My mother was diagnosed with a form of skin cancer. Her doctor decided to treat it by applying Aldara cream over a period of time. 24 tubes of the cream cost $658.50.
Mom’s Medicare D provider, Humana, refused to cover the claim. I got a letter of medical necessity from Mom’s doctor, and then spoke to a Humana representative.
I was told that Humana only allows doctors to prescribe half the amount of cream that her doctor prescribed.
I suggested that they at least consider paying half the claim, the half they would have paid for had it been prescribed according to Hoyle.
I was told that since the claim was for the wrong quantity, the whole claim was rejected, and that was that.
Piece of Mindful 
Welcome to Almost-100%-Socialist Health Care, Mark.
Hard to believe there are people who believe 100%-Socialist-Health Care will be better.
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Did you, like, totally miss what’s going on here? Humana is for-profit, sucking a governmetn teat, and minimizing medical loss payments to enhance its bottom line.
A government plan would have 1) negotiated for a lower price, and 2) paid it.
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Sir,
Humana is wholly beholden to the legislation and government monopolies that dominates the market place.
Since competition has long been removed from the delivery of health care, and run as a cartel, you’re ability to design both the form of your care and the contracts for its provisioning are wholly limited.
Humana’s customer is not you – it is the government. You are a cost to Humana. Humana operates in a manner to fulfill its obligation – not to you – but to its customer, the government.
Re: Government negotiate lower rate.
Sir, based on what economics?
It appears you believe there is an economic law that says, simply, “Because I buy more of a thing, the price must go lower”.
There exists no such economic law. For example, doctors….
You cannot buy a doctor any greater then his time. If you go and ask for a price for his services of 36 hrs per day, he will laugh at you. He cannot (and would not) discount his fee simply because you offered him more hours.
Since it is his time that determines the roots of all health services, he can only visit so many beds per day – thus, limiting the number of beds – and equally, the number of procedures.
Guaranteeing him a lump sum will not increase the hours he has available to sell.
By this one example, you theory of ‘bulk buying’ collapses.
“Marginal Utility” is the economic theory that describes why some purchases in bulk result in a lower cost per unit.
You buy an apple for $1 to satisfy your immediate hunger – for that is the value you place on that instance’s satisfaction of your hunger. The 2nd apple you may eat satisfies only the part of hunger that the first one did not, if that. Thus, the value you place on the 2nd apple is lower than the first. If I wish to sell you the second apple, I have to lower my price to be equal or better than the value of you consequential sanctification. This continues until the value of satisfying your hunger approaches my cost – and I no longer offer a lower price.
However, if the utility of the product is exactly the same for every unit, there is no price reduction. Your value for that product does not change.
You buy medicine to cure you. You do not buy more medicine than you can reasonable use – for you do not take medicine if you are not sick, for that would poison you. You do not consume more medicine if the price is cheaper, for that would poison you. However, if you do not take the medicine, you will remain sick or die.
Every pill you take has exactly the same utility as the first pill you take. There is no need to discount the price because you value the 100th pill you need to take like you valued the 1st pill.
After you are well, the utility of that pill is exactly zero. I have no hope of future sales.
So why would I discount the product as you buy it? There is no advertising motive in hopes of future sales, nor do you discount your value of additional purchases since those purchases are directly for need.
Therefore, government health care as a measure to reduce prices has no cause. Certainly they can buy up huge volumes of medicine from manufacturers – but based on what cause? Can you predict who will get what disease in the future? No one can. Thus, they will have to warehouse – and because it is government, you ignore the cost of capital in inventory.
Yet such cost exists. Government must tax you to pay for it, and transferred that cost of capital to you, Mr. Taxpayer – OR – it had to borrow it from the market, and pays interest on that money – OR – printed the money, and inflicted inflation on the entire economy. Simply because you ignored the cost of capital does not mean it disappeared.
A single-payer is a monopoly, and like any economic monopoly, it exists only by writ of government and applies every destructive influence upon the market – thus, will consistently lower quality while consistently increase costs.
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Thanks for the lecture on econ101, as you guys like to call it for the benefit of us dopey lefties that don’t know how the world works.
I look look forward to meeting someday with a right winger who has studied Econ102, or how the world really works, for dopey righties.
Medicare could easily negotiate a lower rate with the drug cartel because of the volume it deals in. That’s why the drug cartel, when it wrote Medicare D, had to specifically prohibit the practice.
