask some questions of about healthcare, and more specifically Health Insurance. I waited because this is neither a political blog, nor a legal blog. I want to leave the political commentary and questions to others, and let the legal types parse the Constitutional questions.

My questions are more personal and directed to us who are consumers of health care, especially about Insurance and how we pay for healthcare than healthcare itself. It is also about the high costs of healthcare.

While we may all wish to blame others (HMOs, hospitals, doctors, government et al.) is it not also possible that we all share some of the blame for the “off the hook” costs of medical care and for the Insurance debacle we in?

I would like to state a few questions and ask your feedback because a lot of the Health Insurance landscape is puzzling to me.

1. Let’s start with the concept of insurance. Most of us have several kinds of insurance: Car insurance, homeowners insurance and medical insurance. And yet the word “insurance” with reference to healthcare has taken on a vastly different meaning than any other kind of insurance.

Insurance is normally used to cover catastrophic, or at least significant costs. When I need new tires, I do not call my car insurance company. When I need an oil change or a 30,ooo mile checkup I pay for these things out of pocket. Same with homeowners insurance. We do not ask or demand our insurer to pay for new light bulbs, or even more expensive things like a new roof or HVAC system. No, Insurance is for catastrophic losses.

So why, when it comes to medical “Insurance” do we demand that every little pill, every doctor’s visit, every medical device be almost wholly paid by “insurers?” How did this system evolve? Is it necessarily reasonable for us to expect third parties to pay for everything when it comes to healthcare?

2. You may say, “But Father, if money were a consideration, many might neglect their health.” And this may be true. Although many do that now. But this leads to my next question.

3. Are Medical prices artificially high because third parties pay the bills? On the patient side there is inelastic demand. We run to the doctor with almost no thought to the cost. But on the supplier side why should an x-ray cost $1,100? Why should a night in the hospital cost thousands? Why should a 15 minute office visit to the doctor or specialist be $90-180? I wonder if market forces had predominated all along, would prices would be this high?

4. When did prices start going out of range? I vaguely remember as a child in the early 1960s that my mother paid the doctor cash when we visited. Only later did insurance start picking up the tab. At one time a doctor visit was considered affordable. My Grandfather, who was a doctor, surely did have some patients who could not pay, and I know he still saw them, but most could afford a visit a few times a year.

5. What role does technology play in costs? I realize that in the old days there was far less expensive equipment either available or used. Technology is expensive to be sure, but in other areas where market forces predominate, technology is still affordable. Very sophisticated computers, TVs and electronic devices that start out expensive, become affordable to the average person quickly, when market forces kick in. Is medical technology really all that different? Has the lack of a natural market due to third party payers meant that things have remained overpriced?

6. Malpractice Insurance is surely a huge factor. Is there anything we can do to limit frivolous lawsuits or limit the damages that must be paid? Can we stop suing each other so much?

7. What part has insisting that employers and government (more third parties) cover healthcare insurance played in driving up costs? Would insurance be more affordable if we all had to personally write the check every month? Would insurance companies compete more for our business? Would they have more incentive to help keep costs low?

8. I am personally happy to see “urgent care centers” beginning to spring up. So many these days run to hospital emergency rooms for what is not really an emergency, it is just urgent. They are not bleeding out, having a heart attack, or trouble breathing. They are not unconscious. They just have a headache that won’t quit, or have turned their ankle and fear it may be broken, or have a severe cold. Perhaps their doctor is away or it is a weekend or holiday. Urgent care centers perhaps with a doctor and several trained nurses may be a less expensive alternative. Can we develop more creative solutions like this?

Please understand these are real questions I am asking, not rhetorical points.

At the moral level I do think it is important for all of us to ask if we have not personally contributed to the high cost and increasingly unmanageable nature of the healthcare system. We don’t care what it costs, we don’t even ask what it costs. Our demand for unlimited care seems itself to be unlimited. We are part of the forces that have driven costs up.

I realize that healthcare decisions can get complicated. How long should I wait before I see the doctor? Is my ankle just twisted or is it broken and do I risk permanent injury if I don’t attend to it? These are not always easy things to answer, and most of us err on the side of caution. Maybe we should. But is cost never to be a factor?

Our even recent ancestors suffered through things we barely tolerate for a minute. In the old days when you went to the doctor with bad knees he’d hand you a cane and say “No more tennis for you.” We on the other hand demand knee replacement surgery and that others pay for it. Perhaps that is OK, but are there no limits? What part have we played in driving up costs by insisting that everything has to be fixed with no share in the cost other than our premium? And when the premium or co-pay goes up, we nearly hit the roof and scoff at the high price of medical care.

I want to say that decent healthcare available for all is certainly a pillar of Catholic Social teaching.  But are there no limits to be accepted? Is it never legitimate to try and reign in the costs? Are there any limits of what others owe me in terms of medical care or at least in what I expect them to pay?

And a final bevy of questions:

  • – Why do people demand that  contraceptives and things like Viagra be paid for by me or others.
  • – And why is Viagra $15 a pill?
  • – What is truly urgent care that must be extended, and what can wait and be diverted to non-emergency settings?
  • – Is there anything that can be done to walk back the medical system from an entirely third-party payer system and reintroduce market forces such as competition to drive down the cost?
  • – Is there anything that can be done to make ordinary medical care affordable again and keep insurance for the catastrophic and big stuff?

Again, I am interested in your thoughts. I am not writing this post as an expert of any sort. I am asking questions as I try to formulate a moral point of view on the need to provide healthcare coverage to all  but also to recognize necessary and reasonable limits.

I am also trying to start a discussion around the idea that we may have ALL had a role to play in driving up costs, and thus may have a role to play in bringing those costs down.

