I disagree with some of the premises of this article and agree with others:
1). We pay doctors more than other countries do. True–but we also force them to incur the full cost of their medical school education. In other countries, like France, that pay doctors less, they also pay for the medical degrees, so they don’t graduate with hundreds of thousands of dollars worth of debt.
2). Our fragmented array of insurers and providers eats up a lot of money in administrative costs, marketing expenses, and profits that do not afflict government-run systems abroad - this is almost a throw-away line in the article, but, IMHO is the complete crux of the issue: the whole debate about healthcare is even framed in terms of “47 million Americans are uninsured”. From what I’ve seen of the ‘08 Presidential candidates’ healthcare plans, they all involve insurance–when the only thing that can really fix our fractured healthcare “system” is getting rid of health insurers. They are a leach; they take dollars but don’t provide healthcare, only administrative runarounds.
3). This article doesn’t point out that by some key indicators–life expectancy and infant mortality–the U.S. has some of the WORST outcomes in the civilized world.. I’m not clear on how, “by some measures, Americans are getting good value.” How good is the value if we or our babies die too soon?
4). There are geographical variations in care (and cost).. Hmmm. Wouldn’t that be because there are no consistent standards–because there are too many different payers in the mix?
5). Information technology as a solution - Again, sharing information between systems is challenging, if not impossible. Having a single payer system would allow much more potential for better IT solutions for healthcare. (Well, that and getting rid of HIPAA).
6). Disease management as a solution. One of the biggest problems with U.S. healthcare is that even though most of the costs and disabilities arise from chronic disease (like kidney disease, for example), doctors are trained in acute illness–and our whole “system” (such as it is) is set up for that. This is why each time someone needs dialysis, it’s as if it’s never happened before–there is no consistent plan for identifying people early, getting them information, educating them in an ongoing way…those things are all “frills” in acute medical care, where the patient’s job is to seek good medical help and comply with what he or she is told to do. Chronic disease “management” requires vastly more patient education than most “disease management” companies have done–but people with chronic diseases need to solve problems, notice and report symptoms, and follow complex treatment plans on their own most of the time. No wonder the current disease management programs don’t work very well…
7). “Skin in the game” as a solution. ARGHH!!! I can’t fully convey how moronic it is to expect healthcare consumers to make decisions about whether they need a CT scan at $350 vs. an MRI at $850–when most never get any health education in the first place! (If we did, maybe we could be avoiding some of these costly chronic diseases). We had a vet once that worked this way for our cat: “Do you want the Cadillac plan, where we test her blood, give her X-rays, etc., or the VW plan, where we’ll do a urine test and give her vitamins?” How would we know? Did we go to vet (or medical) school? Of course studies show that this can save money. The real question is–did more people die who wouldn’t have if they’d gotten better care?
Okay, call me a liberal–I’ve already shown my strong bias toward a single-payer system. This article gives Medicare a bad rap, but the reality is that Medicare’s administrative costs are only 5.2%–vs. 16.7% in the private sector. (http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf). That’s a difference of tens of billions of dollars. IMHO, we’re fooling ourselves if we believe any private sector plan can possibly give us what other industrialized countries have–better healthcare for less cost.
Since the U.S. is not Canada or France or the UK, what would probably work best here is a Single Payer + type of plan, where everyone is eligible for Medicare, but folks who can afford more can “opt out” and get private care. This would get rid of the concern about “long lines” while still making sure that everyone gets care–not insurance.
