Health Care, The Ripoff
Would you mind having an extra $900 a year? (You’d also get another $900 per kid.) What is that–about the cost of a really nice vacation every year? Going to a great restaurant once a month? Several pairs of shoes, clothes, and diapers for a child?
Often people don’t realize that they have something to lose from this inefficient mess we call “The US Health Care System.” Even if they have health insurance. See, because every time that your employer’s health insurance premiums go up, that’s money that your employer can’t pay you as a raise. So all that raise that you’ve been wanting to get? Oh, you’re getting it–but it’s in the form of higher health insurance costs, not a fatter paycheck. (And you probably didn’t even spend more on health care this year than last, either.)
One of the things I really enjoy about Joe Paduda’s Managed Care Matters is that it reminds me of how much health care really costs. We spend over $5200 per person per year in the US on health care. The next closest count, Switzerland, spends about $1800 less than us. And the Swiss have lower rates of infant mortality and on average live longer than us.
Granted, these are not perfect comparisons–even if I’m half wrong–that the Swiss aren’t as health as us, and they’d need to spend $900 more a year to compare with us–that’s still $900 cheaper than the US. Imagine if every person in the US could receive the same health care, but had an extra $900 in their pocket. As a student, I’d be happy to have it. I heard on the radio last week a guest describing employers that pay the “minimum wage” are actually paying a “subsidized wage;” that is, the public is subsidizing the employer, since the employee is receiving social services (including health care) from a public, tax-funded hospital or clinic.
But because we hold on to this insane notion that our health care system is the best, or that health care reform is politically impossible, we sit here, being inefficient, wasting our own money away. Until people realize that people will get health care, no matter what their insurance status, we’ll continue to chug along in a wasteful system. We are blinded to the fact that providing health insurance, and therefore, preventive, primary care, is more cost effective, and saves us all money.
I’m speaking from a place of complete naiviete (what a surprise) and I understand the great inefficiency of the US system.
You make the argument that you yourself would be happy to see the $900, however, seeing as you are a future physician I find it hard to believe that cutting healthcare costs in half can be achieved without significant physician compensation cuts. Is there really enough bueacracy to be cut in the American healthcare system to keep physician income comparable and give everyone $900?
Maybe there is or I’m sure plenty of people think it’s reasonable for physicians to shoulder their part of the burden.
My question only is, if you decide to practice one day wouldn’t cutting healthcare spending in half cost you far more than $900/yr as a physician?
Sixteen years ago I worked in a very small rural hospital that offered no health insurance. During the six years that I was there, medical expenses for myself and my son were approximately one fifth of what we would have had to pay for health insurance for that period of time. This included an ICU admission (2 days) for my son’s near drowning incident.
We are being ripped off by the insurance companies with rejected claims, and by hospitals/clinics with their reimbursement rate reductions to specified insurance companies (the uninsured pay top dollar for the care they receive), and their so frequent double billing/misbilling issues.
I’m always amused, well not really amused, at the immediate raising of GOVERNMENT BUREAUCRACY as a reason for not considering some kind of universal healthcare system – as if the government could, in their wildest dreams, create a more confusing convoluted bureaucracy than now exists in the healthcare system.
Of course a universal system would cost – but no one would be making a profit from the paper shuffling. You don’t have to look very far – just North – to see a fairly successful system.
When asked, a fairly substantial majority of Americans have indicated that they would be willing to see their taxes increase to pay for such a system. Apparently most of us already realize what a rip-off the present system is.
I’m on Medicare and the cost to me is about $400/month, as an example of what such a system would cost the taxpayer.
I understand that Medicare itself pretty much pays its own way and deficits are mostly in the Medicaid portion of the administration.
Tychecat is really naive when he/she makes the statement that Medicare “pretty much pays its own way.” The projected bankruptcy of the Medicare Trust Fund is predicted to occur far sooner than that of the Social Security Trust Fund. This in spite of the continuing cut back in reimbursement to the physicians and hospitals. I am embarrassed when I see how little medicare pays my physicians.
The thing that none of the advocates of a universal health care system don’t seem to grasp, including our noted blogger. is that the system to the North and any government sponsored system, controls costs by rationing of care. A few years ago it was reported that Canada had fewer MRI’s in the entire country than we have in the metropolitan Portland area. I think that the main reason we haven’t had a real push for a single payor system is that the American public, who have medical insurance, are not about to accept rationing of care that is about the only way that the costs of medical can be brought down to a level that the tax payer would accept. When doctors can stop practicing defensive medicine and not order unnecessary tests and imaging studies. when the American patient can be told that they are not going to get the MRI they want, or the expensive drug that they saw advertised on TV, and when they are willing to wait 8-12 months or more for elective surgery, then, and only then will a universal health insurance program be possible in the US.
If I hear one more doc complaining about defensive medicine and tort costs I’ll throw them under the wheels of their golf cart. Care is rationed in the US – for the 45 million uninsured, for Medicaid recipients, and for those in staff and group model HMOs as well as anyne who has to comply with precert rules.
This rationing argument is nonsense, not only because have de facto rationing but also because it is a red herring. Canadians, Swiss, Norwegians, and citizens of 33 other countries are healthier than Americans, yet we pay about 50% more than they do.
So the good Dr. Thompson et al are delivering an inferior product and charging much more for it.
Finally, what is wrong with rationing of care? The question is NOT how many MRI machines does Canada have compared to Portland, it is what is the right number of MRI machines? And my bet is many of Portland’s MRI machines are owned by docs, who make money by sending patients there, all the while hiding behind the covers of “defensive medicine”.
The great problem with healthcare in the US is not tort cost or defensive medicine, or pharmaceutical advertising, or excessive bureaurocracy. It is excessive reliance on technology. Cutting edge technology costs, big time. A top of the line computer with all the bells and whistles costs $3000. And yet a $250 3 year old used model does about 80% as much. How much computer do you need to surf the internet? Very little.
In the same way, I have seen many a cardiologist do a $10,000 catheterization and send a patient back to me with the instructions: “Maximize medical managment.” Translation: this patient can be treated with medications only. So why spend $10,000 to tell me that I need to control this guy’s blood pressure and give him aspirin, which is what I am doing already?
Don’t get me wrong. Caths are good things and need to be done. But we don’t need to cath everything with a pulse. Nor do we need to MRI every headache, and operate on every painful back. We do it because we can, and because we get paid damn well to do it.
If insurance companies paid $500 to do a cath and $750 to read an EKG and take a very careful history and physical, what would happen? Doctors would suddenly get very, very good at reading EKGs and doing examinations. And less caths would be done. And I doubt the mortality rate for cardiac disease would change one bit.
We can make do with less. We just have to want to.