This video illustrates how third-party payments relate to escalating costs:

45 Responses

  1. Steve C says:

    Great points. Was hoping to see the Stossel clip on this. I was in medical sales until I was laid off after the bill passed (cut backs now 20% tax about to go in so guess won’t be getting job in it again since that costs about another person). Anywho, sold braces, etc (from ankle to neck & everything inbetween). We loved seeing medicare patients for knee braces. We would get them the best, most expensive brace b/c if they met deductible &/or had secondary insurance then they ‘didn’t owe anything’ so badabing. Custom braces. If they didn’t they usually owed between $300-1200 for the brace (unless I called them to keep doctor happy & worked out a way to get them one by calling the company & getting it on our account & have them pay cash for it. That case it was $150 for off the shelf brace. Still quality).
    A wrist brace? Cost us $9 to buy retail. Insurance cost? Billed out $110+ for that. Want to pay cash for it? $15 haha.
    Those knee braces? Insurance cost? $1200 Pay cash? (not on my account) $300ish

    I remember seeing HHS sheets saying they will not cover x brace b/c they deemed it unnecessary. Cold therapy units are amazing for post-op patients. Medicare said it isn’t needed so won’t cover it. Even though studies prove without a doubt it is great & works. Medicare said no so all other insurance companies must follow suit. I asked my trainer at the time “why don’t we all just have one insurance?” He replied “we would be out of a job it that happened”.

    Dealing with our billing office they told me how all insurance companies had to fall in line with medicare. Those guys on their own had to fight with other insurance companies & still follow medicare which doesn’t need to make a profit nor worry about cash.

    Personally, I do not have an insurance card. I pay cash at the dentist, eye doctor, etc. Will I get it? Sure, though I need a job first to pay that expense. Probably see the crash before I get said job.

    Great post, Msgr!!
    Pax Christi!

  2. Mandy P. says:

    Ok, I’ll try to give my thoughts on these as concisely as I can:
    (1) I think we started thinking of health insurance in different terms when it became coupled with employment and we (in general) stopped having to foot the whole bill.
    (2) As someone who has to pay for all of my insurance (which is high-deductible so it really only covers catastrophic stuff) and pays out of pocket for all my routine care, I can tell you that we do not neglect our health in my family due to costs. In fact, we try very hard to take good careof ourseves so as to minimize our health care needs. However, we certainly do try and discern more carefully whether or not that sniffle really needs professional treatment and we talk to doctors and care centers up front about costs to try to either negotiate the best deal or to shop around for it.
    (3) Absolutely. And when it’s not you (figuratively) footing the entire bill, you’re a lot more likely to go ahead with every test or procedure under the sun, regardless of whether or not it’s necessary. Which costs more money.
    (4) I have no idea and am probably too you got remember a time when folks didn’t have insurance paying out the high prices for medical costs.
    (5) I think it depends. There is some technology, like an ultrasound machine for example, that can just be purchased outright by a doctor and the cost spread out among all of his or her patients over a long period of time. That kind of technology doesn’t impact costs so much. But anything requiring extra manpower- advanced lab work- is probably a little harder to judge because it’s not just the piece of equipment you’re paying for. And having your tests or treatments go through multiple hands will definitely drive up costs.
    (6) Two words: tort reform. We really should have a loser pay laws. Although a lot of that needs to be done at the state level, and some states have already done so (like Texas, for example). But it would certainly discourage frivolous lawsuits. And yeah, there has to be a measure of common sense re-introduced into society. Doctors aren’t magicians and can’t magically cure or diagnose everything. And I’m sorry, but there *are* times when whatever is wrong with you (generically) is your own fault. Stop pushing the blame for every little thing off on someone else.
    (7) They have a gigantic role in driving up costs, but in very different ways. Businesses currently get tax incentives when they pay for large shares of their employee’s health coverage. They also have a legal advantage of being able to pool together to get group rates. So businesses get better rates for plans that cover a lot more, but the result is the employees become even more disconnected from the actual cost of the care they’re receiving, which then incentivizes folks to insist on frivolous care items. As far as government goes, they’re half the problem to begin with. At the federal and state level they have passed some seriously stupid laws that muck up things for individuals. For example: Currently, in most states individuals are legally barred from banding together to get a group rate. That only applies to businesses. So you will never be able to afford the plans those businesses provide on your own. They also prohibit competition across state lines. So I can’t get that great plan my neighbors in GA can get that meets my needs because they’re not allowed to sell it to me. Then there’s the utterly ridiculous compensation rates to care providers. The government at all levels shorts the snot out of doctors and hospitals, if they bother to compensate them at all. And the regulations they set up not only drive up costs (my MIL works in a hospital and they have people on staff whose sole job is to make sure all the right boxes are checked so that Medicare/Medicaid won’t turn down payment for services rendered) but serve to ensure that they can slither out of paying as many times as possible. Which then drives up costs to everyone else; who do you think gets charged to make up the difference when the government doesn’t meet their end?
    (8) Yes, please.

    As for the rest: We live in a society where we appear to have collectively decided that nothing should be our own responsibility and we have a right to anything we want without having to sacrifice anything of our own to get those things. That covers the first one. As far as why Viagra is so expensive, it’s likely to recoup the cost of R&D, which is very, very pricey. Truly urgent care that must be extended is that which is life and death, in my opinion. I would probably extend that to serious illness that could *become* life and death if left untreated, and broken bones. A case of the sniffles can wait.

    As far as the last two things, they’re pretty much related. I think de-coupling insurance by getting rid of the tax incentives for businesses would force more people to buy it for themselves (and be more discerning, shop around,etc.), which would in turn force everyone from the insurance companies on down to the local doctors to adjust their prices in order to meet that demand. It would also be nice if doctors and hospitals were required to eitherdiscuss costs upfront with patients, or had a sort-of menu board with costs listed out so that people know what they’re paying for (like just about every other business on the planet has to do!). I also think that opening up insurance markets across state lines and doing tort reform to discourage frivolous lawsuits (and thereby minimizing the need for and cost of malpractice insurance) would do wonders, as well. On an individual level, I think we need to look at getting more clinics and such in our own areas. My parish is actually affiliated with a local free clinic for indigents and some of our offerings go to providing that care. Doing similar things in the private sector would alleviate some of the burden on the Medicare/Medicaid system and might help us to scale that back some (and the government interference/hindrance that goes along with it).

    And as I am on my iPad (and autocorrect seems to actually hate me) I can’t properly edit this post. So I apologize in advance for errors.

