2017 Mar 20^th

Mona Charen, who leans as far right as any columnist, comments on the American Health Care Act. This is the substitute plan the right wing hopes will replace the Affordable Care Act. Charen is no Trump fan; she calls his promise that the ACA’s replacement will cover everyone and will cover them more cheaply than the ACA is “cotton candy.” For a change Charen is right about something.

But then she boots it by writing, “Congress further distorted the marketplace in 1986 by requiring hospital emergency rooms to treat everyone regardless of their ability to pay.” Well, shame on congress for that. How un-conservative of them to “distort the marketplace” by insisting hospital emergency rooms treat all comers.  I mean, why not just let the impoverished accident victim bleed to death in the hospital entryway?

She does recognize that there are problems but tells us that there is some movement in the “right direction.” She means the repeal of the surtax on the very rich to help pay for the ACA; she is comforted by the move to health savings accounts. Health savings accounts are another example of the cotton candy she called Trump’s promises. If you are unemployed, married and have two kids where does “a health savings account” come from? The conservatives would like to give you a 3,000-dollar subsidy to buy insurance from your favorite provider.

That’s not very much help. There is an outfit called the Milliman Medical Index that tracks the cost of medical care. These people have estimated that the total medical cost for a family of four for the year 2016 was 25,826 dollars. This included everything, dental and eye care as well as immunizations. The Milliman report can be found in “Forbes,” not a notoriously left leaning publication. The Milliman estimate comes to just under 500 dollars a week.

It is well known that we pay more for healthcare here than is paid for better health care in other countries. What’s going on?  Why are drugs so much more expensive here than in Canada? Why are physicians paid so much more here than they’re paid in other countries?

Orthopedic surgeons in Canada make less than half the $440,000 average net income of colleagues in the States while doing more procedures, two U.S. health-policy professors concluded in one of the most detailed looks yet at the differences in doctor compensation between nations. An American internist earns about 185,000 dollars after expenses. That declines in other countries with the Australian internist earning just about 95,000 dollars.

How have physicians managed to become America’s royalty?