A remarkable letter to the Times!

MONDAY, JULY 8, 2013

Concerning the ridiculous cost of American health care: This morning, the New York Times has published a striking letter.

First, a bit of background, including an observation about the puppies who haven’t barked.

On Sunday, June 2, the New York Times began a series of front-page reports which ought to be important. In these reports, Elisabeth Rosenthal is going to explore the ridiculous cost of health care in this country.

For our original post, click here.

For many years, the mainstream press corps has worked like dogs to avoid exploring this topic. Given the massive amount of looting which is involved in American health care, you’d think progressives would be very interested in this developing series.

People, guess again! Last Monday, Rosenthal ran the second report in this series. But on the One True Liberal Channel, have you heard a single word, pro or con, about these first two reports?

We just ran Rosenthal’s name through Nexis. Not a single reference! Through other searches, we find no sign that these first two reports have been mentioned on MSNBC at all.

Why aren’t the puppies barking? We’ll turn to that question next week. For today, we were struck by a letter in this morning’s Times about the ridiculous cost of American childbirth, the subject of Rosenthal’s second report.

This letter comes from a retired primary care doctor in Berkeley. Can you see why we found her letter so striking?

This is the way it starts:
LETTER TO THE NEW YORK TIMES (7/8/13): I was utterly shocked by the information in “American Way of Birth, Costliest in the World,” even though I regularly follow news about health care. The lack of price transparency was not as surprising as the figure of $37,341, the average 2010 billed charges for having a normal pregnancy and delivery.

It is so important that we Americans learn more about health care costs and try to understand what is behind them, because their growth is outstripping the growth in our gross domestic product...
The writer is a retired physician. She says she regularly follows news about health care.

Despite these qualifications, the writer says she was “utterly shocked” by Rosenthal’s second report. Despite her profession, despite her interest, she apparently had no idea how crazy the costs of childbirth are in this country, as compared to the costs of childbirth in other developed nations.

For what it’s worth, this letter vastly understates the lunacy of the situation. Let’s assume that the growth in health care costs “is outstripping the growth in our gross domestic product.” The problem is, we start from a baseline in which U.S. consumers are paying two to three times as much as everyone else in the world to begin with! Rosenthal is building her series around those crazy disparities.

At any rate, this retired physician was “utterly shocked” by what she read last week. She had no idea how crazy the situation is.

If she had no idea about this, what are the chances that non-physicians understand this topic?

Answer: Average people don’t know squat, squadoosh or squadoodle about this absurd situation. Most people have no idea about the extent to which they're getting looted through health care costs. The silence of our corporate liberal puppies plays an obvious role in this widespread public ignorance.

We had planned to start with this topic this week. We decided to jump to the Zimmerman trial as our primary focus. We’ll plan to return to this topic next week.

In the meantime, why do you think the puppies aren’t barking on the One True Channel? What has kept these fiery players from urging Rosenthal on—from insisting that she push even harder toward the heart of this matter?

Fourteen years ago, we asked these questions about the mainstream pundits who refused to discuss the Gore-Bradley health care debate. This morning, we expand our search.

Why won't the puppies bark?

What do progressives care about: At Slate, Friedman and Lithwick offered two pieces last week about the current state of the liberal/progressive agenda.

Who decides which topics get discussed within the career liberal world? We wouldn’t have written those pieces ourselves, but we think they’re well worth reading.

We plan to discuss them next week. For the first presentation, click this.

For the second column, click here.


  1. Quaker in a BasementJuly 8, 2013 at 12:42 PM

    Average people don’t know squat, squadoosh or squadoodle about this absurd situation. Most people have no idea about the extent to which they're getting looted through health care costs.

    You're most likely right. I DO know that the productivity of American workers has steadily improved over the last 20 years while wages have remained stagnant. That means somebody other than workers are reaping the benefits of increased productivity.

  2. My wild guess, one reason our MSNBC puppies don't bark over this stuff is that they are first and moremost social or identity liberals. The fascination with pocketbook issues pales when there are civil rights issues at stake.

    When he wasn't playing the perfect counterpart to Fox pundits in his attacks on the enemy, Ed would focus on such working man issues more than the others, and look what happened to him, relegated to weekend afternoons.

    I guess MSNBC knows who their teeny, teeny, tiny audience is. Pointcasting, indeed.

  3. I recommend readers to reread all comments to TDH Dec. 3, 2011.

    Also, is this from NYT on July 5, 2013


    A big question is when we see our Statement of Coverage, and see the charges to Medicare are padded by our physician, what do we do about it?

    Call the doctor's office and be told to call the billing office, which will tell us to call the insurance company, which will tell us to call the doctor's office?

    If we do blow a whistle, and someone listens, what will happen?

    Will fraud stop? Will the doctor declare he is not taking Medicare patients and kick you out of his practice? Will you be blacklisted to local doctors?

    Will you have to start over with a new doctor, maybe twenty or thirty miles away?

    The risks of complaining are unknown, and could far exceed the rewards. After all, Uncle Sam is paying, not me.

    Why take a chance?

    1. I don't think this is a problem of padding bills with services or goods not provided but rather what the billed costs of the items provided is compared to the actual costs.

      Hospitals and doctors charge inflated prices for everything because they do not get reimbursed for goods and services provided to indigent people who consume more care than they should because our system is inefficient and does not provide preventive care or proper management of chronic conditions. Thus people repeatedly come to emergency rooms in crisis and require expense services because they are not seen routinely when their conditions are manageable. This is a systemic problem, not a matter of individuals being vigilant about reviewing their bills for fraud.

