Advice for Cash-Paying Patients: Just Walk up to the Desk and Demand Your 50 Percent Discount

When I received an MRI on my knee back in October, I knew I wasn’t going to hit my health savings account (HSA) plan’s $2,600 deductible. In other words, I knew I would be paying for the MRI myself, in cash.

The radiologist charged me $1,500. But my PPO negotiated that price all the way down to $1,300.

I wasn’t impressed. An imaging center near my home quoted me a list price of $1,275 for one knee, which they were glad to reduce to $637 for cash-paying patients. I mentioned this to the radiologist, and they dropped the price to $1,035.

I still wasn’t impressed. So today, seven months later, the radiologist and I finally settled on a price of $700. That’s 53 percent less than what they originally charged me.

The woman I negotiated with has handled this radiologist’s billing for the last 20 years. She told me that if – God forbid – I ever need another MRI, I should just walk up to the front desk and demand a 50 percent discount.

She described insurance companies as “evil” and “rich,” and said, “I don’t mind making the insurance companies miserable, but we don’t do that to our customers.”

A Brave Heart for Atlas Shrugged

Randall Wallace’s script for the movie Atlas Shrugged is 129 pages long, according to an interview in Script magazine. That seems pretty short for such a massive novel. According to one TV critic, “On a two-hour movie, the average screenplay runs 120 pages. Maybe 125. For ‘A Few Good Men,’ [the famously dialogue-heavy] Aaron Sorkin’s weighed in at 149. For ‘Schindler’s List,’ on which he did a final ‘dialogue polish’: 183 pages.” I don’t think they’re going to include John Galt’s Speech.

Wallace says he has finished the screenplay, and it’s been “greenlit” by the studio. Angelina Jolie has been signed to play Dagny Taggart, and the movie may be in theaters next summer.

Wallace was nominated for an Oscar for his script for Braveheart, another movie popular with many libertarians. He first read the novel when his son at Duke University recommended it. Wallace gave his son C. S. Lewis’s Mere Christianity, which suggests some interesting dinner-table conversations. (He’s also writing a screenplay for Lewis’s Screwtape Letters.)

Wallace found a familiar theme in Atlas Shrugged:

The assertion that change occurs when heroic individuals are willing to stand up–and further, that people in the herd want to be heroic individuals but aren’t encouraged to do so until they find a leader worth following–is very much in Braveheart, and it’s something thoroughly ingrained in the American psyche.

Wallace himself does not claim to be an Objectivist or a libertarian. He seems to be more enamored with the idea of great ideas than with the ideas themselves. And many fans of Atlas Shrugged are going to be skeptical that you can capture its essence in two hours. But I think Wallace is correct to say that a movie is not a book on screen. It has to be a creative work in its own medium. If it works well, it will introduce the ideas and the book to millions of new readers.

Wallace may direct the movie as well. The New York Times tells the story of the 35-year struggle to bring Atlas Shrugged to the big screen, with key roles played by Godfather producer Albert Ruddy and Objectivist businessman John Aglialoro. Script magazine is here, but the Wallace interview is not online.

A Rising Tide Lifts all Boats

Kennedy was right. Not Teddy Kennedy, of course, but his brother. President John F. Kennedy stated that a rising tide of economic growth generated benefits for all. A new study from the Congressional Budget Office looks at income trends for families with children and confirms JFK’s wisdom. The Wall Street Journal reviews the key findings:

A new study by the Congressional Budget Office says the poor have been getting less poor. On average, CBO found that low-wage households with children had incomes after inflation that were more than one-third higher in 2005 than in 1991. The CBO results don’t fit the prevailing media stereotype of the U.S. economy as a richer take all affair – which may explain why you haven’t read about them. … The poorest even had higher earnings growth than the richest 20%. The earnings of these poor households are about 80% higher today than in the early 1990s. … CBO says … earnings from work climbed sharply as the 1996 welfare reform pushed at least one family breadwinner into the job market. … earnings for low-income families have still nearly doubled in the years since welfare reform became law. Some two million welfare mothers have left the dole for jobs since the mid-1990s. Far from being a disaster for the poor, as most on the left claimed when it was debated, welfare reform has proven to be a boon. … The report also rebuts the claim, fashionable in some precincts on CNN, that the middle class is losing ground. … every class saw significant gains in income. … the CBO study found that, with the exception of chronically poor families who have no breadwinner, low-income job holders are climbing the income ladder. When CBO examined surveys of the same poor families over a two year period, 2001-2003, it found that “the average income for those households increased by nearly 45%.” That’s especially impressive considering that those were two of the weakest years for economic growth across the 15 years of the larger study.

Even Swiss Politicians Concoct Bad Tax Ideas

Proposals for global tax schemes normally emanate from places like Paris and Brussels. Swiss officials, by contrast, generally have a more sensible attitude – especially since they often are in a position of having to defend Switzerland’s fiscal sovereignty. But as Tax-news.com reports, one Swiss Minister wants a “tax on information” to fund global redistribution:

Swiss Communications Minister Moritz Leuenberger has suggested a ‘tax on information’ to help bridge the digital divide between wealthy countries with good communication infrastructure and poor countries where most of the population have no access to modern communications. Leuenberger revealed his proposal to a United Nations meeting convened to follow up on the World Summit on the Information Society (WSIS), held jointly in Geneva and Tunis in 2003 and 2005. … Leuenberger surmised that such a tax could be raised on information content which is paid for and computers.

