Wednesday, November 28, 2012

Inflation and real money

Something I've been thinking about:

The "increases outpacing inflation" in college tuition, and the rise in prices of medical care are probably caused by similar reasons.

In both cases, it's rare you're paying "real dollars" for it. Most of us have health insurance that covers the medical costs. And granted, there are tests and medications and things now that there weren't fifty years ago, but one of the men I go to church with was talking about how a friend of his who is on dialysis found that Medicare is billed some $7000 (I think that was the figure) per SESSION of his dialysis. Of which he has three sessions a week. And there are set-ups for six or eight people to get dialysis at the same time.

I wonder what dialysis would really cost, if the government wasn't paying for so much of it. (Or insurers. I wonder if there are some insurers who are heartless enough to "time out" someone on dialysis; to tell them they've used up their allotment for the year).

On the one hand: dialysis is necessary for people who have kidney problems. But on the other: does a 3-hour session of it REALLY cost $7000?

I've had more doctor visits lately than I have in a while. My heredity caught up with me and I developed a little chronic health issue that runs in my family. It's partly reduced by diet and exercise (which I am DEFINITELY doing, and I told my doctor that I will probably be one of the most compliant patients she ever sees in that area, because I'm a control freak and if I feel like I can control the issue by eating healthfully and doing stuff like avoiding salty fatty pizza and hamburgers, I will do it.) and also by a low dose of a medication. And by learning to calm the hell down, but I'm having a harder time with that.

But I've had something like three appointments in the past month, each of which has a co-pay for me of $25. My insurance pays about $100 per visit. Is 20-30 minutes of my doctor's time, plus a weigh-in, heart-rate check, blood pressure check, and temperature check worth $125 or more? And I'm assuming, based on the appointments I've made, my doctor sees at least a dozen people per day, five days a week. I know there's overhead on the building and costs of equipment and everything, much of that is "that's really what it needs to cost" versus "that's what insurance will pay." (And I wonder: if I had NO insurance, would I be charged $125 per visit? I could afford it - just barely, by cutting back elsewhere - but it would be a strain to pay $375 in a month to see a doctor (though in the future, that will probably be less frequent - every three months, or every six. And thank God the problem I have is minor and controllable)

I don't know. I do know doctors go to school for a long time and have lots of expenses (malpractice insurance, for one thing) but I know if I were doing consulting in one of my areas of expertise (say, soil science), I wouldn't be able to charge $125 an hour (at least not where I live) and have clients.

Granted: I want doctors to make good money. I want it to be an attractive profession for "the best and the brightest" but I suspect there are other things (like tort reform) that would make it even more attractive without charging as much money. (And if malpractice insurance dropped in price....) Or if doctors had less paperwork. I have friends and relatives who are doctors and one of their major complaints is the mountain of paperwork and regulations they have to deal with.

I've also heard of some doctors who have a revolving door - patients see them for maybe five minutes at a go. I guess I chose well in my doctor in that she takes a lot of time to talk with me, and she does listen to my heart and lungs and all that every appointment. And I'm sure some of the revolving-door stuff is again driven by money - cost of overhead, cost of malpractice, maybe cost of paying back med school loans.

I think of the things you read about the older days - when someone went into the hospital to have a baby and the total bill was like $150 (including hospital stay) rather than the thousands it is today. And while I realize, as I said, technology is a lot more advanced (and there are a lot more things they look out for in newborns now), and there's been inflation everywhere, I still wonder.

I suppose some of the high cost to those of us with insurance is the fact that there are people who can't or don't pay....(for a while I was dealing with collections calls for someone with my same last name and same first initial, and it was apparently medical debt. I finally did make it clear to the company that I was not the person they sought). But there does need to be an option so that those with no ability to pay get at least a basic standard of care....but I know of a number of doctors and dentists here who do "free clinic" days several times a year and invite people who cannot afford care, or who can't afford regular care but could make a small donation, to come and get at least diagnosed and some basic treatments for free. And I am sure there are charitable groups who help provide healthcare for the indigent or those who simply can't afford it....but I guess there aren't enough of them. I mean, there needs to be some basic humanitarian standard, even someone like me who objects to carrying "freeloaders" on her back (figuratively speaking) gets that.

But again, I wonder how the cost of medical care is calculated.

And I wonder if something similar is operating in college tuitions. Again, I want professors to make a decent salary (and I most definitely have a vested interest in that!) and for people like deans and secretaries and librarians to. (What they pay the secretaries and janitors here is pretty sad. Most of the service staff have a spouse who makes better money, or they have a side career, like being a landlord). But tuition does seem to keep going up, and I wonder if some of that is the high percentage of people on financial aid or scholarship....if it's that the money becomes "unreal," that it's not clearly coming from one person's pocket, and so it's like Monopoly money.

I have talked before at some length about things that I think drive up tuition. Some of those things are perhaps necessary evils (more administrators to deal with the increased paperwork and federal/state mandates), some of the things are because parents and students say they want them (fancy workout facilities, wifi in the dorms, dorm rooms with kitchenettes and private bathrooms) and all that stuff costs money.

But it does seem that on a lot of campuses, what you pay has outpaced what you get, and it makes me wonder where the money goes.

Oh, I'm not complaining about my salary: I do very well, thank you. If I teach in the summer, I make just shy of $60K a year, and I get health insurance and the option to pay a small amount for extra dental and vision and long-term-care insurance. But there's an awful lot of deferred maintenance on my campus, and the library is always suffering cutbacks....and I wonder where the rising tuition money goes. I know we have lots of administrators and lots of coaches and they make some pretty high salaries. And I know there are certain mandatory costs, like site licenses for software in the computer labs.

But....I just wonder, sometimes, you know? (I will say: I strive to work hard at teaching, to do a good job grading. I want the students to feel like they got their "money's worth" in my classes and then some. I do know of a few profs in other departments who could be accused of phoning it in - but in my department we all seem to work pretty darn hard and care a lot about getting our students the best education we can, so they can go out and get a good job in their field. And our track record of doing just that is pretty damn good, if I do say so myself.)

I wonder how things would change if we had to go back to the system of YOU pay out of YOUR OWN pocket for most medical stuff (I would think we'd still need something like catastrophic insurance, to cover really dire stuff) or back to the system of parents and/or kids working to pay their own tuition. Could we go back and do that? What kind of cutbacks would that take?

No comments: