Well, what a story. I’m a Canadian physician, and I am glad I never had to deal with greedy insurance companies. When a patient walked in my office, my main concern was to determine what was the best treatment for the patient in front of me. I made a decent living, but nothing compared to my American counterparts. However, I practised medicine for 41 years and was happy all the time and this can’t be measured in money. Now I am retired and I have the feeling of having done my best and my patients got the best and didn’t lose their shirt to get it. My American friends, keep fighting, just like most of the Western countries you too deserve the best, the easy way.
It's capitalism at work. "Markets" can be, and are, very innovative. But EVERYTHING has up-sides and down-sides, although there are different "up's" vs. "down's" for every thing. When a thing has mostly ups, markets continue to do well. But the more downs there are, markets do less well, and help from the government is needed. Health care insurance really got going during WWII as a benefit to auto workers. As more and more things got dumped into the pot, it has started to work less well. The US now pays more for health care with worse results than most "civilized" countries. Perhaps, if folks in the US started voting for people who believe that government can actually work, rather than voting for people who think government doesn't work and then do their best to make it fail (scooping the profits into their own pockets), we might do better. Not sure we will we wake up by 2026, but we will see...
The way I always put it is that when somebody has a heart attack and a bystander calls an ambulance, the person who's in crisis isn't gonna price-shop for the best-value ambulance, or check whether the hospital they're driving to has "in network" care.
The whole concept that patients can price-shop, or that having "skin in the game" matters, is completely broken. Putting more out-of-pocket cost on patients probably causes more deferral of useful preventative care, than elimination of wasteful spending, and hence is counter-productive.
I suspect the polling that says "most people like their health insurance" is crap. I'm willing to bet if you polled people "do you like your life insurance plan" you would get like 60% to say they had a good plan, even though definitionally none of them would have used it.
I think what the election has shown us is that a referendum on the status quo is going to lose, so forcing the GOP to defend the current health care system could be an effective strategy. I am aware of the polling that most people are fine with their insurance coverage, but they are the healthy ones. Its the ones that have actually had to USE their insurance that will have the gripping stories - as Brian does - that indict the status quo.
There is also a lot of skepticism on the right about Big Pharma that should at least in part be transferrable to skepticism about big very profitable health care companies.
Sorry this is so late- I am behind on my emails. Have a similar story - took my brother to the ER over a year ago - severe stomach pain, and no bowel movements for a couple of days. Was immediately admitted, and discovered he needed his gall bladder removed. (The doctor said it was the worst gall bladder she had seen in anyone who survived - had gangrene). Insurance denied his ER visit, because "stomach pain" wasn't a good enough reason for an ER visit. Seriously? They didn't even wait for the diagnosis, although they really would have had it by then, seeing as I brought him in on a Sunday night, the diagnosis was that night. I can guarantee the person denying it wasn't working that night.
There a number of tensions inherent in any healthcare system. As noted in the piece, rationing or prioritization has to happen because the well is not bottomless. And the definition of what constitutes effective care changes with each health care provider and the circumstances of the case and the environment in which the care decision takes place. Doctors may order unnecessary tests to be able to make more money or to cover off potential liability from high malpractice costs. One doctor may agree to see a nervous patient repeatedly hoping to calm their need to go to see a doctor frequently while another will the cut the person off early on.
In theory costs to the whole healthcare system could be reduced if greater funds were devoted to preventative care. Both for profit and not for profit could improve overall results by shifting to preventive care but neither does a good job of that as users are focussed on treatment rather than prevention. Also, both systems can have problems with what is covered. Many universal for all systems, in fact, leave out major facets of healthcare such as pharmacare, dental, etc.
"the biggest perverting factor in American health care, the thing that makes it worse and more expensive than elsewhere, is the profit motive"
...is that actually true? If we suddenly changed all insurance companies to be nonprofits, AFAICT we'd trim a few percent of the problem off, but not much more than that.
It's certainly the most galling part of this, and probably a politically effective angle of attack. But I'm not sure it's the crux of what actually solves this in practice.
Something missing from this is that if we had single payer you get monopsony - monopoly of buyer. Then the buyer (the gubmint) can tell doctors what they will be paid. This is how Medicare Part A/B work. If you set the payment from single payer to Medicare levels the AMA won’t stand for it for a second.