FYI, all other countries here on earth pay less money for drugs than we do. Reasons:
1) The drug cartels have made it illegal to “re-import” drugs into the US. (They also want it to be a criminal offense for Americans to go to Canada or Mexico to buy drugs.)
2) Other countries buy in large quantities and negotiate lower prices.
Now, onto Econ103, how Ayn Rand knew as much about economics as she did the effects of tobacco or about human sexual relations.
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Mark,
Given your economic offerings in the few posts of yours that I’ve read, it appears you were absent during economics class.
…” for dopey righties.”….
Mark, you have no competition. They are economic crackpots as well.
Because the ‘left’ (whoever that means) have no economic sense does not meant the ‘right’ (whoever that means) is correct about theirs.
They are not.
Keynesian economics dominates 98% of the economic mindset and is used by every political power to justify is attack on the market.
One group justifies its attack on ‘fairness’ and ‘equitable outcome’.
Another group justifies its attack on ‘top down mercantilism’ and stability of cartels.
Both groups equally destroy the market place and drive into the ground.
…”Medicare could easily negotiate a lower rate with the drug cartel because of the volume it deals in.”….
Again, you offer some bizarre “Because I buy more of a good, the price must fall theory” – with absolutely no economic theory to back it up.
Use the gray matter, Mark, and think.
What drug are you going to buy millions of doses for right now?
You don’t know, do you – because you are not sick.
You do not know who is sick, or why they are sick, or how long they will be sick.
But you have to buy a million doses of something.
Do you believe that by the finger of God you know which one to buy?
Your only recourse is to buy everything and store it.
As I pointed out, because it is government and you think it gets money for free, you do not calculate the cost of capital.
Thus you believe the government ‘got a deal’ simply because you ignore a line-item cost.
Typical economic crackpot game…
FYI, all other countries here on earth pay less money for drugs than we do.
(1) They do not tax the product
(2) They subsidize the importing of the product
…”1) The drug cartels”…
As soon as you point to a cartel, Mark, you are pointing at government.
A cartel cannot exist without a government grant.
If you have anger at cartels, your blame wholly must be leveled at government who prevents competition.
If you point somewhere else, you’ve been duped.
..”2) Other countries buy in large quantities and negotiate lower prices.”…
Again, because you fail to understand cost of capital, you believe this ‘cheap’ buy is actually ‘cheap’.
Until you can provide a coherent basis of you theory of “buy more, pay less” – you will continually make mistakes in allocating economic cause and effect.
…”Now, onto Econ103, how Ayn Rand knew as much about economics as she did the effects of tobacco or about human sexual relations.”….
Do you have sexual problems that you believe can be solved by reading Ayn Rand?
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See below – it gets too skinny
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Forced Govt. care will create jobs.
Black market jobs.
Call me sometimes, I’m sure I can get some Aldara wholesale.
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I don’t suppose you are aware that your comment contains a glaring internal contradiction.
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Big Swede,
You are precisely correct.
Any economic good subsidized below its market value will be consumed to exhaustion.
Since price mechanisms are no longer useful in allocation resources, wholesale rationing (except for the elite) will be applied.
With any rationing – black market sources expand.
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What about economic goods priced above their market value and held there by means of cartels?
Once you leave the US, the price of drugs goes down dramatically. There are no shortages, as the actual products are simple chemical combination using base resources.
And that is how the world is run. All your theories about markets 101 102 103 are like counting angels on the head of a pin – you’re talking about a world that doesn’t exist, and cannot be willed into existence. It is like theologists – you’ve made yourself into an expert on something that does not exist.
And you really haven’t read Rand, have you. Otherwise, you would know her attitude about human sexual behavior.
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What about them?
Mark, you see cartels as ‘bad’.
I see cartels as ‘bad’.
We agree on that.
You think cartels exist in a free market. But that is impossible.
All cartels are a result of a grant of government.
Your anger about cartels is misplaced.
You blame free men – who can never create the beast – and cheer government as the entity to curb cartels – when its is government that creates them.
No debate there.
Because of the cartel system in the USA, there is no competition.
The cartels are created by patent law and legislation and licensing.
All these items creates legal barriers to entry, preventing low cost producers access to the market.
It is no surprise that in a cartel – created by writs of government – you pay a price over premium.
Don’t like that?
End the government writs that create cartels.
Sir, economic theory is the science of human action.
This is how the world works.
I have explained what the optimum of free market would provide.
I have explained the consequences of government interference into that market place creates.
You do not like the consequences – therefore you believe it is the fault of the free market.
You ignore the cause – government interference.
Hence, you always get the wrong answer.
