Enough Inefficiency to Go Around
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32 responses to “Enough Inefficiency to Go Around”
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I feel your pain. I have had the same issues and actually are in the throes of them as we speak.
Here we are in the 21st century with internet – and doctors “communicate” by fax.
geeze.
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“Somehow, the private sector is sacrosanct and, thus, is immune from criticism.”
Oh no Dick, I can tell you the health sector is loaded with the same bureaucratic bungling and mismanagement and foolishness as any other. That is just one of them, but no, they’re not immune.
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Dick I’m glad to hear that your wrist is doing better. It’s a good thing you didn’t blow a gasket while dealing with all the red tape!
I doubt you’ll find a single conservative contributor to this blog who would argue that the private sector is always more efficient. All bureaucratic organizations, whether government or corporate, tend towards inefficiency. The question is whether or not incentives and governance systems are in place to counteract the inevitable bureaucratic sloth and lethargy.
There are plenty of big bureaucratic corporations… but they don’t last long. They go out of business or someone takes them over and shakes them up. Governments never go out of business. And it’s rare that they get shaken up. (The Goochland Revolution might be an example of a rare instance in which a local government did get shaken up.)
Among the worst private-sector offenders are monopolies and companies that use the power of government to thwart competition. The health care industry is probably the very worst offender in the U.S. Private-sector inefficiency is rampant. The critical question to ask is why. Is that inefficiency due to some inherent property of the market economy? Or is it due to the way government has shaped the industry to thwart competition and accountability?
The only consolation is that there is so much inefficiency that we could drive down health care costs for years to come if we could only figure out how to reward the right kind of competition.
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Add internet monopolies like Cox …
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It’s true, the private sector has competition to chase inefficiency but I’d point out a couple of things.
1. – Medicare is said to be exceedingly efficient in terms of administrative costs compared to the private sector:
https://www.healthaffairs.org/do/10.1377/hblog20110920.013390/full/
2. – Government run health care in other countries is much more efficient than ours, costs are 1/2 or so and despite claims of horrendous wait times and people dying of cancer, etc… all those other countries actually have longer life expectancies than us.
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“There are plenty of big bureaucratic corporations… but they don’t last long.”
Clearly someone who has never worked for big oil…
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Conservative Fairy Tales are like pimples… No matter what you do ………..
One of the significant difference between Govt and the private sector is transparency.
We’ll never know most of Walmart or GM or Verizons screw ups… and we surely don’t know all of govt, but we do know a fair amount comparatively.
Then when we actually do have comparisons – like with our schools and SOLs and really a plethora of data , Conservative types used that transparency to argue that private sector schools will do better but almost never have I seen the same Conservatives argue for equivalent transparency.
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Sometimes you need a big bureaucracy to do big things. There is a reason why big oil operates in the harshest and most remote environments and small oil hangs out in Texas. You will note that Shell is a big player in offshore wind in the Northeast. Yes, insurance companies are big bureaucracies but look at what they have to do. Same thing for government – they have the biggest job of all. Private corporations are just not up to the task – it is not what they do.
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Looking at one of the biggest GOvt bureaucracies – the US Military and their airlift… good, bad and ugly for sure but surely one of the few organizations in the world that could carry it out.
And yeah, they left a shit-load of equipment there already ..
That airport – needs, electricity, water and sewer… and definitely sewer with 10,000 people pooping ever day…
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Yes noticed today they are up to 53,000 people airlifted. Quite impressive and our military is the only organization that could do it.
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BUT – how EFFICIENT are they REALLY?
All we have is their word and a successful-looking operation, eh? They could be burning dollars left and right!
I’m betting they still have $600 toilets on those planes… AND that they are likely full of you know what…
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I am glad you got through everything. But I would not exactly call our health system private sector. It is so screwed up with government entanglements. What is the “real” price of anything? If Anthem, A; if United, B; if Aetna, C, if Medicare, 0.85 A b or C; if no insurance, 2A,3B or 4C. If an illegal, FREE!
Have you noticed how all the non-insurance elective things have competitive pricing? It’s neither fish nor fowl right now…
But I am with you on working your way through…absolutely frustrating, and often you get info that is not quite right…oops!