    • Bender says:

      when it’s not you (figuratively) footing the entire bill, you’re a lot more likely to go ahead with every test or procedure under the sun, regardless of whether or not it’s necessary

      Conversely, when it is you who is paying mega-bucks on premiums for a health plan, you’re a lot more likely to want to get your money’s worth and go ahead with tests and procedures that you otherwise would not bother with.

      If you are paying out of pocket $500 per month on premiums, you are going to want to get something back in return even if you are perfectly healthy. Otherwise, all of that money paid into the system will go to waste. If you stop paying the premiums today and the plan lapses, they are not going to provide coverage and, unlike a personal savings account, it does not matter one bit that you had paid in $50,000 the previous five years and not obtained any care during that time, you will get no credit whatsoever for those payments. So, you better use it or lose it.

  3. esiul says:

    Dear Msgr. Pope, you ask some very good questions. Just how did we get to the situation we now have.
    I remember always paying the doctor, whether for myself or my children. Insurance only came in when
    we were hospitalized. Paying your doctor was affordable then. Now, however, we just can’t come up with the money. You cannot even make a Dr. appointment as a new patient unless you tell the office staff that you have insurance and what kind and company. The new government plan does not address this for me because it won’t be any cheaper and the limitations will bring much chagrin. As for the HHS, how we as a nation ever would
    be forced to comply is totally against my conscience.
    True, the new medical equipments cost a fortune, but doctors became very specialized and greedy and that
    got the ball rolling. I just can’t foresee any reasonable solutions. Hope some commentators have some good ideas.
    Glad you touched this subject.

    • AnneG says:

      How did we get this way? Medicare’s institution in 1965 was the beginning. Before that doctors, even specialists, made a normal salary. They also gave away a lot of free care which was good for everybody. Then, they were guaranteed payment, then the bureaucracy took over. Not greedy doctors, to begin with.
      Then, if you were smart, good at math & science, and ambitious, you started to go into medicine. I saw a character change with a generation change in the 70′s as a nurse.
      Medicare was always intended to be an introduction to single payer.

  4. Bender says:

    How did this system evolve?

    Scams and distortions, faulty economics, faulty ideology, and, among other things, sloppy moral theology, including a poor understanding and usage of words like “rights” (which are grounded in jurisprudence and political philosophy, not theology), as well as poor reasoning that leads to equating and conflating the provision of actual health care and treatment with the entirely separate matter of a medical insurance policy, as if they were the same thing, and which also leads to ready acceptance of the ends justifies the means.

    From the Catholic perspective, some of that sloppy moral theology stems from ideological/political considerations, some of it from sloppy application of Catholic social doctrine which, while authoritative, too often uses imprecise and ambiguous language that is ripe for misapplication and distortion.

  5. Robertlifelongcatholic says:

    I think it is fair to say that the fish rots from the head down. The rising cost of healthcare is a result of federal government programs instututed over the decades since FDR’s New Deal and LBJ’s Great Society which used fedral tax dollars to fund programs which gave opportunities to insurance corporations, medical institutions, medical product manufacturers, pharmicutical laboratories to gain financially through political lobbying for the monies and advantageous regulatoy policies that have spawned the current mess we are in. Once upon a time companies such as railroads, steel industries, mining and union organizations owned and provided hospitals and healthcar programs for their employees and families. Religious organizations provided hospitals and healthcare programs for their members as well as charities for the indigent. Families provided for the care of their relatives. States provided for the healthcare institutions and medical staffing of their citizens. You can leave politics aside but the fact is federal regulations and interventions which usurped those authorities of the states, private enterprise and individual citizens is what has createdd the mess we have and power, money and control is the corruptive vice from the top down is what stands in the way of resolving the problems. You have politicians and federal employees pandering to the special interest groups who fund their political campaigns, stuff their ballot boxes, and launder their slush funds made from our increasing tax dollars that rise exponentially with their ever increasing regulations on the private sector. The solution starts with educating the voting public but even that is an exercise in class warfare verses individual responsibility and the very power from which one would derive a moral point of view has basically been declared unconstitutional by fiat. If you catch my drift.

  6. bill says:

    dear msgr pope- yes, that is the big question-health coverage for all-great for those who can afford health insurance and not so good for those who can’t afford it. i was blessed with st. mary’s hospital in richmond, virginia in some health issues. i heard recently, that the orthodox view is they take care of the spiritual health and the state should take care of the rest of the needs of its citizens(health care). there are some small “risk pools” of individuals who cover themselves by contributing an amount of money into a common pool. maybe, we need to start with a small picture of health insurance for everybody in a town of 2000-3000 population and see how everyone might be covered. would gov’t pay a role(taxes; they are not an income producing entity). thank you for asking questions. god bless you and keep you,msgr. bill

  7. JuneT71 says:

    I think that one of the problems with costs is that healthcare institutions (primary care, x-ray centers, pharmacies, et. al.) have no idea what the price of anything is. Recently, I went to get an x-ray I asked the center – what is the cost of this x-ray? The answer, it depends on the insurance you have. I said that I didn’t have any and was told it could be 3-5 days before a price could be determined. My local grocery store doesn’t price things and have to confer 3-5 days before I can purchase some peanut butter. In short, I think it would be helpful if people knew the actual costs – particularly those doing the billing.

    • Mandy P. says:

      That’s not surprising, actually. There is definitely a fair market value for those services. The problem comes in when you have one insurance company that will cover only so much of the procedure and another that will cover an entirely different amount (and, of course it’s different *within* each policy depending on how much coverage you actually have). Then there’s Medicare and Medicaid and their compensation rates, which are usually far below what a private company will pay out. And then you introduce all the folks that will get that x-ray and never bother to pay for it at all, and the price gets jacked up for every paying customer to cover those that don’t. They were probably also a bit shocked that you asked, because most folks don’t.

      Like I said upthread, my husband and I carry high-deductible insurance and so we pay for almost everything out of pocket. We shop around and it’s like pulling teeth to get a straight answer from medical folks on a price up front (you have to be really persistent). They want to just do the procedure and bill you *whatever they think you can pay for it* and they’re usually irritated with us for insisting on getting our price up front. They never fail to take our money, though, and I will say that even though we pay a lot out of pocket, many times what we pay that isn’t covered by insurance ends up being less than what my mom pays for the same care. She has one of those “Cadillac” plans that technically covers everything. But because they bill the insurance companies so much extra than they would if they were just sending a person a bill (I think the logic is they’re big corporations and can afford it) the amount owed by my mom after the 85-or-so percent that the insurance folks cover still ends up being more than my out-of-pocket rate.