Abortion Restrictions, Desperate Women, and Children Without Smiles

Moebius syndrome is a neurological disorder that causes facial paralysis, impaired speech, limb deformities such as club foot, difficulties eating, autism and an inability to smile. Moebius syndrome may have genetic roots but is also caused by misoprostol, a drug commonly used to induce abortions. In Brazil, where elective abortions are illegal, misoprostol is cheap and readily available. Moebius syndrome appears in 20% of children born after failed misoprostol abortions. Unfortunately, misoprostol abortions are also not very effective and 80% result in the pregnancy going to term. “Since the mid-1990s, dozens of cases of Moebius syndrome have been linked to misoprostol.” See the May 11, 2007 issue of Science [pdf].

A Positive Health Care Agenda for Free-Market Advocates

If you know any limited-government types who are looking for a positive health care agenda (off-hand, I can think of ten), be sure to let them know about a forum Cato is hosting on Thursday titled, “Health Savings Accounts: Not Entirely Consumer-Directed (Yet).”

HSAs are the most important step Congress has taken toward liberalizing America’s health care sector.   At this forum, I’ll be introducing a proposal that would let workers own every one of their health care dollars – not just the few thousand dollars that HSAs let them control.  Tentatively titled “large HSAs,” this proposal would:

  • Allow workers to control 100 percent of their health benefits dollars
  • Allow HSA holders to choose any type of health plan
  • Eliminate the tax code’s biases toward employer-sponsored insurance and excessive coverage
  • Cap the tax exclusion for employer-sponsored insurance and
  • Provide tax relief to those without employer-sponsored insurance, including the uninsurable.  

Joining me to comment on the proposal will be the CEA’s Katherine Baicker and Jason Furman of the Brookings Institution’s Hamilton Project. 

The forum will be held just two days from today, on Thursday, May 24, at 4pm EDT at the Cato Institute.  Click here to register or watch the event online.  Click here for directions and parking information. 

Patent Rent-Seeking

When I worked in Cato’s DC offices a couple of years ago, I always found it kind of depressing to go to lunch on K Street and see thousands of smart, attractive young men and women crowded around me, the vast majority of whom worked as lobbyists. They were people who otherwise might have been entrepreneurs, journalists, accountants, or doctors, creating wealth and improving society. But instead, they were enticed by the fat paychecks to come to Washington, where their talents are devoted to finding clever ways to enrich their clients at the expense of taxpayers and consumers.

I had a similar sinking feeling when i read this article (via Techdirt) about the flood of young scientists and engineers who are leaving the lab for careers as patent lawyers:

Demand for these specialists is being driven by an explosion in patent applications in recent years and a growing need for lawyers to protect old patents or challenge new ones. The U.S. Patent Office estimates 450,000 patent applications will be filed this year, up from about 350,000 five years ago.

Law professors say they’re seeing more students with strong science backgrounds make the leap to law, where recruiters are snapping them up.

For at least some students who might otherwise gravitate toward a science career, the promise of much bigger paydays is a powerful lure. Others say the opportunities in academia are not as certain as they once were.

“It’s an exciting area of legal practice right now,” said University of Pennsylvania law professor R. Polk Wagner. “Every year I see more and more people coming into law school with technical backgrounds.”

“It almost scares me,” said Wagner, whose proteges include Weathers. “Who’s left in the lab?”

Who indeed?

Now, I believe that some degree of patent protection is beneficial, especially for capital-intensive fields like pharmaceuticals. But we are now far past the point where the marginal patent, or patent lawyer, spurs economic growth. Quite the contrary, in recent years, the patent office has lowered patent standards so much that for the most part, obtaining and litigating over patents has become little more than a form of rent-seeking. A company obtains a patent that covers a broad category of innovation and then uses it to blackmail other companies that have succeeded in the marketplace.How else do we explain a company with no products winning a $612 million settlement from the company that pioneered wireless email? Or the company that pioneered Internet telephony fighting for its life against Verizon, a company that’s not exactly known for its innovative Internet applications? I could bore you to tears with examples of attempts to extort money from productive companies using the patent system. Every single one of those controversies was carried out by bright, ambitious individuals like those in the USA Today article, being paid six-figure salaries to find ways to obtain advantages in the courtroom where they weren’t able to prevail in the marketplace.

The Supreme Court’s recent Teleflex decision should reduce this problem somewhat by raising the bar for patent obviousness. But more fundamental reforms are needed as well. For a start, we should be asking whether certain categories of innovation require patent protection at all. Software and business methods are two obvious choices. Neither category was eligible for patent protection before the late 1980s, and there was certainly no shortage of innovative new software or business models during that time period.