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Anthem, United, Aetna, etc. are not “government.” They are private companies.
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No…but you have the intersection of employer provided plans, ERISA, Medicare, etc. The large employers are essentially all self-insured and the insurance companies are regulated at the State level, acting as re-insurers there, while the employer has to comply with federal and then many State specific laws. The InsCos are not all that different from public utilities at this point. Sort of like the tobacco companies…the States are so hooked on tobacco money…
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Even using a doc in the same health system is no assurance these days. Sometimes the insurance co fights that.
Interestingly I was about to write an article about the Boston Properties’ mismanagement of the Reston Town Center.
For years parking was free. I worked in the Town Center for 12 years and marveled at the mixed use, walkable features.
A few years ago Boston Properties (who I understand owns most of the Reston Town Center) implemented this clumsy and inefficient paid parking system which required a special smartphone app, recording of your parking place, paying to park although you are going there to spend money, etc.
One would have though that COVID might have changed things in the commercial real estate business.
I went there at 11:30 am last Wednesday. It was a ghost town. The garages were empty. But you still have to pay to park in an empty garage.
Then I went out into the Town Center to shop. I was amazed by the number of closed stores. A once popular Asian restaurant (Big Bowl) is completely boarded up. The best Thai place in NoVa (Busara) is long gone.
I checked the internet. Paid parking killed Busara in Reston. That was in 2018. Then came COVID. Then came the commercial real estate meltdown. Then came the pressure on restaurants.
But you still have to pay to park in an empty garage.
https://www.restonnow.com/2018/05/23/busara-thai-restaurant-in-reston-town-center-has-closed/
Stone knives and bear skins, Dick. We’ve come along way.
The private sector is just as inefficient, plus is more expensive (profit must be had, don’t ya know), AND with a higher level of redundancy (get three bids).
Any sufficiently large organization is going to suffer from inefficiencies. It’s easy to pick on the government’s because government is the largest organization there is and because it is beholden to a level of transparency that has analog in the private sector.
The older I get the most absurd our entire method of delivering health care appears. It’s expensive, opaque, confusing, and time intensive.
So now you can read minds. As a sometimes critic of government, I take no pleasure in discovering or commenting on its failures.
Are you really so uninformed that you do not know most conservatives and anyone else favor the government doing what it is supposed to do – assure that all have equal opportunity not equal outcomes, maintain a level playing field and prevent the criminality which is inevitable wherever there is money to be made? People with common sense are not in favor of government leaning on the scales to create some social outcome bureaucrats and politicians think best for us.
Do you not know that the health industry is a government creation where regulation has created the most non-competitive sector in our country, prevents new competition with idiotic CON requirements, crushes doctors with paperwork and bureaucracy, is permitting hospitals to further monopolize the industry by purchasing medical practices, and actively suppresses competition by outlawing cross-state competition for insurance companies — to name just a few of the ways in which elected officials and regulators, both clueless and bought, have made health care much more costly and increasingly more inefficient.
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There are few inherent functions that governments are “supposed to do”. Protecting the nation from foreign invaders and providing internal security for its citizens are the two that spring most readily to mind. For most of the functions beyond that, the government is “supposed to do” what “we the people” decide we want it to do.
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I keep looking for the countries that do health care like folks like Gillispie advocate.
Unfortunately, we know a lot about medical systems, as my wife was diagnosed with a very serious, life altering condition in 2013, and has been treated for that, as well as treated for the complications of the treatments since then. Here’s what I have learned about our health care system. Since most patients are not the ones who write the checks (at least the biggest part of the bill) to the doctors, hospitals, etc., there’s really no incentive for the providers to address our concerns on such matters. They really are beholden to the insurance companies, since they do write the checks. If a patient gets upset, so what? There’s plenty more folks who will take their appointment slots.
I really think that we have conflated healthcare with health insurance in this country. I understand that this happened during WWII, when the government instituted price controls on labor. Since there was a shortage of labor, and companies could not offer increased wages to entice workers, they offered benefits such as health insurance. From that time on, health insurance was primarily tied to employment, which brings on other problems.
