Sunday, July 26, 2009

A Q& A about U.S. Healthcare

In response to my post, "National Healthcare may cause real crisis," where I describe how free healthcare actually drives up the cost of medicine and discourages people from making rational healthcare choices, I received the following response:


"Ok, a few things to point out here. If government involvement in health care is so bad and expensive, why do the other civilized nations that have universal health care pay a lot less than the united states (about half as much in almost all cases on a per capita basis http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/May/Mirror--Mirror-on-the-Wall--An-International-Update-on-the-Comparative-Performance-of-American-Healt.aspx)? Although I don't neccessarily think that you need government run health care to fix the problem, I do think you need A LOT of health care reform, and I think the entity that is best suited for this is the government. Basically, under your current system, a doctor gets paid for each patient he/she sees, each test he/she prescribes, and the treatments handed out. Furthermore, lawsuits in the US for malpractise tend to be huge and very expensive. So this means that each doctor has a huge incentive to see as many patients as he/she can, and prescribe as many tests and treatments as possible, both to make money and reduce the chances of getting sued for missing something. Add to that the fact that many in the US are making poor lifestyle choices, and that there seems to be more of an emphasis on treatment than prevention (which has been shown to be a lot cheaper to implement and is a lot more cost effective - since it costs little to give a vaccine, teach hygiene, and excercise and eat properly, and it costs a lot to treat diabetes, lung, cancer, heart disease, or even a case of malaria). Finally, I completely don't understand how this public health care would be as complicated as the republicans make it out to be. You just have to be registered, and go to the doctor. The doctor would know what is and isn't covered, and could act accordingly. Its privatized healthcare that seems more complicated and costly, as insurance companies want to make money, and will often do as much as possible to pay out as little as they can, making it much more complicated in some cases, and more costly to the system."
Now, I don't make a habit of responding to comments, nor making them a headline post, but I thought this one was exceptionally great as it is the sentiments of a majority of Americans.

So I've created the following list to further the public interest as best this humble small town RT is capable of:

1. U.S. Healthcare is more expensive because you have to pay for quality. It's like going to a Quality Inn as compared to an old run down hotel in the inner city.

2. There really is no problem with the healthcare system in America. That's a myth. The problem lies within the entities that pay for Healthcare, such as the government and and private insurance.

3. Why are you so sure the government is the answer to lowering healthcare costs. I challenge anyone to name one successful government program that is run as it was drawn out or costs less than was predicted. The historically best way to lower costs of any consumer good in not through government, but through the people. Thus, competition is the answer. We need to create more competition between HC insurance companies.

4. I have talked with many doctors in my day (both liberal and conservative) and not one of them has ever said to me he orders extra therapies just to make money. I'm sure there are unethical doctors that do that, but the majority don't. The reason doctors order extra therapies is because they are afraid of being sued. What we need, therefore, is tort reform to limit the amount of money someone can make for suing a doctor.

5. Likewise, the only people who pay full cost for healthcare are those who pay for healthcare out of their own pockets. Most insurance companies and the government pay one flat fee for the patient regardless of the number of procedures performed. Yet, since the risk of getting sued is still out there, doctors have no choice but to order so many procedures. As an RT, I can tell you that 80% of what I do is frivolous, and yet neither the doctor nor the hospital makes one cent extra for having me do all this work. Yet I still have to do it.

6. There is going to be an incentive for doctors to see as many patients as possible whether there is the risk of a law suit or not. That's the whole purpose of working: to make money. If doctors are going to make less money in this new system, then young men and women are going to choose a different profession, diminishing the quality of healthcare even more.

7. On that same note, if government gives more people free access to healthcare, more people would be headed to already packed emergency rooms and doctor's offices. The lines would be even longer. You know the old saying: if it's free people will take it. And, as any ER doctor will attest, most people come to the ER for free medicine don't consider the seriousness of their illness (a mole on your butt anyone).

8. With more people vying for free healthcare, and the supply of nurses and doctors staying the same (or going down since the government will pay them less), that means the cost will go up not down as the Obama administration is saying. This is economics 101.

