Is The US An Employer-Based System?
Not anymore, at least. 40% of businesses do not offer health insurance to their workers, and that’s up from 31% in 2000. How can people possibly think this is working?
- More than one-third (34%) of adults ages 19 to 64 (both insured and uninsured) either had medical bill problems in the past year or were paying off accrued medical debt.
- The $10,880 average annual premium for a family of four in 2005 surpassed the yearly gross earnings of $10, 712 for a full-time minimum-wage worker.
- Forty-one percent of adults with incomes between $20,000 and $40,000 a year did not have health insurance for at least part of 2005.
- 51% of women without health coverage have not had a mammogram in the past two years, compared to just 9.2% of women with coverage.
What an utter disaster. We should be ashamed of this level of care.
We should be ashamed of this level of care
That’s level of coverage/em>, not level of care. It’s an important difference. Please do not fall into that trap and conflate them.
The level of care is actually quite good.
best,
Flea
I said that on purpose, Flea. I’d argue that for the uninsured, the patchwork system we’ve put together makes for a pretty terrible health care experience. The coverage affects the care itself.
You can say that, but, as Flea stated, the level of care that our indigents get surpasses a very high percentage of the world’s population’s care. You can walk down the halls of my community hospital, and the only way to tell if a person is Blue Cross, Medicare, or “Self Pay” is to look in the chart. They all get private rooms, color TV, meals as ordered by their docs, and the same meds, imaging, and operations. Same nurses. Their outpatient services are different- they go to less plush facilities, but you just do not see anyone dying in the streets in this country for lack of medical care. There will always be individual anecdotes about the woman who really wanted a mammogram but couldn’t afford it, and then showed up a year later with metastatic disease. For every one of them there are a hundred who have good insurance but do not get the screening they should for any number of other reasons.
We do not have a perfect system, but the imperfections, which are substantial, are mostly a consequence of interference in the medical system by outside forces- government and legal. When the govt unilaterally controls a majority of healthcare spending (Medicare and Medicaid), it necessarily distorts the private sector minority of healthcare. There was a time when MDs determined the appropriate course of action to evaluate and treat medical problems. This meant that a much lower intensity of resources was required, and there was more than enough resources left over for charity care. Now, the govt requires a full workup on everything that comes into the ER, and the extent of that workup is determined by the legal system. THere isn’t wnough money in the word to do that everytime for everybody, and therefore it’s a “pretty terrible health care experience” for just about everybody.
There was a time when MDs determined the appropriate course of action to evaluate and treat medical problems.
This was, not coincidentally, also the time of total medical paternalism, where the doctor was always right, and told the patient what to do. I don’t know what government requires any more full of a workup than one would get to normally rule Badness out.
THere isn’t wnough money in the word to do that everytime for everybody
You’re right, there’s not. But the other countries in the world seem to do a decent job of it for half the cost.
You can call it paternalism, but that sounds kind of icky. I’m not sure what the best word for the situation is when you have finished your med school training, then you have finished three or five or ten years of residency/fellowship, and maybe have a decade or 2 of real world experience, and a patient comes in with a problem, and you can form a differential diagnosis in your mind as you are listening to her, confirming and eliminating possible diagnoses as the interview progresses. Your patient is an intelligent person, possible has spent years learning her own profession of accounting, or law, or maybe she builds cars or furniture, but in any case, she has no concept of the pathophysiology of ulcer disease vs. biliary colic vs. pneumonia vs. myocardial angina vs. esophagitis vs. a few dozen other things that you are responsible for sorting out so that you don’t waste her time and money or subject her to invasive and potentially dangerous diagnostic procedures that are unnecessary. There is a very good reason that it will take you a decade or more to learn to do this sorting out- the human body is very complicated, there are a lot of things that can go wrong, and the tools that we have to help our patients are also ever more complicated. Using words such as “paternalism” to describe this necessarily asymmetric relationship means only that you have been to buzzword class, and paid attention. When I ask my accountant, lawyer, pension consultant, mechanic, or physician for help with a problem, I assume that she knows way more than I do about my problem, and I do what she recommends. That’s not paternalism, it is respect for her knowledge, training, and experience.
You are right about other countries doing a decent job of providing medical care for lower cost. You will find that when you get out into practice, a decent job will not do in this country. Doing a decent job will have you spending an uncomfortable amount of your time in depositions with trial lawyers. You will have to do a near-perfect job, and then be very lucky, to avoid being the object of attention of the attorneys. A good chunk, probably 1/3, of the resources nominally used to provide medical care in this country is more appropriately categorized as supporting the legal system and government bureaucracy. Get that supposed $10K per family of 4 down to $7K and we’re in Canada/France/Germany territory with far superior customer service