      • JuneT71 says:

        Mandy,

        Stated so well the problem with know what something actually costs. An insurance companies are HUGE – and they service the stockholders and the dividends which need to be paid first and formost. Naturally, they will charge as much as possible and pay as little as possible in claims. Unfortuantely, when people are truly ill and need help it is hard to fight and be persistent. I struggled with an illness without insurance for about 3 years and ended up with quite a bit of debt – I just couldn’t battle everyone at the same time – I was plain too sick and since I have no family to help battle – I just ended up paying. Really, these things need to be fixed so sick people can get well without having to be sicker in the battle for costs.

  8. AnneG says:

    We have a very good plan but my husband needed a routine surgery, actually, 2, cataracts. I tried for weeks to get a straight answer about hospital costs and never did find out till after the surgery.
    Msgr, improved technology is so important, but there is no way to justify what some surgical equipment costs. I think it is because hospitals can pay and just charge more. Add in malpractice and lawyers of whom we have an excess and it is a perfect storm.
    And, please, everybody gets care, maybe not the best somebody else’s money can buy. This whole argument is about government insurance.

  9. Todd Flowerday says:

    “So why, when it comes to medical “Insurance” do we demand that every little pill, every doctor’s visit, every medical device be almost wholly paid by “insurers?””

    That’s not my demand. And I don’t hear it seriously requested by anyone else. I’ve become accustomed to making co-payments. My wife and I spend about $10 per doctor’s visit. We pay quite a bit more for tests and procedures.

    “Insurance is normally used to cover catastrophic, or at least significant costs.”

    That would be my understanding, with the emphasis on “significant.” My wife had two major operations this year at a cost of about $20,000-plus–we have yet to receive a final statement for the last hospital visit. We are indebted for about 15-18% of this cost. Clearly, we are better off owing four medical providers a bit more than $3000, than going into bankruptcy. And mind you, my wife and I are grateful for the quality of care that has improved her life.

    Like most people, we would like to have confidence that both care providers and insurance companies are treating us and millions of our fellow citizens fairly. Universal insurance and coverage would not be a magic pill, but it would decouple health care from employment and the ability to pay. And from the possibility of insurnace providers acting as profiteers on human misfortune. And if a majority of citizens would like a fair system in which the costs of “significant” to catastrophic care are not crushing, and there is a willingness to pay a fair amount for the privilege of fair service, it would seem we go with that.

    • Bender says:

      Could you please explain precisely what you mean by “a fair system in which the costs of ‘significant’ to catastrophic care are not crushing”?

      That it would be fair to require a healthcare provider to accept less than the value of their services, to compel a provider to provide the fruits of his labor for less than what they are worth?

      Or that it would be fair to compel other people to pay for your personal expenses?

      • Daniel says:

        Bender,
        I don’t think you should reduce someone’s healthcare to an “individual expense”. Like Rep. Ryan’s attempt at a budget, that notion relies almost exclusively on the concept subsidiarity with almost no concern for solidarity and the common good. Each individual is a member of a community, a child of God, and is our concern as our brother or sister. Even practically speaking, their being healthy benefits all of us because it means they can work and pay taxes..

        • Bender says:

          I don’t think you should reduce someone’s healthcare to an “individual expense”.

          Whom do you, Daniel, mean by use of that “you”? Do you mean, me, Bender, or do you mean the generic “you”?

          If you mean me, why don’t you answer the questions raised? Is it your intention to demand that Todd pay for your aspirin and band-aids, and to compel his payment by government coercion under threat of imprisonment or asset seizure, or will you take responsibility for your own life?

          • Daniel says:

            Your alarmist rhetoric is attempting to oversimplify the issue and consequently to portray people as adversaries who are trying to rob one another. There is certainly a reasonable compromise to be found–Todd shouldn’t be compelled by the local sheriff to pay 2.19 for my aspirin (obviously), but people who are honestly unable to pay for rather expensive treatments need help. We are called upon ultimately to build a system which primarily looks out for the widow, the immigrant and the orphan, not one which guards our individual liberties first and tells those on the periphery to fend for themselves…

          • Todd Flowerday says:

            Actually, Bender, your queries illustrate something of an ignorance about insurance. I’ve contributed a small fortune to insurance companies over the years. If this capital had been preserved, I would be able to absorb significant costs these days, even including buying my own pain relief medication.

            Insurance has been a successful business because it provides for the situations in which a twenty-something person has a debilitating accident or contracts cancer, because in a large pool of insured persons, there are people like me who have only incurred two four-figure medical procedures in my life. Like many people, I don’t object to the concept of insurance, because I know I will be covered should I get seriously injured or suffer a major illness.

            Your caricature about prison or theft doesn’t do the issue justice. Libertarianism is an interesting theory, but in a civilized society, we have necessary interactions with other people. In an insurance pool, few behaviors are truly individual or private.

            I think the solution for successful insurance is to convince people that a large pool of insured persons means security for everyone. As for the person of any age who wishes to opt out of medical insurance, a fair system will have a difficult time absorbing grasshoppers. How to deal with such people, respecting their freedom and yet ensuring they won’t become a burden–which they very likely will–is a difficult puzzle for public policy. Or it could be that people like that are just cheapskates and con-artists.

  10. Janet says:

    Monsignor, thanks for this post, and I have some answers for you. Health insurance got crazy during World War II, when Congress gave a tax benefit to employers for employee health insurance. The U.S. is the only developed nation to link health insurance with employment, so that some people have great health insurance, some have expensive private insurance, and some go without. Furthermore, not everyone’s health care dollar buys the same service and/or good for the same price, as it depends on what one’s insurance covers and pays.

    Four years ago my family had federal Blue Cross/Blue Shield; we did not realize what a luxury that was! No questions when a child went by ambulance to the ER for seizures, or all the doctor visits, medications, tests, etc. to get the seizures under control. Now we have private insurance, and pay a much higher premium with a high deductible. Even though we have health insurance, we do not really have health care, because we would go broke before we meet our deductible. We get acute care only, as I am not going to get cancer screenings if I would not be able to afford the treatment. Same thing with the arthritis in my hands; if I went to the doctor, there would be a blood test, x-rays, and then drug prescriptions, besides the co-pay for the doctor.

