healthcare-spending

American Health Care, Expensive, Ineffective

You hear it from Republicans all the time, like Senator Jess Sessions of Alabama who recently claimed: America has “The greatest health care system in the world,” yet new hard data only proves what most Americans already know: America has the most expensive health-care system in the world, and we don’t get much in return for it.

Cost

 

A report released by the International Federation of Health Plans shows just how expensive that system is. While Republicans like to pick on socialist France for expensive health care, we pay as much as 4x more for a hospital visit or c-section, 7x more for bypass surgery and up to 15x more for a single day in the hospital. Even a routine doctor office visit costs Americans at least double what it costs the French on average and can routinely cost up to 4 times as much. Oh and the French are high on the scale, England, Spain and Argentina pay considerably less than the French!

Overall QualityHealthcare Performance

Oh but what about quality? Wealthy Republicans insist that we have the best health care in the world, even if we have to pay a little extra (or 15x as much). Well how about our performance numbers, after all, the proof is in the pudding. According to the World Health Organization, we are #14 in preventable deaths, #24 in life expectancy, #72 health system attainment and performance and #37 overall health system rank, behind Costa Rica.

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We do lead in one area though, we are #2 in Total spending on health care as a percentage of GDP. We aren’t even #1 on spending, tiny Luxemborg beat us to the punch. The hard data shows that countries with universal health care had better mortality rates than the US, even Cuba had a lower infant mortality rate! In fact, we are ranked 50th in total life expectancy! Yet we are paying the most, and boy are we paying. 62% of all bankruptcies in this country were due to medical illness and three quarters of those people HAD HEALTH INSURANCE!

 

Opinion

Oh but it can’t be THAT bad, right? What’s the word on the street? Well, for this, I can turn to my own experience in this awful system, which I will go into further detail further down. Yet I have been fortunate enough to also know numerous nurses, both R.N.s and L.V.N.s, as well as a few doctors and a few close friends that work in medical billing and at a prominent insurance company, and I must say, that including everyone I have ever spoken to on this topic, which is quite a few people, it is nearly a universal conversation point that our health care system is a mess. A point especially believed by those who have either experienced it first hand, or worked in it.

This dissatisfaction is backed up by polls that show Americans very upset with the quality of health care they are receiving. Most feel there are major problems, costs are too high and are largely dissatisfied with the quality.

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It really is a wonder that anyone regurgitating this ridiculous talking point: “the greatest health care system the world has ever known” can keep a straight face. If it were the “greatest health care system the world has ever known”, it wouldn’t be one of the least popular in the industrialized world and people in single-payer systems like Canada, U.K., France, Mexico, Belgium, Sweden, Denmark, Norway,etc.. wouldn’t be overwhelmingly satisfied with theirs. If it were the “greatest health care system the world has ever known” so many people wouldn’t be going bankrupt from medical bills, which is the single largest reason middle-class people go into bankruptcy. If it were the “greatest health care system the world has ever known” I wouldn’t get so much spam for cheap Canadian pharmaceuticals  that are ironically manufactured here in the US. If it were the “greatest health care system the world has ever known” the US would not be a leading supplier of Medical Tourists where people go to places like India and Thailand for life-saving surgery. I don’t know what reality the Republicans live in, but you’d have to be on a whole lot of free pharmaceuticals to think this system is the “greatest health care system the world has ever known”.

I find this point especially daunting since people like our friend the GOP Senator Jess Sessions are receiving a government run, Public Option, health care plan, FOR LIFE! If they love it so much, why can’t they share this public plan with the rest of us? This, Public Option was voted down repeatedly by Republicans during the Health Care debate, despite the fact that a majority of Americans, and even a majority of Republicans were in favor of such a plan.

 

But the Rich DO Get Great Healthcare

The other vocal proponents of our amazing health care system are incredibly rich, like Rush Limbaugh, who, as we all know, loves health care. He especially loves the prescription drug part. A love that almost landed him in jail for pharmacy shopping with phony prescriptions. Though his point is valid, yes I said that, and yes, I am cringing, though it must be said that billionaires and millionaires get probably the best health care in the world here in the US.

While many middle-class Americans are becoming medical tourists fleeing the broken US system to avoid costs, the world’s wealthy are coming to America’s most wildly over-priced clinics to find the world’s most wildly over-priced doctors. They may not be worth the money but there is a reason they can charge as much as they do. Damn the Hippocratic Oath, these guys are in it to become millionaires, like the only patients that can afford them.

To the super-rich, paying $5000 a month for top notch insurance is a drop in the bucket. Why not save the dough and buy the $200,000 surgery in the first place? They can fly to Hawaii to see a world-renown specialist like Rush did or even hire the best doctors in the world to come to them. If they get overcharged, they could even hire a lawyer to force the hospital, clinic or doctors to lower their wildly over-inflated prices or risk a lawsuit.