For reasons that only you seem to know, it appears you have some fetish about Rand.
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**See below
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This reminds me a little of the accounts of Copernicus informing the Catholic Church that the Earth was not the center of our solar system. Over 100 years later the Church jailed Galileo for observing with his own eyes what Copernicus had already proven.
“Free-market,” anti-government authoritarians will not admit failure for generations. Maybe never.
The U.S. is spending more on health care, and getting less by any measure, than any other country in the G-20. I wonder why? I don’t really wonder. I am amazed at what I see with my own eyes, and what others cannot observe in the face of overwhelming evidence. The Empire is indeed crumbling.
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Ayn Rand has a following in this country unmatched in others. What’s up with that?
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Ladybug,
As typical with crackpot theories, you are confused by the economic system exercised by the Government of the United States.
The United States economy is not a ‘free market’ system, and hasn’t been since 1932, and perhaps arguably as far back as 1865.
Your argument amounts to no more than pointing a dog and calling it a polar bear, and then claim all the actions of polar bears are what dogs do.
Most of the US economy is fascist – state run capitalism. The rest of the economy is socialist.
The ongoing confusion as highlighted by yourself and Mark is to believe that this system represents a free market system.
The failure you witness is the collapse of the socialist/fascist systems – of which both are predicated that government interference in a market place can design better outcomes then the voluntary decisions of free men.
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** Its not like you are saying anything new or different here. “Free” markets are an intellectual construct, and the word “free” an Orwellian thought-blocking mechanism. You mean “unregulated”.
Unregulated markets naturally coalesce into monopoly/oligopoly,and private power is a cruel master. The logical end of the process you advocate is slavery. Remember, it was not government that owned slaves in the South. (Stop the presses! You’re going to say that since government didn’t stop it, government caused it. Wrong. Government stopped it.)
Yes, monopolies are often broken up by natural means, as kerosene replaced whale oil. The point you miss is that we don’t want them to exist in the first place.
You repeated point that governments create monopolies is wrong. If government fails to regulate monopolies, private power usurps control of government, which is what we are witnessing right now. You’ve got cart and horse mixed up.
I’ve come to think of this as Budgeism – the notion that unregulated markets are some sort of panacea for all that ails humanity. You put yourself in a secure little cocoon – you cannot be wrong. Since virtually all the world is too smart to let markets go unregulated, “free” markets don’t exist, so you get to say they are infallible without having to show evidence. And, whenever anything goes wrong, as with the recent crash or California power or the oil bubble, you get to say that it is really, in the end, all government’s fault.
You cannot be wrong. How very nice for you.
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When I mean free, I mean free – it is not Orwellian, it is an action, a verb.
Freedom exists when no one imposes upon me.
You are free when no imposes upon you.
By what economic theory?
The only way this is possible is by use of violent power to prevent entry into a market.
Individual violent power is a crime, therefore the only way this can occur is by legal violent power; government.
Government tyranny is the logical end to this process and that is slavery.
Actions of men are sometimes evil – observational fact.
To battle that, you create an organ that, by the root of its nature, centralizes the use of that evil you wish to stop as a legitimate tool.
And then you wonder why almost everything you idolize is a contradiction.
Your glasses are missing a lens in one eye.
A government allowed it and made it a law, and it was replaced by another government who extended it over the entire citizenry.
I am not surprised that you advocate broad violence upon men to fix broad violence on men.
If you do not want monopolies to exist, end their grants from government.
One need only to read history of Soviet Union – where nearly every industry was a monopoly. With just a little bit of review, you see who created them.
The cart is fine.
The power of government attracts the worst of society, for government legitimizes violence.
It is not a surprise that men of means will attempt to control this violence for even the mere reason of preventing this violence to be used on themselves.
Once tasting of such violence, it becomes useful to use it to prevent competition to themselves, and then further, to guarantee their profits.
If government did not exist, there would be nothing to attract such vile.
The issue is you cannot provide any economic theory to back up your contentions – merely unsupported hypothesis laced with rhetoric.
I can be wrong by premise – but not by reason.
You are wrong by premise, and often by reason.
This may appear to the unobservant that I am always right.
They are, as they are all rooted in government interference.
Because this interference is systemic, you are fooled by the slight of hands.
California power was not an “unregulated market” – in fact, California law (reminder: the thing government uses to create edicts) put onerous requirements on the power companies that prevented them from performing in a manner to reduce there risk.
To you, of course, this is the fault of free markets.
You do not see the law as the cause.
It is a curse that I bear well.
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