Well, what a story. I’m a Canadian physician, and I am glad I never had to deal with greedy insurance companies. When a patient walked in my office, my main concern was to determine what was the best treatment for the patient in front of me. I made a decent living, but nothing compared to my American counterparts. However, I practised medicine for 41 years and was happy all the time and this can’t be measured in money. Now I am retired and I have the feeling of having done my best and my patients got the best and didn’t lose their shirt to get it. My American friends, keep fighting, just like most of the Western countries you too deserve the best, the easy way.
It's capitalism at work. "Markets" can be, and are, very innovative. But EVERYTHING has up-sides and down-sides, although there are different "up's" vs. "down's" for every thing. When a thing has mostly ups, markets continue to do well. But the more downs there are, markets do less well, and help from the government is needed. Health care insurance really got going during WWII as a benefit to auto workers. As more and more things got dumped into the pot, it has started to work less well. The US now pays more for health care with worse results than most "civilized" countries. Perhaps, if folks in the US started voting for people who believe that government can actually work, rather than voting for people who think government doesn't work and then do their best to make it fail (scooping the profits into their own pockets), we might do better. Not sure we will we wake up by 2026, but we will see...
Markets don’t work that well with healthcare. You often don’t have the option of not needing the care and voting with your feet.
The way I always put it is that when somebody has a heart attack and a bystander calls an ambulance, the person who's in crisis isn't gonna price-shop for the best-value ambulance, or check whether the hospital they're driving to has "in network" care.
The whole concept that patients can price-shop, or that having "skin in the game" matters, is completely broken. Putting more out-of-pocket cost on patients probably causes more deferral of useful preventative care, than elimination of wasteful spending, and hence is counter-productive.
You don't price shop on MRI machines? ;)
Capitalism works great for cereal and cell phones. It doesn't work at all in health care. I can't walk away from chemo because of price.
I suspect the polling that says "most people like their health insurance" is crap. I'm willing to bet if you polled people "do you like your life insurance plan" you would get like 60% to say they had a good plan, even though definitionally none of them would have used it.
I think what the election has shown us is that a referendum on the status quo is going to lose, so forcing the GOP to defend the current health care system could be an effective strategy. I am aware of the polling that most people are fine with their insurance coverage, but they are the healthy ones. Its the ones that have actually had to USE their insurance that will have the gripping stories - as Brian does - that indict the status quo.
There is also a lot of skepticism on the right about Big Pharma that should at least in part be transferrable to skepticism about big very profitable health care companies.
Sorry this is so late- I am behind on my emails. Have a similar story - took my brother to the ER over a year ago - severe stomach pain, and no bowel movements for a couple of days. Was immediately admitted, and discovered he needed his gall bladder removed. (The doctor said it was the worst gall bladder she had seen in anyone who survived - had gangrene). Insurance denied his ER visit, because "stomach pain" wasn't a good enough reason for an ER visit. Seriously? They didn't even wait for the diagnosis, although they really would have had it by then, seeing as I brought him in on a Sunday night, the diagnosis was that night. I can guarantee the person denying it wasn't working that night.
There a number of tensions inherent in any healthcare system. As noted in the piece, rationing or prioritization has to happen because the well is not bottomless. And the definition of what constitutes effective care changes with each health care provider and the circumstances of the case and the environment in which the care decision takes place. Doctors may order unnecessary tests to be able to make more money or to cover off potential liability from high malpractice costs. One doctor may agree to see a nervous patient repeatedly hoping to calm their need to go to see a doctor frequently while another will the cut the person off early on.
In theory costs to the whole healthcare system could be reduced if greater funds were devoted to preventative care. Both for profit and not for profit could improve overall results by shifting to preventive care but neither does a good job of that as users are focussed on treatment rather than prevention. Also, both systems can have problems with what is covered. Many universal for all systems, in fact, leave out major facets of healthcare such as pharmacare, dental, etc.
I'm not sure about this part:
"the biggest perverting factor in American health care, the thing that makes it worse and more expensive than elsewhere, is the profit motive"
...is that actually true? If we suddenly changed all insurance companies to be nonprofits, AFAICT we'd trim a few percent of the problem off, but not much more than that.
It's certainly the most galling part of this, and probably a politically effective angle of attack. But I'm not sure it's the crux of what actually solves this in practice.
I still don’t understand why Medicare for All is such a bad idea. Vagueness here doesn’t help.
People fear change, and it is easy to sow doubts.
Something missing from this is that if we had single payer you get monopsony - monopoly of buyer. Then the buyer (the gubmint) can tell doctors what they will be paid. This is how Medicare Part A/B work. If you set the payment from single payer to Medicare levels the AMA won’t stand for it for a second.