It's been said over and over: the US spends twice as much in health care as the average developed nation, and yet 1 out of 6 US citizens are uninsured. If nothing is done, the number of people without health care will continue to grow, or the government will eventually go belly up -or more likely, both.
OK... but why is this happening in the first place?
Answer:
The underlying problem has to do with the lobbying mechanisms that allow interests groups to exert such enormous influence on the Congress that it amounts to legalized corruption. Lobbying should be a democratic mechanism for minorities and groups that otherwise would have no voice; unfortunately it has become a tool for groups with huge sums of money to push legislation that favors their interests at the expense of the country, and over the past decades it has had a negative effect on health care.
Specifics:
1. Doctors get paid based on the drugs and tests they prescribe -the more they order the more money they make. Yes, this is a fact, and the result is doctors are rewarded for unnecessary spending and labs have no incentive to control prices.
Guess who benefits from this?
a) The drug companies
b) The hospitals/labs/health contractors
c) The doctors
d) All of the above (Yes, you won!!)
e) The patients
Solid evidence suggests that by cutting back on unnecessarily expensive procedures and prescriptions, between 10% to 30% of health costs could be saved. As the Mayo Clinic in Minnesota, the California-based Kaiser Permanente system, and others have shown, it is possible to save money and produce better outcomes at the same time.
2. The government subsidizes half of the cost of employer provided health insurance. This means that:
a. Insurance companies are encouraged to come up with expensive/luxury coverage options.
b. All taxpayers share this burden, including those who don't get insurance via our employers, or no insurance at all.
3. Health insurance is not mandatory, therefore most uninsured people don't go to the hospital until the problem becomes serious enough, turning a potentially easy treatment into a an expensive one.
4. There is no incentive for preventive health care. Again, catching a problem before it gets expensive and crippling would benefit everyone... except the health industry. If you're like me, having health insurance is not enough of an incentive to do what we hate the most: going to the hospital. We are big babies, we are legion, and we need to be disciplined because if we don't, everyone has to share the burden of our poor decisions, and that is not fair. A tax break, a tax penalty, our names on the wall of shame -something. Preventive-oriented health care, I suspect, is the most important piece of the puzzle.
5. Lack of competition.
Lots of health care price-fixing lawsuits seems to demonstrate this point, and here is a report that shows that most states are dominated by one or two insurance providers.
6. Obsolete and expensive bureaucracy.
Question: OK... so just put in place legislation to correct these issues, what's the big deal?
Answer: Because when you spend less on health care, the health care industry earns less providing it -the industry is very profitable as it is, and therefore it is exerting its very considerable influence to maintain the status quo.
Question: but the legislators in congress say all kinds of scary things, they make it sound like the people would suffer terribly if we do anything to seriously cut costs.
Answer: If you look at all those arguments, you will first find that some are easily answered, for example, the Mayo Clinic case proves that you can definitely increase quality AND reduce cost at the same time. But most interestingly, you will find that all these arguments have one thing in common: the end result either protects the staus quo, or changes things in a way that does not compromise the interests of the health care industry. What a remarkable coincidence, isn't it?
But here are some specific points to ponder:
-If some go out of business, it means they were not efficient to begin with and/or not able to adapt, this means business from the least efficient providers would go to the more efficient; a net gain for patients and the country at large.
-As in the Mayo Clinic example, costs can be reduced and quality improved at the same time -we shouldn't lower the standard of the whole industry so that the worst providers don't have to change, which if you reduce it to the essentials, is exactly what some people in Congress are saying.
-There are many examples of health care systems on other developed nations that provide better care for less money, besides, to measure the quality of health care without factoring in the 50 million uninsured is a sad joke.
Question: who will win, Reform or Status Quo?
Answer: I think there will be modest reform, better than what we have now, but not the kind of real solution that we need to provide quality health care for all and not mortgage the future. I hope I'm wrong.
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