    I am glad that we have to pay for routine doctor visits out of pocket, as it does force us to regulate health care expenses and to take care of our health. I do not like the inequality in “health care dollars,” where I pay more for the same service/drug/good than others.

    Thank you again for your helpful, informative, thought-provoking blog (the Benedictine vow of stability is still rolling around in my head!). I give thanks to God for your wonderful work and pray for you.

  11. MikeM says:

    I think that the one thing not considered here is the high cost of liability insurance that doctors have to carry. And let us also consider the amount of money that was saved when we had dedicated sisters and brothers who did a lot of the grunt work with so little pay.

    Torte reform would go along way in bringing the cost of doing business down for the doctors, but we need to pray for vocations all the more. My experience with lay professionals that do the work that traditionally was supported by religious, has at times been less than dignified, because it is no longer a vocation but a job that I can leave behind after I leave. I don’t mean to criticize the majority of dedicated health professionals, that truly care about their patients, so if you are like many of relatives in the nursing profession, I think that most are wonderful. But even they will tell you of the professionals who look at health care as a means to an end. The presence of religious among the laity had a significant impact on the dignity of the needy.

    As a personal note on costs from my experience, in the early 90′s, I spent the night in the hospital after an emergency room visit for a broken nose and a possible concussion, x-rays and a followup visit with an EET specialist, my entire medical bill was less than $400. That hospital was run by Franciscan Sisters, who eventually had to sell it to the local secular run hospital, under the premise that it would save money if they could combine services. It basically created a monopoly for local services and the prices for medical care skyrocketed. When the motivation for healthcare is money, it will always be detrimental to the patients.

  12. Vijaya says:

    Thank you for this post. You raise a lot of questions that I’ve wondered about myself because for a large part of my youth, I did not have health insurance. Our family paid for the expenses we incurred. They were affordable. I did not go in to get my teeth cleaned annually, nor go in for a check up. Of course, once I got married and was insured under my husband’s policy, I was grateful because the babies had to be born Cesarean and had a hospital stay due to severe jaundice (blood incompatibility). I still think cutting the middleman out would surely lower the cost of healthcare.

    Seems that ever since the Great Depression, there has been more and more govt. caring for the people instead of people caring for people (family, friends, neighbors). I prefer the latter because it builds a community who are aware of the needs of its members.

  13. LMH says:

    Very interesting topic. To a Briton, the medical system in the US can seem alien and dare I say, brutal. Looking from the outside, it can appear that if one does not have the funds, or necessary insurance required, one may simply have to go without vital treatments.

    Much is said about Britain’ much derided NHS, but each tax paying citizen pays 11% of their taxable income towards the NHS and in return, we are all guaranteed care and treatment (of sometimes admittedly low standard) when we need it.

    Our system is far from perfect. It is oversubscribed, sometimes abused and often unappreciated but the thought of privatisation seems much more daunting.

    • Jan says:

      if one does not have the funds, or necessary insurance required, one may simply have to go without vital treatments.

      Dead wrong. Vital treatments are the one certainty here. NO ONE is turned away from live-preserving care.

      • Todd Flowerday says:

        Actually, many Americans have died because they lacked the resources for medical care. It happens, even on the Republican watch.

  14. RichardC says:

    I liked the song. I think Catholic employers and insurance companies shouldn’t pay for Viagra and Viagra-like drugs for unmarried men. I don’t think that can be real reform until the nation clearly go bankrupt.

  15. Steve M says:

    I find myself very conflicted by the entire debate over health care coverage and insurance. My daughter was born with very serious medical issues. If it had been left to my wife and I solely, we would have quickly been bankrupt and she would have died at a very young age. We lived in a state that had exceptional support so after some initially staggering bills, we were able to have her covered by a combination of my employers insurance and state assistance. There is no doubt that the costs to maintain my daughters life contributed significantly the rates for insurance that my fellow employees paid. She was never going to contribute back to society in any financial way no matter what procedure was done. She has now passed away (3/28/2009). It seems somewhat easy to talk about the routine costs of life like a sprained ankle and catostrophic issues like cancer. There are many reasons why the prices for medical care are so crazy high that should be able to be addressed. I have some shocking stories about tape from hopsital stays. Somehow though we need to arrive at a balance of costs that we can meet within our own incomes, protection against disaster and provide good quality of life care for those who truly cannot afford it on their own. Watched a program last night about acient Rome. There was no safety net so disabled children were simply “exposed” on the trash pile. How can we as a society provide for the common good but also be responsible for ourselves. I am over weight. Shouldmy insurance be mroe expensive since I am adding to the risk of expensive care?

    In the 1940′s my daughter would have been institutionalized and died within 18 months of birth due to the lack of care. I am biased but I believe the world was a better place for the 20 years she spent with us. How can we morally make decisions about providing health care givne the seemingly endless increases in cost. I thank everyone who paid in to help me cover the cost of my daughter. Very thorny issue. Viagra should be only an individual’s expense in my opinion but then I turn around and asked everyone to help pay our medical costs.

  16. Jan says:

    First, let’s all just admit that Obamacare has absolutely nothing to do with health care and everything to do with government control and pandering? Can we just get that out of the way?

    As to your questions – I guess I could write a response about twice as long as your post, Monsignor. This is really complex stuff, but I’ll try and simplify at least some of it.

    The things that are going on in medicine today, just like the rot in the government today has less to do with what is actually going on right now than it does with what happened years ago. So it boils down to this – when the practice of medicine ceased to be a vocation and became a money-making “job” – that’s when things changed.

    When someone figured out that insuring for health care (be glad it wasn’t for food!) could make money, and physicians figured out that hey, even a little bit beats not being paid anything by some patients, that’s when things changed.

    When medical conglomerates came into the picture – you know, those gigantic corporations with the CEO’s and their seven-figure incomes came into being; when those places began recruiting physicians away from private practice and made them employees (just like nurses and accountants and housekeepers), dangling major perks like great company-owned healthcare plans, free malpractice, little or no overhead and huge amounts of time off for paid vacations, etc, that’s when things changed.