One of the biggest problems with health insurance is that is has strayed from the original intention of being a hedge against catastrophic health costs, and has gotten into the more routine health costs, such as yearly checkups, regular medications, and etc. This has further distanced the providers from market forces since the consumers (patients) don’t deal so much with the actual costs. Therefore, providers tend to charge more that what they would if the patient was paying. Don’t believe me? Check out what the cost of medical care with and without insurance.
So, in my opinion, government interference in the labor market back in WWII had long lasting impacts which negatively affect us to this day- some 80 years later. Of course, that interference was viewed as necessary because of the emergency of WWII, not unlike the emergency of 9/11 (the Patriot Act), and Covid (destroying our economy with lockdowns and paying folks more to produce nothing other than a butt divot in the couch). Hopefully, one of these days, we will become wise enough as a country not to let our betters in government use emergencies to foist their well intentioned policies upon us which very often have very detrimental unintended consequences.
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Similarly seen in the price of College that has ever increased as the Government backed loans. Which is why you’ve got a Physician who gets a 4 year pre-med degree ($120k) and immediately spends another ($200k) on Medical School.
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Hey Matt. Always good to hear your reasonable views!
The simple reality is that we COULD CHOOSE to self-insure – to simply be responsible for our own health care.
But when we buy insurance, we do cede to them, what affects THEIR interests over ours – your point.
Also, Government “interfere” with Medical Underwriting which means the insurance companies cannot refuse to insure you if you are too big a risk for them which is what a life insurance or home insurance company CAN DO.
Are we prepared to let health insurance companies decide who they will cover or not and let those they refuse to cover make other arrangements?
My point? You can’t have it both ways.
choose one – and understand the consequences.
Lots of inefficiency in the private sector, but competition, if extant, tends to drive out inefficiencies or put the inefficient company out of business. There is no such pressure on government, and less pressure on private businesses that are funded by government or a captive customer base (e.g., Dominion Energy).
As I’ve posted before, years ago I attended a conference on regulation. One of the other attendees was a former Labour Party member of Parliament. He spoke about the fact that, by and large, competition in the private sector had generally shifted market power from producers to consumers but not in situations involving the government or de jure monopolies. It was one of those paradigm-shifting moments. Ever since talking with that gentleman I looked at things differently.
The surgery itself went well and my wrist and hand seem to be healing well.
That’s the most important thing. I am glad it worked out for you.
There are 3 basic components of healthcare cost:(1) Hospitals, (2)Drug Companies, and (3) Insurance companies. Unfortunately the public sees only the insurance companies; but they are only the Sharksuckers at the party and not the cost drivers.
Force competition into the hospital world with the same consumer and anti-trust protections demanded of other businesses; force national competition with larger risk pools on the insurance companies; and prevent drug companies from writing off their worldwide market-share expansion costs on the US public and we would see dramatic cost reductions and increased efficiencies.
The big-company controlled Democrats will not permit the first two and this globalist-controlled administration immediately rescinded the MFN mandate as it has done with everything else the previous administration did which addressed “main street” problems.
Given that hospitals in most communities have no competition and rely on third parties and not health care consumers for compensation most are less concerned about inefficiency, cost and consumer experience than, say, the average fast food restaurant, Walmart or Amazon which see the elimination of inefficiency and customer satisfaction as key to increasing revenue and net income.
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True. But in many cases they have no competition because of now-idiotic CON requirements. And even if remote, they would respond to market forces. The ever-growing increase in “medical tourism” demonstrates that clearly.
The number one way to have true competition in health care is to allow the insurance companies to use traditional actuarial underwriting standards like they do for other types of insurance.
Let the insurance companies set premiums based on the risk level of each subscriber just like we do for life insurance, auto insurance and homeowner insurance.
If you truly want a free market – put your money where your proverbial mouth is. Otherwise, admit, you do favor the govt telling insurance companies who to insure and for how much.
Gubermint is arguing and wasting (inefficient) time becasue it is not their money. Private has a profit to worry about. Time is money. However yes they are not above reproach in some of their practices.
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