 

Extortion and the Real Sickness

This is something the rest of us could never do. We can’t shop around for good doctors all over the country, we take what is available to us. This includes the infamous $15,000 ambulance ride that we’ll be paying off for the next 10 years. Did you know that the Ambulance industry makes more money than Hollywood? It’s true! Better to drive if you can, yet if you’re having a heart attack, what can you do? Is this fair? Or perhaps a better question is, is this extortion? This reminds me of the famous Roman aristocrat Marcus Licinius Crassus (a fellow Triumvir with Julius Caesar  who made his vast fortune by owning the only fire company which only put out the fire if they sold the land to Crassus at rock bottom rates on the spot. He ended up owning most of Rome, until he was killed by the Parthians whom allegedly poured molten gold down his throat. Is our health care system really any different?

healthcare-spending

I actually think it’s worse since we’re talking about people’s health and even lives. Are you going to negotiate with some low end paramedic? Not likely, especially when you’re seriously injured or even having a heart-attack. So all of these companies take advantage of you, charging you inflated prices for a car ride, or an aspirin or an ice pack, or a stay in a bed. It ads up and before you know it, you are $100,000 in the hole. Insurance takes care of some but these days, deductibles and yearly spending caps can leave you owing tens of thousands. As mentioned before, most of the people who went bankrupt from medical bills had insurance!

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In our health care system the people who are profiting from the non-treated and therefore seriously ill, are Big Ambulance, Big Pharma, Big Hospital and Big Insurance, everyone else, even most doctors and especially the patients, are the losers, financing a system that is inflated so badly it makes any government excess story pail in comparison. I’ve been hearing this term, “the health care bubble” more and more from people who work in the industry. It’s scary because they say that when the dam breaks, it will have an enormous impact.

My Experience

For me, however, I don’t need statistics to tell me what I already know, that our system is terrible. I’ve lived it and I’ve seen what my friends and family have gone through. Through my employers, I have had an average health-care HMO plan for many years. I have lived part of my life with no insurance, I have been on COBRA, multiple HMOs and have experience with a PPO as well. I have been to the ER, I have been to the county hospital, I’ve had major and minor surgery and even spent time in ICU. What I have seen is a system so woefully inadequate, so broken and backwards, so needlessly confusing and bureaucratic that I would take waiting at the DMV for a week, than have to go through what I did to get my gallbladder removal covered again.

I’m talking about all the fighting I had to do to get it covered. I’m talking about all the time I lost when an employer switched insurance companies and I lost my doctor. I’m talking about spending 2 hours on the phone one day only to be ultimately rerouted to the phone number I dialed in the first place! I’m talking about time wasting back and forth phone calls and faxing paper work and the struggle to get referrals approved that dragged out so long, that my routine safe removal of my painful gallbladder was days away from rupturing when they finally got around to it. I’m talking about getting a bill for $15,000 from the hospital a few weeks later which was supposedly just to scare me into calling my insurance company so the hospital could squeeze more money out of the system. I had so much stress after my surgery from dealing with the system, that I was a PTSD case. Though I never sought any treatment, since jumping through the hopes to see a psychologist or psychiatrist in this system is likely to worsen any condition you already have, and I wish I was joking.

I have seen it all, from the infamous $20 aspirin tablet and $40 ice pack to people bleeding in the ER room trying to fill out papers at the county hospital. I experienced the joys of being on COBRA, having to pay $600 in back-fees I shouldn’t have had to pay because a moron at my employer forgot to file a form. The funny part is, COBRA is a government program, which sounds dreadful right? Wrong, the government people were the easiest part of the journey and were helpful, honest and courteous. It was the insurance company that gave me the cold-sweats at night and drained my savings. As for the quality of care, it ranges from good to piss-poor. My time in the ICU was almost like a vacation, albeit a painful, drug induced vacation spent watching TV. However I’ve had some pretty mediocre experiences as well, from doctors who really didn’t care, or were sarcastic and mean, as they were leading up to my operation. I’ve had a doctor get offended by my getting a second opinion and I’ve even had a doctor close the door and confront me in a creepy manner for being 15 minutes late due to a scheduling mis-communication.

However the worst thing, by far, was not the direct care the doctors gave me, rather the fact that they were constantly fleeing my medical group, forcing me to change both Primary Care Physicians and specialists on numerous occasions. A doctor is a very personal thing, finding a good one is hard, and the back and forth with the insurance company and those stupid effective dates that start a month later, just to find a doctor you like only to find that effort wasted when they leave a few months later for greener pastures, it’s really frustrating. Not to mention that this led to me ending up with doctors that are booked up 2 months in advance. By the time you see your PCP, the problem is worse, then they just send you to a specialist anyway and guess what? They are booked 2 months in advance too! 4 months can make a big difference in your life and your condition. Something you think is docile can prove serious, like say Cancer. My mother developed an aggressive form of breast cancer in under 4 months. Yet how do you go to urgent care if you aren’t sure you’re sick? It’s madness!