    Amazing technological breakthroughs have upped the costs a lot, but it has also cost the world a lot by providing CYA for inept physicians who couldn’t diagnose their way out of a wet IV bag. Really good diagnosticians keep those costs down as much as they can because they know what they are doing and don’t need the back up or to double check with an expensive test.

    And speaking of malpractice, with regard to number 6 – you’d have to talk to the lawyers about that.

    As for the pharmaceutical companies – Viagra or oral contraceptives or what-have-you aside, the pharmaceutical companies spend an enormous amount of money developing and researching drugs and they have a right to be compensated fairly. They should also have the right to do so without so much government interference that they constantly have to change this or that because some group or other is protesting. On the other hand, if you have insurance and you pick up a perscription for, say, penicillin, it will likely cost you $5 to $10 for your copay, whereas if you opt to pay cash for the generic brand, it might be $2.00.

    The government and insurance have made the practice of medicine a joke. Get rid of insurance, get well-trained physicians back into private practice and keep the government out of it and it will all eventually even out.

    • Bender says:

      when the practice of medicine ceased to be a vocation and became a money-making “job”

      This is crucially important. And it is basically the same point made by Pope Benedict in Caritas et Veritate, where he said that the answer to the various socio-economic troubles was not more laws or more government intervention, but freely conferred gift, i.e. the vocation of charity in truth.

      Sadly, medicine as vocation is less and less a reality. Even amongst our women religious, those heroic sisters who built our Catholic hospital system, there has been the transition to medicine as money-making job, with even certain nuns having six and seven figure salaries.

  17. Max says:

    One way to drastically slow down lawsuits would be to institute a “loser pays” legal system. Where basically, if you file a lawsuit and lose, you have to pay the other’s attorney fees. Most countries in the world operate like this. Without it, if a lawyer agrees to represent you for free (or you yourself are a lawyer) there is nothing to stop you from suing anything and everything without ever paying a dime (and forcing others to pay exorbitant legal fees).

    Stossel has a great show about this as well that I’m sure could be found on YouTube.

    • Bender says:

      Of course, Max, that presumes that the legal system is fair, that the only people who lose are those who should lose, those who do not have the law and the evidence in their favor. And we need not look very far to see that a great number of cases are decided contrary to law, reason, and the evidence.

      Leaving aside the example of the ObamaCare decision for the moment, let’s use Roe v. Wade (or most any other abortion decision) as examples, or the “same-sex marriage” cases. In those instances, the right party lost.

      There is a good chance that, given the ObamaCare decision magically transforming an unconstitutional mandate into a constitutional tax, Catholic institutions challenging the No Contraceptive Coverage Tax (formerly known as the contraceptive mandate) will lose. Should they be compelled to pay in that instance?

  18. CS says:

    Too reasonable Father, it’ll never fly.

  19. Shelly says:

    Msgr Pope,
    Your questions are excellent. I realize you are asking “consumers” to answer here, but our experience may be instructive. My husband is a solo family doctor in a small town (not many left anymore), so I have a different perspective since we are in the trenches. First, insurance on its own increases the cost of providing medical care, because: 1. you must hire someone with billing/coding experience who must be continually on top of all the changes which seem to be constantly thrown at the medical care providers. 2. with insurance the office/doctor must wait for the money to come in: what is two to six weeks worth? 3. you have to follow the medical coding rules (see #1) and not charge on a cost per visit/procedure basis (this system is skewed for many reasons, and it is easy to “game the system” and get away with it – it is also easy to inadvertantly code incorrectly). 4. Each insurance company has their own set of rules and regulations regarding referrals, so we have to hire/train a person just for the referrals we generate. There are many more points, but I’m sure you get the idea. It is a game, and every time we think we’ve got it figured out the rules change.

    As a solo doc, we try to keep the overhead very low, but it still is around $1000/day to run the office (this does not include his salary). When a patient does not pay their bill, not only does my husband not get paid BUT he still has to cover all the overhead so he is essentially subsidizing many patients’ health care on his own. His yearly take home is about 1/3 of what an employed physician in big group makes. Part of this is because we do a fair amount of charity and reduced fee care, and part of it is just an inablity to take advantage of economies of size.

    It is my experience that those who pay the least for their insurance, utilize the system the most on a regular basis. Those who have no insurance or high deductibles only utilize when absolutely necessary or often beyond the time it is necessary. We, for example, have no dental insurance, so we have waited and tried to save money for what we know will be expensive procedures – as we are waiting, are they getting worse and therefore more expensive? Probably, but we have little choice. This is the situation many people also get into with their healthcare. It is very difficult for a non-medical person to know if something can wait, if it is urgent, or if it is truly an emergency.

    I have more ideas, opinions, “answers” to you question etc., since we are right there on the front lines and see the entire system at work. If you have questions, or want elaborations I am happy to oblige. Thank you for starting this discussion.

  20. Peter Wolczuk says:

    It seems that, through common and shared adversity, a Christian unity is evolving into place. Check out; , 2012
    http://www.christianitytoday.com/ct/2012/februaryweb-only/catholics-contraceptive-mandate.html and http://www.christianitytoday.com/ct/2012/julyweb-only/wheaton-joins-contraception-mandate-lawsuits.html
    Notice how Lutheran Pastor Martin Niemöller’s famous poem; which he read to the US Congress Congressional Record, October 14, 1968, page 31636; has been paraphrased in opposition to the Obama administration in one of the articles..

  21. Annette says:

    Thank you for another thought provoking article! We are all to blame for this mess. The saying, “You can pay me now, or you can pay me later,” comes to mind. Now that we have miss used the system for decades, we are all going to pay for better or for worse.

  22. LMH says:

    Jan says:
    July 18, 2012 at 1:09 pm
    if one does not have the funds, or necessary insurance required, one may simply have to go without vital treatments.

    “Dead wrong. Vital treatments are the one certainty here. NO ONE is turned away from live-preserving care”.

