Ruminations on a Visit to the Doctor
If you think we have the best health care in the world you probably haven't used it. I recently used the “healthcare” system and experienced first hand some of the problems and issues. I needed to have an office visit and an outpatient procedure done. These two visits to the local medical big box got me ruminating about the state of healthcare in America.
When most people talk about the “healthcare system” they usually mean the heath insurance mess. Insurance is not healthcare. It is only one way to pay for healthcare. Having insurance is what gives most people “access” to actual healthcare from medical providers. If you are wealthy enough you don't need insurance and can get excellent care. If you are poor enough you may qualify for government programs and have access to good care. Then there are 27.5 million people (8.5% of the population) with no insurance. Most of us have some convoluted combination of expensive insurance with deductibles, co-pays, and restrictions on who you can see and what is covered.
But we are told this is the best healthcare in the world. But how do you define “best.” In general the medical facilities and providers are good (as they are in other countries). If you can pay for it, you get good care. But those people with inadequate or no insurance have a different story. Of course, if you are profiting from the hugely expensive system it is wonderful. But the data on health outcomes tell us we have the most expensive system in the world with poor results for the overall population. This fact has been proven with many studies and widely discussed for decades.
The biggest problem with our health care system is the exorbitant costs. In my case the bill for two visits to the system came to just under $10,000. Granted the outpatient procedure did involve use of the operating room and sedation. But this is still an outrageous expense for a few minutes in the doctor's office and less than one hour in the operating room. They charged $20 for drawing blood and $29 for sticking a finger up my butt! Being on Medicare much of this cost will be reduced. Medicare has cost control measures that limit the gouging. But this in not the case for many using private insurance.
Our system is simple too expensive, primarily because it is mostly for-profit. According to the Centers for Disease Control total health spending in 2015 was $3.2 trillion (17.8% of the Gross Domestic Product) which was about $10,000 per person. This is twice what many other countries pay. Back in 2011 the New York Times reported
"the United States is far and away the world leader in medical spending, even though numerous studies have concluded that Americans do not get better care and prices are the highest in the world.”
Compared to other countries, we have higher prices for the same services, higher administrative costs, higher salaries for providers, more profit and less government intervention to control costs. The exorbitant costs of prescription drugs and profit gouging by drug manufacturers has been widely reported. Prescription drugs cost two or three times more in the U.S. than in Canada or Europe. And the government has been prevented from negotiating these excessive prices by the Republicans in Congress. As economist Jeffrey Sachs points out,
In other countries, the government sets delivery prices and typically pays the health bills through the budget
[for the national system]. In the US, the monopolists set the prices.
Real healthcare reform would deal with these exorbitant costs. Healthcare reform done right would cost us all less – not more – than we currently spend. So all the flap about “how do we pay for” a universal single payer program (like Medicare for All) is bogus. We pay too much for a wasteful, bureaucratic, for-profit system. In the U.S. administrative overhead runs 20 - 30% of of total spending while other countries pay 1 - 3%. Again Jeffrey Sachs says,
“Let’s be clear on the central point. Medicare for All, as first proposed by Bernie Sanders and endorsed by Elizabeth Warren, is affordable precisely because it is cheaper, much cheaper, than the current system.”
A health care economist William Hsiao, who helped set up Medicare in the 1960's and designed Taiwan's successful single payer system in the 1990's says,
“Under Senator Sanders’ proposal...you can save close to $800 billion a year... from inefficiency, from fraud and abuse of claims, and from duplication of services and also, from using your buying power to bargain with pharmaceutical companies for a reasonable price. That $800 billion has to be used partly to pay for the uninsured people and the under-insured people. Even then, every American, on average, could save $1,000 every year. Those are the numbers.”
Conservatives say the free market would solve these problems if consumers were empowered to manage their own health care. This is obviously pure bunk. Ever try to read a billing statement from an insurance company or medical provider? Most people can't balance their check book much less understand the complexities of modern medicine or the health care system. There are also many hidden costs that even the most astute consumer can't control. Excessive emergency room use and bad debt for medical providers result from the lack of universal coverage. Useless, harmful advertising, billing fraud, malpractice, defensive medicine and legal battles in our litigious society all add costs. All this could be eliminated with a well designed national system.
Medicare for All is not a perfect fix. Medicare was designed by political compromise (like the Affordable Care Act). Medicare doesn't cover all needed medical services such as vision, dental, and prescription drugs. Medicare cost sharing deductibles and co-pays created a need for very profitable Medicare supplement insurance. But despite its faults, Medicare has been a huge success.
We should not be fooled by the self-serving propaganda about “socialized medicine” or the other lame arguments against a national healthcare system. We would all be better off with a rational, national health insurance program that could control costs. All it takes is a trip to the doctor to know our current system is broken and needs to be changed.