A friend shared a fascinating article from the Washington Post about many of the misconceptions that Americans believe about health care in other countries. Due to the huge amount of incorrect information being thrown around in this country during Congress’s attempt at fixing our broken system, you’ve probably heard some of these already.
I don’t claim to be any sort of expert on health care, but I have no doubt that our system is broken. You’ve seen and experienced it yourself. We have some of the best doctors, nurses, and facilities in the world. Yet tens of millions of people inexcusably lack health insurance, the costs of health care continues to rise much quicker than inflation, and the entire system is a jumbled, confusing mess of paperwork and bureacracy.
For one example, consider Jenny’s recent gallbladder surgery. The hospital sent our insurance company a bill for over $11,000 for the surgery itself and a separate bill for $700 for the ultrasound that revealed the stones that got things rolling. (heh heh) The surgeon sent the insurance company a bill for maybe $3000. In each case, the provider was billing MORE than the actual cost of the procedure knowing that the insurance company would only cover a lower amount, which is related to whatever government-run Medicare decides is a fair price for that procedure. The provider writes off the difference, which provides them some tax benefits. Then we have to pay 10 percent of whatever amount the insurance company decides is fair. So out of a total “bill” of over $15,000 for a surgery that took less than an hour and an ultrasound that took 5 minutes, we are paying about $500. Only God and perhaps the providers know that actual cost of the care Jenny received, but it has very little to do with what we paid or what the insurance company paid.
At the same hospital, and hospitals around the country, pregnant women show up every day in labor with no insurance at all. The hospital is legally obligated to help them, so they deliver their babies and provide the same high level of care that we received when Brenden was born. The mothers’ out-of-pocket cost? $0. Reimbursement to the hospital and doctor? I assume they get something from Medicaid, but less than they got from us and our insurance company. But they probably got NO prenatal care because they didn’t have insurance, adding risk to both baby and mother.
I don’t understand why it’s so difficult for the wealthiest, most powerful, and most advanced country in the world to provide a cost-effective, efficient, and innovative health care system that makes coverage available for everyone in a fair way. As you can read in the Washington Post article, countries around the world have added great ideas to their own systems. I hope that our leaders can learn from the many examples out there and hammer out a plan that works for us.
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I always enjoyed being a doctor but the reason I got out of healthcare was because of the business of healthcare. I couldn’t take all the back biting and manipulation of the system that is standard procedure for our insurance companies, hospitals and fellow doctors adhere to. We don’t need a public system but a system that has fair and timely reimbursment for services provided. We also need tort reform to stop the practice of defensive medicine. If insurance companies had their feet held to a fire to pay for services fairly and timley, doctors only performed diagnostic as well as other services that are statistically necessary, and hospitals that would not manipulate the system for higher reimbursments (i.e. holding people in icu longer because no other beds are available etc.) then the world would be better. These guidelines are here now with the exception of tort reform but no one will hold their feet to the fire. I say what America needs is a “hold people’s feet to the fire” tsar.
I thought it was interesting that the US is the only developed country on earth that allows its health insurance companies to pursue a profit like a normal company instead of forcing them to operate as a non-profit organization. Normally I’m a fan of capitalism and the motivation of profit-seeking, but perhaps the whole health care system would work better if the insurance companies took profit out of the equation.
I would love to see more accountability for doctors, hospitals, and insurance companies, but it seems like only Congress has the power to make it happen. Unfortunately Congress tends to get too bogged down in political party squabbles and trying to get re-elected for its members to focus on doing the right thing.
In reading the Post’s article and Mad Bomber’s comments, I would agree that the American insurance provider has a skewed interest. On one hand, I understand running a business and wanting to make a profit that is after all the name of the game. On the other hand, we have millions of individuals that are without health care. In its simplest form, insurance is transferring risk from one party to another. This begs the question of what is the appropriate amount (premium) an individual (or country) should pay to transfer that risk and what is an acceptable amount an entity should receive to accept that risk? What I find interesting is that in France and Japan, you do not have a choice of provider, your profession dictates that. This raises a question; do professions that are considered “hazardous” receive a higher premium from their mandated providers? Who negotiates these pre-determined premium prices? The respected governments?
