Reagon's little bumper sticker that says that "government doesn't solve problems, government is the problem" is not some kind of universal axiom, nor is it even partially true, although conservatives are very fond of quoting it. For a distressing number of people, a good bumper sticker, no matter how erroneous, seems to replace the necessity of thinking.

Anyway, with reasonable regulation, the way Bobert's insurance company is screwing him over would not happen. And insurance companies are not the only entities that need some kind of government oversight. Remember Enron? When private companies that supply essential services such as unilities, infrastructure, law enforcement, and health care run amok, some kind of regulation is essential for the protection of everyone. That's not socialism, that's just the kind of good government that the Constitution mandates when it says that one of the duties of government is to assure the general welfare.

Here are a couple of items that might shed some light on just how bizarre the American health care system has become:

Such diagnostic devices as CAT and MRI scanning machines cost millions of dollars per unit. In countries with relatively up-to-date health care like Canada, most of Europe, and much of Asia, including Thailand and Indonesia, if one hospital in a particular area has a CAT or MRI scanner, nearby hospitals send patients needing diagnostic scans to that hospital. This is a simple and reasonable way to do it. With one machine in the area that can be used by all, the overall cost of health care is kept down.

How this is paid for depends on the health care payment system in each country, but with a single-payer system such as many enlightened countries have, neither the hospital nor the patient need concern themselves. The system covers it. Yes, taxes are relatively high, but proportionally, in relation to income, the share of an average individual's tax that goes to support health care is far less than what a similar individual in the United States (or his or her employer) has to pay in the form of health insurance premiums. And everyone, man, woman, child, employed or unemployed, is covered. Incidentally, with a single payer system, the reduction of paperwork alone saves billions. God knows, a serious illness is bad enough without it putting someone (and often their family) so deep in debt that they will never get out.

But in the United States, competition fever and profit motive are such that if one hospital in a particular area has a CAT or MRI scanner, all the other hospitals in the area feel that they have to have one too. So they all buy them, and since they have to be paid for, they use them for everything from brain tumors to hangnails, not only charging the patient for its use, but raising the fees for all kinds of care that take place at that hospital. As a result of this kind of unnecessary and expensive duplication of facilities, health care costs go sky-high, and insurance companies raise their premiums accordingly (of course, since they are private, for-profit companies, they add a substantial mark-up to sweeten their own profit margin). Finally, adequate health care becomes prohibitively expensive for the uninsured individual, and even group health insurance rates have become so expensive that many employers who customarily include health care in their benefits package find that they, too, can no longer afford to insure their employees.

Three small anecdotal bits, but they illustrate how insane incidental charges have become in American hospitals these days. In two of these, the amounts are minuscule, but it shows the attitude that prevails in our profit-oriented system. A nickel here, a dime there:

1) A few years ago, my quack decided that my blood pressure was elevated to the point where he felt I needed to control it, so he prescribed a beta blocker. Okay, fine. With a low dose of the beta blocker, my blood pressure currently hovers around 120/70. No sweat. Now, five years ago I broke a leg badly, had to have surgery on it, and spend three weeks in a hospital.   While I was there, Barbara brought me my little plastic pill bottle containing my beta blocker prescription. I had to fight with a doctor and a couple of nurses who insisted that, rather than allowing me to administer them to myself as I had been doing for a couple of years, they had to dole them out to me--and charge me $8.00 a day to give me my own goddam pills!! I got very loud about it, and they eventually decided to drop the matter, lest I get even louder. By taking charge myself, I save (my insurance company) $176.00. Not a great deal compared to the total bill, but it all adds up, and it was ridiculous on the face of it.

2) During that stay in the hospital (surgery for a broken femur, remember, followed by rehabilitation), my insurance company also got charged for a $300.00 brain scan. One afternoon I mentioned to the rehabilitation physician that I had a headache. Now I knew it was simple muscular tension brouight on by stress (understandable, under the circumstances)--I could feel it in the back of my neck. Without blinking an eye (or offering me an $8.00 aspirin), she sent me down for a brain scan. The technician found that a) I did have a brain (contrary to what a few here may believe); and b) there was nothing at all abnormal. Totally unnecessary.

3) A good friend and fellow frequenter of Mudcat recently had a hip operation. Prior to going into the operating room, the doctor, to make sure there were no embarrassing screw-ups, handed him a ball-point pen and asked him to mark the appropriate hip, which he did. Later, when he went over the bill item by item (which not everyone bothers to do), he discovered that the doctor had charged his insurance company $8.00 (Yup. It seems that $8.00 is the minimum charge for any little incidental in a hospital) for the use for an 89 cent disposable Bic. And he handed the pen back to the doctor, so for the eight bucks, he didn't even get to keep it!

By the way, Seattle and environs have many hospitals, several of them quite large. I live in an area about a dozen blocks from an area that is so densely packed with hospitals, clinics, and health centers that it is often referred to locally as "Pill Hill." I understand that there are more MRI and CAT scanners in and around the city of Seattle than there are in all of Canada. Not that Canada has any scarcity of them.

And don't get me started on the obscene profits made by the pharmaceutical companies and their "people be damned, get the money!" philosophy. I used to know a fellow who worked for a pharmaceutical distributor . He told me what some over-the-counter drugs really cost. For example, a popular, brand-name analgesic. 98 cents per thousand, sold in "economy size" plastic bottles for $16.00 per hundred. With similar or even greater percentage profit margins on the much more expensive prescription drugs.

Stay healthy!

Don Firth