No wonder costs are so high! The level of preventative care in this country is non-existent. Then you see a doctor and you’ve got a list of problems and a list of specialists to see that end up costing more in the end. It’s the sick and the worried that drag up costs that can be combated by good routine preventative care.

Oh but that’s just my experience, right? Well my luck must have rubbed off on the people around me. I am surrounded by friends, family and significant other that have been on every type of plan from catastrophic coverage to Medicare, to Kaiser to the Veteran’s Administration Hospitals to the supposedly great PPOs. The only people happy on that list are the ones on Medicare. It’s pretty much a universal point, shared by most Americans until the ACA passed, then it became a Republican talking point about how great our system is. What a scam! You know it’s BS especially since even Tea Party morons complain that the system is bad, they just try to pick on Medicare or illegal immigrants to find the blame.I have yet to speak to anyone personally, who loves our health care system.

 

Diagnosis

The Affordable Care Act, or Obamacare, doesn’t go nearly far enough to stop what will happen if runaway prices continue, because it leaves the healthcare system in the hands of the people that are profiting from sickness, and are killing the industry purely out of greed. These industries think they can get away with it because we’re talking about people’s lives, again extortion. They skim here and there and increase the skim year after year like some kind of mafia or cartel. This reckless gouging will eventually break the system and then what?

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It  just boils down to the simple fact that Single-Payer systems like most of Europe and most of the industrialized world have are better. It is not perfect, by a long-shot, and keeping costs from ballooning in these countries is a real factor. Yet the cost explosion seen by Americans on employer-based family premiums has risen 113% since 2001. Single-Payer may not be a magic pill but the American health-care system is treating sickness with leeches and bleeding in comparison. Aside from that, America has tried single-payer, and it loves it! Medicare is single-payer and it is beloved by people so much, even rank and file Republicans love it. A poll before the Republicans starting hating health-care reform and made it an issue saw 2-3rds of Americans supporting Medicare for all. It sets price caps the industry may not like, yet need. That’s supposed to be the point of an insurance company! Is it any wonder that hospitals are unhappy when what they consider happiness is charging $40 for an ice pack? It also forces everyone to be covered, puts in place preventative care measures and overall, does a better job taking care of its patients. The proof is in the pudding.

I challenge anyone who disagrees to find me the proof that America has the best system. The best you will come up with is to try and tear down single-payer because there is no proof to be had on the American front. You will find an outdated and doctored “no pun intended” average wait-time list for specialists in Canada, that is often refuted as cherry-picked and dishonest. Also, while wait-times are a factor in Canada, not as much France or the UK, that standard seems really dishonest to me, since I have waited 8 weeks just to see my Primary Care Physician, and 4 weeks for a specialist is like a dream. I’ve even seen someone trot out a list of how America did a better job of treating hip replacements or other elderly afflictions than the UK and Canada. While their data was highly suspect, the funnies thing this Tea Bagger didn’t notice was that virtually all of the elderly in this country are covered under Medicare, which is, of course, single-payer!

If what Republicans say about socialist single-payer health care was so true, why would it see such approval ratings that the US only sees in Medicare?

 

Treatment

So what do we do? Obamacare will not solve all the woes in the system  however it’s a start. Add a public option on to it and you’ve really got something. If insurance is so proud of its product, why are they so afraid of a little competition? Could it be that the industry itself is offering an inferior product? You bet!

The ACA also limits profits, which can be increased over time. Most people don’t know that our health care system is for-profit. They think hospitals are non-profit and are often shocked to discover their local hospital is owned by a major corporation. We need to take the profit out of health-care, just as we did with the fire and police departments. Capitalism creates competition when competition can exist, in places like fire, police, military and baseline education, capitalism creates plunder and our health care system is the smoking gun evidence of that.

If hospitals profit from the sick, what’s the incentive to push preventive care that keeps them from getting sick? If a sick person costs an insurance company money, what’s to stop them from letting people die. These two factors are a lethal combo that has led to a flood of money going to all the wrong places. It is not your local community doctor that is getting rich. It is the health-care conglomerate that is getting rich. So again, we need to fight to make health care non-profit. Oh and of course, we need to keep up the fight for single-payer. If the system breaks, the solution will need to be on everyone’s mind. We can’t cede this argument to conservatives. They have nothing to offer so they argue for the status quo and we all know, the status quo sucks and it is no fault of Obamacare, especially since it has barely started and not even implemented yet.

Eventually, this sick patient called American Healthcare will get better, though it will be a long haul. We need to be there to support it, so it can purge the cancers of free-market plunder and greed. We must be well read and ask the right questions. We must have 2nd and 3rd opinions from other health care systems. There is no magic pill, and America is a unique patient, though it can recover and be around for generations to come.