The country that intrigues me the most is the British system. They utilize government run hospitals with the government picking up the tab. As the Mad Bomber alluded to in his essay, I would expect that Britons are treated and released in a timely manner; not held for additional and often superfluous observation.
If you are careful to note, not all of the hospitals are public. So how do the private hospitals manage their costs? What is the yearly malpractice insurance cost to these foreign physicians?
I guess I could ramble on and on about this. My question is how can we find a healthcare solution that will accomplish everything to everyone? Every foreign healthcare plan has cons and pros. Is it possible to take the best and leave the rest?
I think the sheer number of options is probably slowing the process down. Perhaps that’s a good thing. I want our leaders to take the best of the world’s systems and figure out a way to put them together. I figure Congress is doing that to some extent, but political squabbling is getting in the way.
I’m also concerned about all the ignorance out there among the American people regarding the reform options. Being resistance to change is natural, but many people are blindly believing rumors and jumping to wild conclusions that are completely incorrect, possibly spread by insurance companies who stand to lose money after reform.
I like your definition of risk. It got me wondering whether a risk-based model is even appropriate for health care. It’s perfect for negative events that are likely not to happen, such as a major flood that destroys your house or a terrible wreck that totals your car. But health care is a mixture of expected services, such as a yearly physical and your kid’s braces, and unlikely expenses, such as a brain tumor. I could live a lifetime without filing a homeowner’s insurance claim, but I can hardly go a month without filing a health insurance claim. My company and I are paying for the service of routine health care plus paying a premium for the risk of a serious claim.
Risk analysis and compensation is important, but companies currently use risk analysis to exclude people with expensive pre-existing conditions because those people would be guaranteed to cost more than they pay in premiums. Our new plan needs some method of caring for people like that. If I openly run a meth lab and build bombs in my house, the insurance company has a legitimate right not to insurance my house. But if I have cancer and lose my health insurance, I should still have the right to get health care. That’s a bit simplistic, but I hope you see my point.
Another excellent article, Andy: It is thoughtful, and provocative. May I add a few thoughts to the already presented excellent ones. I agree with you (and I believe, most Americans), that we should have good health care for our citizens, at a fair price. How to legislate and implement such a program is the dilemma. We have a perfect storm:
a. A poorly informed congress on this subject.
b. Powerful pharmaceutical companies who don’t want to change.
c. Political parties out to get even with each other.
d. Demagogue conservative media personalities.
e. A poorly informed public citizenry who fear change.
f. A 24/7 media who loves the fight.
This may sound harsh, but I don’t think I’m too far off point. I would lay one proposal on the table for debate: Let the president appoint a non partisan commission to develop a plan. The commission could hold hearings for input from all parties. Present the plan to congress for action.
One added comment – Nothing is going to change unless congress acts. So everything should be done to enact good, solid, fair, and comprehensive law. This is likely to require massive change in the funding and delivery of health care as we know it., GD
I don’t know what the solution is. Larry and I are in dispute as we read your post. We have a private health insurance plan that is pricing us out of the market (we are old). I know that I do not want someone else making my health care decisions for me! I am encouraged that your generation is paying attention and getting all of the facts…I just hope the government doesn’t kill off all of us baby boomers in the mean time! Larry wants you to go and rent the old movie with Charleston Heston called “Soylent Green.”
Situations like yours and my parents’ are part of the reason I hate the current system. Since all of your are self-employed, you must find and purchase your own insurance at great cost. I work for a huge company that buys insurance in bulk, so my premiums are much lower.
I certainly don’t advocate putting the government in charge of every aspect of our health care. Personal choice is important. The expertise and opinions of the doctors and nurses are important. However, I don’t see any way we can fix the current system without some kind of government intervention. The rules have to change, and Congress is the only body that that change them. I just hope they do the right thing, whatever that may be, so that all of us can get the health care we need at a reasonable price.