9. There will always be more of an incentive on treatment than prevention because most people don't want to think about all the bad things that can happen to them, and then they just treat the bad when it happens. That's the way it always has been. The only way the government will change this is by forcing people to be healthy, which is unConstitutional.

10. Do you want someone to force you to eat properly, and use good hygiene? I don't. If I want to go to a smoke filled bar and drink 10 glasses of beer, I have the right. I have the Constitutional right to have fun. I have the Constitutional right to be stupid.

11. You are right that insurance companies are the problem, and they have too much of an incentive to take advantage of people to make extra money. Just the other day I watched a show on CNN where a wheelchair that cost $350 was charged to Medicare for $1,000. This is where the problem lies, not the underlying Health Care itself.

12. The government can play a role in health care, however. The government should provide "catastrophic insurance." If your body has a catastrophe, like a heart attack or you need to be put on a ventilator to survive, that is what the government might consider paying for. It is "catastrophic healthcare" where most of the healthcare expense is anyway.

13. It's also a fallacy that some people don't have access to good healthcare. The truth is, everyone has access to good healthcare. It is against the law to turn any patient who comes to the ER doors down, no matter what they come in for. Thus, we all have access.

14. The quality of healthcare in the U.S. is the best healthcare in the world. You never hear stories about people leaving the U.S. to get their Healthcare. They may leave Shoreline to go to the Mayo Clinic, but they never leave the Mayo Clinic to go to Cuba or Britain for example.

What I'm afraid is that by fixing the entire healthcare system as Washington is trying to do, they will in turn make it worse. Sure the President says that in 10 years the program will cut the cost of healthcare overall, but can we take the chance? I don't think we should.

Besides, as I asked above, can you name one government program that ever ended up costing less nor working as well as it was written? Sure it sounds, smells and feels like a good idea as so many more people are thought to benefit from this program. But what sounds good, smells good, and feels good is not always good.

Social Security is a perfect example of another program that smelled good and felt good. Social Security was written by FDR's administration to be self sufficient. It was supposed to be a good retirement program, making it so people didn't have to worry about surviving after 62. The truth: It is anything but. In fact, it is nearing insolvency.

The U.S. Postal service is nearing bankruptcy. Welfare and Medicare are great services, but they are also nearing bankruptcy.

The truth is, something needs to be done to lower the cost of medicine and make it more readily available to the common folks in this country. The government, I am afraid, will succeed at nothing more than making the best healthcare in the world worse.

Personally, I don't think it's worth the risk.

2 comments:

Victor said...

Okay, I'll try answering the questions in order.

1. Here's a study conducted that looked at the quality of health care in 5 developed countries (Australia, Canada, New Zealand, England, and the United States). http://content.healthaffairs.org/cgi/content/full/23/3/89
While it didn't find that any country did best or worst overall, and each country excelled in some areas, each of these countries spends half of what the U.S. does per capita on health care (info on this can be found in the link in my original post). Also, here's a link to a study done on how the people in each country percieve their healthcare http://www.commonwealthfund.org/Content/Publications/Chartbooks/2002/May/Inequities-in-Health-Care--A-Five-Country-Survey.aspx
I found the fact that many more low income families in the U.S. percieve that they can't afford healthcare than in other countries very interesting.

2. I recently found an article on the New Yorker that sheds some light on this: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all
What I think is really interesting is how many of the doctors in this town are much more likely to perform expensive and somewhat risky procedures for illnesses that, ten or fifteen years ago, most patients would just recieve advice, a few basic tests, and maybe some pain meds for.

3. I'm not saying that the government is the only way, but I think it is the best. While I agree that competition does drive prices down, It's important to note that private insurers care most about profits. The government, on the other hand, is supposed to be a non-profit organization. Furthermore, some of the cost stems from administrative work coming from doctors having to deal with a large number of different insurers, as well as the government. Also, the private insurers do not want to pay out money, which means that they will sometimes figh to not pay for certain procedures. With a government program, many of these costs would be eliminated. Another important thing to note is that with a government program, there would be one set of rules for what is and isn't covered, and it would allow for better health economic research to find the best practises for doctors to adhere to (so that they don't spend money on expensive and inneffective procedures, and so that they use more preventative measures). Also, the countries mentioned in 1. all have government run health care programs, and they pay, on average, half of what the U.S. pays per person. Than in itself says a lot about government vs. private healthcare.