    2. Anon,
      I'm not referring to ER charges. That's another area altogether.

      What I'm referring to is the MA asking if you are still taking Allopurinol, (used to prevent gout), then billing for a consultation on gout when the patient didn't have it, never brought it up, and the doctor never mentioned it.

      I often see two or three of these codes on my insurance 'Explanation of Benefits'. Since they don't affect my co-pay, I have no financial reason to dispute them.

      As far as "actual costs", what is the actual cost of telling a patient that his blood work looks good so keep taking the same meds?

      The actual costs are the physician's income, rent, utilities, supplies, a Medical Aide's salary, a Physician's Assistant's salary,(who, incidentally, charges the same rates as the physician) appointment clerks, billing clerks, file clerks, etc.

      Doctor's offices in the US are bloated beyond all reason. I frequently see two doctors with an office staff of eight or MORE.

      I had been going to a doctors office in Scottsdale, Arizona for seven years, and never ONCE saw the physician of record, only his PA.
      I didn't mind, however, since the PA was outstanding and was always right.

      You are absolutely right in it being a systemic problem.
      The problem lies not only in the healthcare re-imbursement system, but in the healthcare delivery system itself.

      Again I recommend TDH Dec 3, 2011 for a lively discussion on these subjects.

  4. Another contributor to this problem is the pharmaceutical industry. It is focused on profit and thus does not produce generic or needed drugs but rather expensive and newly packaged/designed drugs that it can make a large profit on. When Bob talks about profiteering, that is part of what he is referring to. The companies claim they must recover research and development costs, but their profits suggest they are pricing drugs way beyond such expenses. It is like the argument that athletes get paid a lot because they will only be able to work for a decade or so. Pharmaceutical companies bilk the health care system because they claim they can only profit from a drug for a short time and thus need to make as much money as possible during that time. So drugs are unaffordable without insurance and the insurance companies pay through the nose for treatments that should be much less expensive (and are in other countries that will not and cannot pay the exorbitant prices charged in the US. When we try to buy drugs in Canada (for example) we are told that cannot be done because of possible forgeries. So we are being held ransom for our medications. Again, that is a systemic problem that cannot be addressed by individuals checking their bills more carefully. It takes political action, organized by progressives on our liberal channels -- those same people who Bob says have been entirely silent about this.

  5. My cousin's wife is a doctor who has been employed by various organizations. She never earned a great deal of money. Yet, she has pretty much always worked 12-hour days. Several hours a day are devoted to calling insurance companies and government agencies to get approval that they would pay for the treatment she felt was best. Her devotion to her patients is extreme.

    I think Health Reform will do nothing to reduce this burden on doctors. If anything the burden will increase, unfortunately.

    Another source of higher costs in the US is a tort liability system like no other on planet earth. Costs of malpractice claims here are typically 10 or 20 times the cost of other countries. Perhaps more costly than the insurance premiums is the defensive medicine, where procedures are done for no good medical reason, but simply to help defend a potential lawsuit.

    1. http://www.motherjones.com/kevin-drum/2010/02/john-mccain-and-californias-caps

    2. Interesting article.. As an expert in California malpractice insurance, I will resist presenting a dissertation on the subject, since malpractice is somewhat peripheral to Bob's point.

      If I had had the power to reform malpractice, I'd change the law to permit patients to sign away their right to sue in exchange for lower medical fees. I think a lot of patients would take advantage of this opportunity, especially if health insurance were structured so that the patient, rather than the health insurer, got the benefit of the lower medical fee.

      I'm dreaming. Courts have held that the Constitution prohibits giving patients this option. Today's very Democratic CA legislature isn't going to pass a law that substantially cuts into the income of plaintiff's attorneys -- a prime Democratic constituency. And, even if they did, the courts would rule it unconstitutional.

    3. Slightly off-topic, but since you brought up medical malpractice.
      Medical malpractice insurance costs go up, even when cases of medical malpractice go down. This is because the insurance companies need higher profits and sometimes get less ROI due to the stock or bond markets going down.


    4. Texas is one of the most physician friendly med mal environments in the country. How does that translated into reduced patient costs? Last time I checked they were one of the top four medicare billing states on a per capita basis. There is NO DATA to support the view that malpractice reform translates into lower costs. This is a Republican talking point, which is typically used as a substitute for honest discussion about the cost drivers in medicine. At one time in the southern part of my state (Florida) malpractice rates for OB/GYN were such that the majority of that subspecialty 'went bare', hiding their assets from litigation via bankruptcy attorneys. Do you think that they passed the savings on to the consumer? The idea that an individual would forfeit his legal right to redress for harm done to him that might impact his entire family is, needless to say, sophomoric and ridiculous.

  6. The highly-paid commentators on MSNBC never talk about healthcare costs for the same reason the high paid hosts of the Sunday talk shows don't. They've got awesome healthcare, with low copays and low deductibles. Even if they did have insurance with high copays and high deductibles, they make so much money they don't care.

    Any discussion about the high costs of something - or about poverty or the minimum wage or jobs being lost due to trade agreements - does not touch upon their lives. They can only discuss it in the most abstract way, therefore they don't care about it. When Rudy Giuliani went on their shows and claimed America "has the best healthcare system in the world" they didn't know how to contradict him, because for them, just like for Giuliani, it IS the best healthcare system in the world. You have to be poor, or not have insurance, or have really horrible insurance, to recognize that we have a horrible, damaged healthcare system except for the 1%.

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