We know our health care system is broken; most pundits and the mass of the Great Unwashed agree on that, though they might disagree on particulars.
So what’s to be done?
My own experience with hands on health care here has been mixed but in general I would have to say favorable. I still believe most practitioners are in the profession because the do care, and they do want to help, thought that percentage is heading in the wrong direction because of the system. My experience with the system has been almost invariably abysmal.
The problem with the system is that it is not about health care at all. It is about profit. And I believe that is the crux of the matter.
Because those who control any real discussion of reform are swayed by the very problem in the system itself: money.
Health care has to be paid for; those who provide the service need to be fairly compensated; those who provide the drugs and devices need to be fairly compensated.
But that discussion can’t happen now because the massive flow of money from each and every person in the United States into the existing system provides those in control of the system unlimited resources to skew the discussion.
Just one small example.
Prescription drug ads now flood the media. When did that happen and why on earth should something studied and prescribed only by professionals be advertised to the Great Unwashed? The reason would be that prescription drugs are incredibly profitable besides being uncomfortably dangerous. Advertising was forbidden anywhere in the world until 1985, when the ban was partially lifted in the US, then expanded and relaxed in 1997 when the Food & Drug Administration “(FDA) eased up on a rule obliging companies to offer a detailed list of side-effects in their infomercials (long format television commercials). Since then the industry has poured money into this form of promotion, spending just under US$5 billion last year alone. The only other country in the world that allows direct-to-consumer drug ads is New Zealand, a country of just over four million people.” Bulletin Of the World Health Organization, Volume 87, Number 8, 2009.
One would like to believe that the drug companies want to promote better health, hence the advertising. That is not the world of business. Drug companies are not spending $5 billion a year because their heart is in the right place.
“The distinguished doctor who has been introduced as the “inventor of the artificial heart” turns to the camera and says, “Just because I’m a doctor doesn’t mean I don’t worry about my cholesterol.” He then recommends people use an anti-cholesterol drug, Lipitor, and to show just how confident he is in his own ticker, he rows across a lake. It was a killer advertisement, part of a campaign put together at a cost of US$ 260 million for drug company Pfizer. But it relied on the audience being unaware of several important facts: Robert Jarvik, the distinguished “doctor” in the boat, had never been licensed as a medical doctor, could not legally prescribe anything and was not the inventor of the artificial heart (at least according to three former colleagues at the University of Utah). It later turned out that he hadn’t even rowed the boat. Welcome to the world of direct-to-consumer advertising.” (op. cit.)
One small example repeated hundreds if not thousands of time in the US throughout the system.
Time Magazine devoted and entire issue to an investigative piece “Bitter Pill: Why Medical Bills Are Killing Us”, by Steven Brill, April 4, 2013. In it he tracked the overcharging that is part and parcel of the system, built into it.
There is no, absolutely no incentive to reign in excess billing. In fact, there is every reason to over charge, over prescribe, unnecessarily operate, and to order unnecessary and invasive and expensive testing.
I wrote about health care three times in September of 2013, and twice in 2012 (June and September), hashing and rehashing much of the same ground.
The rhino head on the table is that we don’t need insurance to have good health care.
But we can’t really talk about it in a public debate, because insurance companies and those who profit by the existing system fund the public debate.
As Curt wrote in response to one of my columns, we don’t want some bureaucrat making medical decisions for us, and as I wrote, I don’t want some insurance functionary making medical decisions for me.
I want to talk with a medical professional and make a plan for my health care. I want that person to be well compensated for his or her time, but I don’t want to go bankrupt.
Most of the time I’m healthy, as most of us are.
That’s really the key.
We don’t need a health care system run through fear, but that’s what we have.
What if you get sick? What if you have an accident? You need coverage. You need protection!
No I don’t.
That’s the advertising of fear masquerading as care.
I need to be able to access emergency care, or talk to a doctor and make a plan to repair or restore whatever I can in this somewhat worn body I carry around.
I don’t need coverage that pays for everything but health care.
We are all going to need health care at some time, unless we are very, very lucky. And we will need to pay for that care, as we should.
It makes practical sense to put some money aside on a regular basis to pay for those services we will eventually need. But we won’t do that. At least few of us will. And even if we did, the average person would never be able to put aside enough money to cover even routine surgery. But if every person in the US put aside a small sum each month, or year, we could easily cover both basic and emergency health care.
That’s what the single-payer model strives to do. We all pool some small sum to cover those of us who are unfortunate enough to need health care at any particular time, knowing that our time will probably come.
You can call it a tax, call it coverage, call it anything you want, but we are already paying exorbitantly for health care here in the US, at the rate of $7,146 per capita, more than any country in the world. (World Health Organization, 2008). And most of us are hesitant to go to the doctor because of the cost. Not because of the pain, or the inconvenience. Because of the cost.
Single-payer health care is a tough sell in the US. President Clinton rediscovered that in 1993 with the Health Security Act, roundly disemboweled, beheaded and hung on a gibbet by the insurance and pharmaceutical industries as a warning to all who would dare meddle with their profits.
But it is time for that discussion.
What happens under a single payer plan?
You go to the doctor and everyone helps pay. No filing claims, no risk assessment, no denial of claims. We all share the risk for all of us, for those lucky enough to have good health and those less fortunate. What happens then? What are the savings?
Well, for starters, we can eliminate a lot of government programs. No need for Workman's Comp…an enormous savings for business. No need for health insurance coverage at businesses; another huge savings. No special government packages of insurance for congressmen. We eliminate the Federal Employees Health Benefits Program, Indian Health Service, Veterans Health Administration, Military Health System/Tricare, Medicare, Medicaid, State Health Insurance Program (SHIP), State Children's Health Insurance Program (CHIP), Program of All-Inclusive Care for the Elderly (PACE), Prescription Assistance (SPAP) to name a few. We eliminate the necessity for dozens, if not hundreds, of different legislative acts.
We can drive costs down, because there is only one game in town. We’ve done it before. Prior to the early 20th century, fire fighting was a business. People subscribed to that service, and if you didn’t, and a fire started, you burned down. We, the people, didn’t think that was a very good plan, so we changed it. We also agreed to pay for police service, and military service, thinking those were areas that could be terribly fouled by the profit motive.
The health care industry has proven to be one more of those areas. Profit is driving fees to the stratosphere and marginalizing service.
It doesn’t have to be that way.
How do we change it?
I think it will take most of us working together and putting pressure on those we choose to elect. We can do that. But we have to shut our ears and close our eyes to the malicious and malevolent advertising and mud-slinging campaigns that will crawl from the swamp of profiteers and foul the airwaves, journals and talking-head shows.