Saturday, November 10, 2007

The Price of a Pen

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Go to your neighborhood Walmart and walk straight to the pen isle. That's correct. The pen isle.

Now just stand there and look. Look at the number of companies that make pens. The types of pens. The sizes. The colors. The "bacteria free". The "check book proof".

The prices. Look at the various prices. A vast array. Pennies to dollars.

Every pen you could ever imagine

Why?

Competition.

Something as simple as a pen has hundreds of variations. Cheap to expensive all priced to perfection? How do I know that it's priced to perfection?

Because they are on the wall. If you, the consumer didn't buy it, it wouldn't be on the shelf for very long. You do not have pen insurance. If you like it, you will buy it.

What the heck does all this mean to health care?

There is no competition in health care. Medicare sets the rate, all other third parties follow suit. Hospitals cloack their product prices in secrecy. You the consumer don't pay. You don't care. You're insurance picks it up. The status quo has flattened the system.

Where's the competition.

Where's the innovation? Everything in this world is getting cheaper (except gasoline and subsidized agriculture) and better with more variety. Health care is not getting cheaper. And I'm hard fetched to say its getting better (for the money being spent)

Where is the drive for innovation?

Where is the 100 different pens per say?


It's bottled in the Medicare highway. Price controls create artifical limits to productivity. Success is determined by somebody else, not yourself. You are the slave of someone else. There is no sky is the limit.

Competition forces innovation on the top line and bottom line. To survive, change must occur, and quickly, or you go bankrupt. That is the American way.

That is innovation.

Not universal health insurance. It will kill innovation. It will perpetuate a status quo and create one pen instead of a 100. I can assure you of that.

Zemanta Pixie

10 Outbursts:

DDx:dx said...

I agree that entrepreneurial free market economy stimulates and rewards innovation. There are some exceptions. Does your computer run Windows? The emerging market of software in the 90's allowed for a positive feed back loop, like thistles growing in a denuded grassland.
And the railroad monopolies of the early 1900's did not encourage innovation. Both done in a "free market".
This is the problem I have with a free market solution. You have time to shop for pens...try one, buy a different next time when this one was lousy...When the sweat is dripping down your face and you are clutching your chest will you want to be transported to Mayo Clinic for that bypass?
I think alot of what I see in the current Primary care situation is that docs are responding to the market forces(poemd/ market forces) and doing BAD medicine to "compete"...giving the patient what they want so the patient doesn't go down the steet...This speaks to an over supply...
I spent a while working for the Guvmint and have no illusions of their "efficiency" or quality...
I think we ought to go to an overt two tiered system, since nearly 50% of healthcare dollars are Federal now anyway. And discard the silly formulas we have for compensation( Maximum allowable, RVRBS, etc) and go to ones that are transparent and predictable...

Anonymous said...

I am so often amused by the hypocrisy of doctors calling for "competition." Why don't we remove the guild monopoly that artificially depresses the supply of medical care, i.e., credentialing.

Let anyone practice medicine who wants to--and let the market sort out quality.

If you really want competition, that's what we should have.

The Happy Hospitalist said...

DDX:DX I blogged about your comment today.

anonymous. What you are looking for is called alternative medicine and is widely available, in unlimited quantities. I hope you find what you are looking for.

Anonymous said...

HH: No you're totally wrong on the law. The power of prescription and performing most medical procedures is, by law, restricted to those who have the appropriate medical degree.

That's a barrier to entry--which physicians continue to use to make more money at the expense of access and choice.

"Alternative medicine" by law cannot use presciption druges, perform surgery, attend at births, etc.

Get your facts straight before you mouth off HH

The Happy Hospitalist said...

anonymous i never insinuated that alternative medicine could prescribe anything. Alternative medicine is the field available to the lay person to practice.

I am just a bit frightened by your stance. It's as if you don't believe medical doctors have anything to offer in this world that a lay person couldn't handle.

That's like you designing a bridge. Would you drive over a bridge that you personally designed and built?

Would you drive over it with your family?

For me the answer is no, but that's just rational ol' me.

Anonymous said...

HH: I'm not sure that doctors do have that much to offer--that PAs or NPs or midwives could not. Many non-physicians can perform many medical procedures better than physicians (i.e., after an injury, my friend the hospital administrator insisted that a PA to do my stitches--a former army medic he had more experience than the plastic surgeons)

You smugly state that it is "rational" to only let those with credentials do medicine. It's an empirical question as to who'd do a better job--and you simply don't have the answers, just your own financial and prestige interests.

I believe that if anyone could do any medical procedure, certain types of flexible signalling mechanisms would develop (like bond ratings) to indicate quality. That would be a whole lot better than the informationless environment in which consumers now chose doctors

Anonymous said...

in many states, pa's and np's can write prescriptions. it sounds like you want credentialing restrictions for physicians relaxed so that credentialed other medical people can perform procedures and take care of patients? where do you think the pa's and np's learned their skills from?
i'm not even sure why you would trust your friend the hospital administrator to know who would do the best job of doing stitches? because he/she systematically studied the results of the people involved or because he just kind of thought so based on limited interactions with a few patients?
that's not to say the medic wasn't very good or highly qualified, just wondering how the administrator determined it would be better than a plastic surgeon.

Graham said...

Innovation in Canada and the UK; More on medical innovation.

We've heard the innovation argument several times over. I don't buy it.

The Happy Hospitalist said...

I think we are talking about two completely different things, I think.

Scanning those headlines, they appear to refer to innovation in medical research/technology.

I am referring to innovation in the delivery of health care, not the health care itself per say. The systems. The costs structures. Making better cheaper.

I can assure you from a physician standpoint, working in the VA system (I worked there as a resident for 3 painful years), it is not, by any means a system to be championed for the patient.

It was slow. oh lordy was it slow. Everything happened tomorrow, no matter if it needed to happen yesturday. I once had an xray technologist pretty much refuse to come in in the middle of the night to do a chest xray because they didn't lived to far away.

Have you ever tried to care for a patient on a ventilator in the middle of the night and not have the resources to get a chest xray if you felt it was necessary.

My experience as a physician working in the VA as a resident was that it was terribly bogged down in beuracratic paper work, unilateral decisions, anti competitive and very obstructionist and SLOW, SLOW SLOW. Some of my greatest, most difficult patients were Vets.

Today as a private practice hospitalist we care for vets ALL the time under their medicare benefits because THEY refuse to use the VA system due to the incredible headaches/obstruction they endure and the SLOW, SLOW, SLOW wheels called VA medicine. I agree with them completely.

I personally, while not a vet, would never admit myself to a VA hospital after working on the delivery side of the business.

That's governement care for you.

Doc R ny said...

I like the gas station analogy because i've used it myself when speaking about the problem with managed care - 'competition' is measured in pennies, fractions of percents. There is no best HMO; there are simply plans that afford greater financial risk in the name of larger deducibles and copays.

I have family in Italy where healthcare is socialized, and the taxation rate is high to cover the costs. However, a cousin of mine needed to be seen urgently for a skin infection and had to pay 150 euros to be seen urgently. Far from ideal.

One the top of my Christmas list is a NON FOR PROFIT HMO that won't get greedy down the line. If anyone knows any philanthropist billionaires out there, pass along the idea. Then we'd see what the true market value of healthcare really is.

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