    I wasn’t necessarily referring to life-preserving care. Vital treatments could include treatments for mental health problems that make life for the sufferer extremely difficult. Or for conditions that are not life threatening but are debilitating, such as chronic psoriasis or acne. My, admittedly incomplete, knowledge of the US healthcare system leads me to believe that some (possibly many) people do without treatments for such conditions because they find the medical bills or insurance policies unaffordable.

    Perhaps I am mistaken?

    • Bender says:

      some (possibly many) people do without treatments for such conditions because they find the medical bills or insurance policies unaffordable

      What is substantially more likely is that many of these people make a conscious decision to use their money for other things instead, like cable television or the purchase of a car or the purchase of any number of other material goods.

      If they can afford to spend $20,000 on a new car, then they can afford to spend $5,000 instead on a used car, with the other $15,000 going toward their medical care. But they would rather have the new car and get someone else to pay for their medical, claiming that it is “too expensive” for them.

  23. Andrew says:

    1. The concept of health care is fundamentally different from any other type of expense for which we purchase insurance. You do not, strictly speaking, need a car or a house. If something in your car broke and you chose to go without a vehicle rather than repair it you might suffer some inconvenience but you probably wouldn’t die. If you’re a diabetic and you can’t afford the cost of your insulin you’ll probably die, or at least suffer a great deal. Medical care, both routine and emergency, is essential to survival, and so it is necessary to have coverage for that which wouldn’t necessarily be appropriate for other expenses.

    3. If anything, the cost of medical care (especially hospital care) is high not because of too much insurance but because of not enough insurance. Hospitals have to provide emergency care to everybody, regardless of ability to pay. For this reason, many poor uninsured people go to the hospital when they should go to a doctor because the hospital will “write off” the bills as charity care. In order to compensate for this loss of revenue, hospitals have to increase the costs on everybody else. If we could figure out a way to provide medical care for the poor that didn’t fall on “charity care,” it would probably lower individual costs by distributing the price of care across everybody rather than just the people who can pay or who have insurance.

    5. A medical scanner like a MRI machine isn’t the same as a desktop computer, there is always going to be a new advancement in medical science and the hospital is duty-bound to obtain that new technology when they can to provide the best care for its patients. Those machines are very expensive, so I’m sure that they spread that cost across their entire system in order to prevent the cost of a scan being even worse than it is now. Hospitals didn’t have such fancy technology in the past, but people also didn’t live as long because there wasn’t the capacity to even diagnose much less fix as many fatal illnesses then.

    6. There is a great deal of abuse in the tort system. However, any limits will inevitably punish good people for the benefit of big business. If they put a cap on damages, it will detrimentally affect those who have medical costs from malpractice that exceed the cap (what if the cap is $1 million, but the costs of treating your injury add up to $3 million?). It will also create a line for unscrupulous doctors and hospitals beyond which the choice of undercutting care becomes profitable. If you could get $10 million in profit from something that might only potentially cost you $1 million, that would be tempting to some. Tort reform might decrease health costs in the short term, but it would come at the cost of decreasing the incentive on health care providers to provide the best care possible.

    7. I think that the biggest thing leading to the vast increase in health costs over the past half-century has been the mentality around the medical profession. Medicine is seen by many not only as a business, but as a very lucrative business. Doctors incur tens if not hundreds of thousands of dollars in student loan debt with the expectation that they will be making six figures when they graduate. It’s not likely that the medical establishment would lower costs too much, because it would cause many of the best doctors to flee for greener pastures (look at the talent drain among doctors in countries like Britain where doctors aren’t well paid) and would lead to a precipitous decline in the number of people going to medical school. If employer-subsidized health care were eliminated, it would lead either to a steep increase in charity care claims or a steep increase in the ranks of those who die because they couldn’t afford to see a doctor.

  24. Blake Helgoth says:

    Msgr.,

    Two thoughts:
    1) I think part of the problems stems from the field of medicine switching from a charitable enterprise to a for profit enterprise. Once upon a time it was considered noble and something expected of the virteous citizen to donate to the community hospital. Now, it is big business.
    2) Big pharma found the could make milions selling medicine and treatments, especialy if they ran exstensive advertizing campaigns – that included “news articles”- to scare the public enough to think they must have treatment or drugs. It is common knowledge in the field that big phara’s goal is to have everyone on at least 2 daily meds. Plus, if they could lobby for favorable laws, well then…

    • Cynthia BC says:

      I believe that the decision (FDA’s??) to allow direct-to-consumer marketing of prescription medications was a huge disservice. Newer and/or more expensive drugs do not always result in better outcomes for patients, and from a cost-benefit perspective may often be a poor choice. Unfortunately a harried physician may find it easier to acquiese to a patient’s demand for the Drug du Jour than to discuss pros/cons of alternative medications [BTW physician acquiesence to patient demands is considered a major contributor to the development of drug-resistant bacterial infections]. Furthermore physicians may not have the time or expertise needed to sort the wheat from the chaff regarding information about the safety and effectiveness of particular drugs.

      While I’m on my drug soapbox

      The fact that a drug has been approved for use in patients does NOT mean that it is effective, or even safe, for all populations. People can metabolize medications differently based on age, size, gender, overall health status, and even race/ethnicity. Testing in children is particularly difficult, because children cannot give informed consent for medical testing, and of course no parents want their children to be guinea pigs unless they are so desparate to find an effective treatment that they’ll try anything. Given that deletorious side effects may not become evident until a medication has been on the market for several years, I wouldn’t touch a new drug with a 10-foot pole.

      I find it troubling that there is fairly little independently-funded research on the effectiveness of certain medications. I’m not wholly skeptical of studies funded by an entity with a vested interest in the outcome, but I sure won’t swallow the results hook line and sinker. Although most researchers are diligent regardless of who’s paying for their work there is still the possibility that underlying bias could affect what they choose to address in the study and their final conclusions. When reading about a study’s conclusion about a medication or other treatment, they should always always look to see who paid for that study.