4. Yes, I agree. However, I'm not saying that those greedy doctors are out to get us. I'm just saying that the system is set out so that doctors are rewarded much more for simply seeing a patient for a minute and ordering a battery of tests, than for trying to use their expertise to diagnose without as many tests. Same goes for treatments. The system makes it easy to prescribe expensive treatments and be done with it, instead of looking for more cost-effective ways of doing it. And yes, I think law-suits have a lot to play in this.

5. Wait, so if everyone pays a flat fee per patient, than who pays for the actual procedures/ tests done on the patient? I'm fairly certain that the insurers pay a flat fee per patient, as well as a flat fee per test and per procedure. But your the one who's working in the field, I guess. I`m just learning it :)

6. I`m not saying to neccessarily make doctors make less money. I`m just saying that we should give them a different pay structure to remove the incentive to do things this way. An example could be to give them salaries (about on par with what they make right now). I realize that this system might be hard to implement at first, and if doctors start seeing patients for longer (since they have less reason to rush with a salary), we would need to pay for more doctors, but the lowering in use of expensive tests and procedures for illnesses that donèt require them should more than cover this cost.

Victor said...

7. Well, then you make the people who are in the ER for unimportant things wait. Trust me, if you go to the ER with a really bad cold, are forced to wait for 3+ hours, and are then seen by a doctor who tells you to go home and drink some tea, you wonèt be coming back to the ER unless you have a real emergency.


8. The cost couldn't go up, because the government would be paying a set amount to each doctor. Instead, wait times would go up. This is a potential problem. However, by raising doctors wages (I never said we should pay doctors less, I just said we should make a different pay structure to take away incentives for doctors to prescribe expensive tests and procedures unneccessarily), or by giving other incentives for students to become doctors, you could minimize the wait times, or even keep them at the same level they are at now, and still lower costs.

9 and 10. (they are basically talking about the same thing) I laughed at this, because the government seems to be in the business of making sure you only have the kind of fun it tells you to have. Take the huge war on drugs, for instance (especially the war on marijuana, which is the most outrageous, since marihuana has been shown to be safer and less addictive that both alcohol and ciggaretes). So the government only gives a damn about your constitutional right to have fun and be stupid if you have the kind of fun that it wants you to have. But that's all besides the point. The government doesn't need to force you to do anything, it can be a lot more subtle than that. For example, large educational programs and advertisements to promote healthy eating. Incentives to doctors for them to promote diet and excercise to their patients. Requiring fast food places to clearly post nutritional information. Making sure everyone is vaccinated. Creating effective screening programs. There are plenty of things the government can do to promote preventative care without denying you your constitutional rights.

11. I completely agree with you, and that wheelchair thing is outrageous. But I don't quite understand what you mean by underlying health care.

12. Hmm...interesting proposition. It would alleviate some of the problems, but it would be pretty hard to implement, especially if the government hoped to cut some costs (americans like to be pampered, especially when dying, and studies show that this is when most money gets spent for the lowest effect). Why go only part of the way if you can go all the way?

13. Yes, everyone can get healthcare. And if you are really poor/homeless, you won't have to pay for it, because the hospital cant track you down or make you. However, if you're middle class, have a home and a job that you don't want to lose, you may not have such an easy choice, since medical bills are expensive, and you would have to pay them if you planned on keeping your house. No, the hospital can't turn anyone down, but it can charge them.

14. Ok, but I've never heard of anyone coming from Canada or Britian to get health care here. All that proves is that I haven't been listening very well.

I'm not saying that the program will work as soon or cost as little as the government says. What I am saying is that Americans pay double what anyone else in the civilized world pays for health care. Given these circumstances, how can the U.S. afford to not move towards the policies and strategies that are keeping the costs in the rest of the world so low comparatively.