I was listening to NPR’s reliably center-left “Marketplace” last night.  And I almost pulled my car over from shock.

They did a piece on a union health plan.  The union – a hospitality workers union in Los Angeles – does things the old fashioned way; it collects its dues, and essentially runs its own private clinic where members essentially get unlimited healthcare for, basically, almost nothing out of pocket.  The report focused on the dental clinic, where workers pay $3 for a filling, $20 for a root canal, and $6 for an office visit.

The actual fees are paid out of a trust fund paid for by the employers, who pay a little over $4/hour into the union workers’ health plans.

It adds up to over $50 million a year, which for some 7,000 union workers and their dependents, means all-inclusive medical benefits, plus dental, which brings us back to [dentist working at the union clinic] Roger Fieldman. There’s a downside to providing good care at cheap prices.

FIELDMAN: We have a high no-show rate. Because essentially their dentistry is almost free.

The clinic’s no-show rate — that’s patients who miss appointments and didn’t call to cancel — is 20-25 percent. In his old private practice it was 5 percent.

FIELDMAN: We might have a two-hour appointment for some complex surgery, some dental implants, and then they just don’t show up! And for two hours of doctor and assistant time, what is the value of that? $1,000? More? The patient’s paying $6.

$6 being the fee for no-shows.

[Plan administrator] THROCKMORTON: When it’s only $6, there’s very little incentive, if it’s not convenient, for them to keep the appointment.

In other words, there’s no incentive to not waste all of that care.

And dentistry is relatively cheap.  But the waste goes into much bigger-ticket services as well:

Throckmorton says if there’s one thing he’s learned after balancing the books and the union’s trust fund all these decades it’s this: That when money is not a factor, people do not think much about waste.

Take, for example, the emergency room.

THROCKMORTON: We have no emergency room charge.

Some members will use the emergency room at any sign of sickness.

Sound familiar?

THROCKMORTON: If there’s any doubt about it, they go.

Or just because it’s convenient. Because there’s no co-pay.

THROCKMORTON: Now they can’t evaluate them and tell ’em, you’ve just got a cold, you don’t belong in emergency care. The hospital is obligated by law to see them in the emergency room. The cost is a minimum of $700.

Which the fund, of course, pays for.

Of course it sounds familiar.  The State of Minnesota’s employees were griping about similar services when they struck a few years back; they were horrified, horrified, at the thought that they might have to pay copays (which were still a fraction of what all the rest of us private-sector proles pay).

We’ll come back to that.

Now, for years the union didn’t make a big deal about how much health care people used. They wanted to give their members the most access to care. Until the recession slammed the hospitality industry.

THROCKMORTON: It was just almost like driving off a cliff.

Union workers’ hours fell 20 percent. Employer contributions, of course, dropped. The fund was spending more than what was coming in.

The story goes on to tell us that the union is raising some modest copays for some of the services, including $50 to hopefully prod customers into trying services other than the emergency room.

I finally did pull the car over (because I was, like, home from the store) and listened to the end of the story (which you should either listen to or read, at the link above); and then I yelled “OK?  It’s that it?  Close the circle!”

The story, interesting though it was, squibbed on two huge connections.

First: Hello?  This is a big reason healthcare is so expensive!  Most of America’s insured population gets insurance paid for by third parties, and are insulated from the true cost.  Third parties (with the union plan in the story being a fairly extreme example) not only hide the real cost, especially the real cost of waste, from the consumer, but also pump money into the system for the limited supply of care; it’s economics 101 that this is a recipe for immense price inflation.

Second: This is exactly how “single-payer” healthcare works, on the care side of things; when people don’t have to think about what they are somebody is paying for their care, they become casual about using it.  Which stretches the resources that are available.  Which means someone needs to react – either by introducing a bit of market discipline (adding copays, as the union in the story did) or rationing the care that the members get (as the UK, Canada, France, the Netherlands and Japan do). 

But then I suppose if you can’t count on NPR to cover for the big left, you can’t count on anything.