  25. Victor Barbercaine says:

    Andrew and Blake both have some very good answers to our current health care problems.
    I would ike to point out that Pres Harry Truman became a strong supporter of national health care after learning that 50% of all draftees in WW2 were 4F because of health problems. I found evidenece of that in the records of my father enlistment in the Navy. When my father enlisted on August 27, 1943 he was 5’9” and weighted 136 pounds, about 10lbs UNDERWEIGHT. He was lucky to be taken and he told me that until then he had very little in the way of health care, but in the Navy he took advantage of everything he could including dental care. Remember, even before the Great Depression, malnutrition and lack of health care were common.
    The Kaiser Shipbuilding Corp pioneered health insurance and day care during the war becuase they couldn’t give employees raises, but they wanted to keep up production and employee morale. With Health insurance employees could afford trips to the doctor and thus take LESS time off work because illnesses etc DIDN’T get worse and cause even greater amounts of employee time off.
    big Pharma? My ex-wife worked for the local univeristy hosptial in a mangement postion and used to tell me about the drug company salesmen who LAVISHLY wined and dined doctors and some senior nursing staff, just to get them to perscribe, even on a trial basis some the new drugs their company was selling. I also learned about the profit motive many of the dr’s had and their investments. In fact, the 1986 tax reform act had bad effect on some of them because they would invest in apartment complexes and keep the rents artificially low so they lost money on the investment to offset the money they made in their practices. Oh and malpractice suits? 60% of ALL malpractice suits FAIL. Loser pays? Big Corp’s LOVE these because they them bullet proof. So do dr’s. WHY? Because they can afford legal big guns and intimidate plantiffs into submission. By the way that same 1986 tax reform bill RAISED the percentage of out of pocket medical bills neccessary to be deducted from 2% to 7.5% In the last 2 years, my wife and I because of her diabetes treatments have been able to deduct this because in both years we spent at least $8750 a year out of pocket. This is AFTER our health insurance coverage.

    Because my wife works for our Archdiocese, it used to be that she had to go to one of the 2 local Catholic hospitals or they would only cover 60% of the bill. THEN the Catholic hospitals got too expensive and they let employees choose and she signed up with MY health insuance which is through our local university hospital which is recognized as one of the 20 best in the country. As opposed to the Catholic Hospitals here, who, according to even Catholic heaelth care professionals, have negative ratings on the “street”.
    Indeed, my wife’s health troubles started with ardentally Catholic doctor, who’s bedside manor and skills left MUCH to be desired. Since, the switch, my wife’s health has markedly improved and she recently had bariatric surgery (after an 18 month fight with the Archdiocse)and is now well on the way to better health.
    One other thing I learned and that is that the clergy of our Archdiocese have what many would call “Cadillac” health plans, as opposed to the lay staff, who like my wife have high deductable plans.

  26. LMH says:

    Bender says:
    July 19, 2012 at 4:36 pm
    some (possibly many) people do without treatments for such conditions because they find the medical bills or insurance policies unaffordable

    What is substantially more likely is that many of these people make a conscious decision to use their money for other things instead, like cable television or the purchase of a car or the purchase of any number of other material goods.

    If they can afford to spend $20,000 on a new car, then they can afford to spend $5,000 instead on a used car, with the other $15,000 going toward their medical care. But they would rather have the new car and get someone else to pay for their medical, claiming that it is “too expensive” for them”.

    I can well believe this to be true in many cases. But my point (not that I’m trying to hammer it home, honest!) is that there must be at least 1 person in the USA right now who is unable to afford to pay for medical treatment that they require in some way, be it for a minor non-life threatening condition, or for something more serious.

    To the bystander, this can seem unfair and dare I say even immoral.

    What about people who are homeless? People who don’t have the means to keep a roof over their head, let alone afford a $20,000 car.

    I’m not trying to be argumentative for the sake of it. I just can’t see the justice in this kind of system. It looks like a money making racket.

  27. Jonathan Hill says:

    Thank you Msgr. for writing on the dangers of making health insurance too ubiquitous. This is a subject of critical importance. Both ObamaCare and RommneyCare are seriously flawed, as they make permanent major causes of high health care costs — third party payment systems. They also do not respect subsidiarity. I wrote about this subject as well in an article that you can see here http://americafirstparty.org/newsletter/issue_2010_02/newspaper.pdf

    Ave Maria!

  28. Jan says:

    LMH, it’s not as though people in the US have no option but insurance. Every state has some kind of program that will assist or pay for vital care. The difficulty arises when ablebodied people decline to work and earn and save and the state can’t keep up with the ensuing demand.

    You should also be aware that government regulation has made it almost impossible for physicians to give charity care from the goodness of their hearts – if they accept any funds from Medicare or Medicaid they can’t legally give free care to anyone.

    Lumping everyone in the nation into a crappy one-size-fits-all insurance plan is criminal.

    The President is very fond of bandying about the word “fair” lately. Why is it fair that some people with good insurance benefits should have to go without so everyone can have less than nothing in some cases? This plan is evil in intent and outcome, resulting in substandard care for everyone, and ultimately, death panels – and no, that’s not an alarmist statement. When it begins to cost too much to take care of everyone, and it will, the government is going to have to begin to eliminate people. At least now, the care that even the uninsured receives is top of the line, American quality.

    Most important – if this is such a good and fair thing, why doesn’t the President subject himself, his wife, his daughters, and the rest of the government to it? The American people are being royally shafted, and some pathetic sense of white guilt is responsible. We are committing national suicide because we are so afraid of being less than fair or being called racist. What a joke we are.

    Perfect equity is not do-able and never will be. The only thing that seems to be constant is envy.

  29. Cynthia BC says:

    An article about drug company profits v. patient safety in today’s (July 20th) Washington Post:

    http://www.washingtonpost.com/business/economy/anemia-drug-made-billions-but-at-what-cost/2012/07/19/gJQAX5yqwW_story.html

  30. amf says:

    Here’s my take.
    When insurance started to cover visits, a price schedule was developed. They would pay x-amount(usually a percentage), for this or for that. So the doctor had to bill more for his services in order to receive enough money to cover his costs and make a living. But, because of the law-he had to also bill his uninsured patients the same amount, even though the price he was charging them was inflated. But when the uninsured didn’t pay the bill-well the doctor then raised his cost to recover the lost income. So the insurance company raised its rates. Thus a profit was realized. So the profit became the goal, not the reasonable costs of the consumer.
    That’s my take on how it got to be so costly.

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