US healthcare Makes Me Angry

The US has possibly the worst healthcare system in the world. Some may not agree, but here’s how I calculate the quality of healthcare:

  1. Is the population kept healthy?
  2. Is healthcare affordable?

Simple really, but for the US the answer to both questions is a resounding NO!

Let’s put the affordable healthcare act (ACA aka Obamacare) to the side for a second, and just look at the basics of US healthcare. Firstly, it is a for-profit system, which means that the system itself is designed to make healthcare as costly as possible, and where possible to provide the least amount of service, as these are the parameters used to maximize profit.

In the US, healthcare services are considered an exception to the normal rules of contract law. If you buy a product or service and at a point of no–return in the buying process the vendor sticks you with crazy last minute terms on a contract, the fact that the contract is not equitable is considered to have made the contract invalid, and yet when you enter a hospital for treatment, the hospital, your doctors, and a plethora of ancillary service staff are able to decide not to accept the payment from your insurance company and instead bill you for anything they like and you will be asked to sign this contract prior to them cutting you open to fix what is broken or you will die. There can be little doubt that an operating table signed contract is the ultimate form of stress and duress, and yet it is normal in the US. A whole industry exists to sue patients or their surviving relatives after medical operations, and anyone who has had even the smallest procedure must spend the following months fighting lawyers to protect themselves from health induced bankruptcy.

Tens of thousands of dollars a night for hospital stays are normal billing rates, and bills will explicitly list every single cotton bud and sheet of toilet paper at incredibly high prices, and while insurance companies may well negotiate significant discounts on the parts they cover, the patient is expected to pay list price for their responsibilities. And there is little advocacy available to help patients unless they choose to hire their own legal team to fight back.

Any company that is used to providing products or services to the US government is very aware of the standard clause in all contracts that states the US government will always be charged the lowest price for a product, wherever it is sold. But of course, this does not apply to healthcare products, where vendors can charge whatever they like with impunity. Every countries healthcare system in the world (except the USA) negotiates centrally, dramatically reducing the cost of products (drugs, devices etc.) as well as standard services. The US has no such central control on healthcare products, and so the costs in the US are exponentially higher. It doesn’t matter if it’s over the counter, Medicaid, Medicare or through insurance, the costs are much higher in the USA than anywhere else in the world. It makes no sense. Oh and (of course) the US government has made it illegal for someone in the USA to buy their drugs form abroad, because that would be free and open and we can’t have that!

Malpractice and medical mistake lawsuits in the USA also pay much higher payouts than anywhere else in the world, which drives up medical malpractice insurance, which in turn drives up healthcare costs. And there is a whole sector of the US legal marketplace focused on healthcare related class actions, pushing up the costs of healthcare related products with most of the costs going to just the lawyers.

Education costs much more in the US, and medical degrees are long, and so the loans doctors and nurses carry are very large, meaning they must earn a lot more to pay them off, again driving up healthcare costs.

Everywhere you look in the USA, healthcare costs are higher than anywhere else, and the whole ecosystem is designed to move money, not to provide quality and length of human life (the primary goal of healthcare).

While every other western country focuses on making and keeping people healthy as a way of driving down healthcare costs, the US does not. Doctors do not visit patients and preventative healthcare is seen as a cost to insurance companies and so is much more limited than anywhere else, so the population is generally less healthy than anywhere equivalent.

Drug development processes in the US are very similar to the rest of the world, but are used as an excuse to drive up costs. While the drugs and devices used may cost a lot less in the rest of the world, the US population is in effect subsidizing everyone else’s use of these products. Why you ask, because the US government has been paid by the healthcare industry to allow this to happen. There are no poor politicians in the USA, their salaries are not that large, and yet they all are wealthy, I wonder how that happened?

And then you have the ACA. A start at trying to change the healthcare in the USA. It started by putting controls on insurance companies to mean they couldn’t stop insuring people when then become ill, or refuse them cover because they had previously been ill, and provided a number of mechanisms to get more people insured. But it didn’t fix the for-profit nature of the US healthcare industry, and so made little long term sense. Ideally it would have been a start and would have gone through year after year of improvements, until it become more workable. And yet it was an easy task for healthcare companies to pay for access to politicians and push a for-profit agenda, which they have done incredibly effectively, to stop any real change that would drive down the overall cost of USA healthcare.

Healthcare in the USA today is more expensive and less efficient than anywhere else in the Western World. You can still go bankrupt from the cost of healthcare if you or anyone in your family becomes seriously ill.

People in the USA still die daily from curable conditions due to lack of available healthcare. If you are rich it may seem great, but if you are rich, healthcare everywhere in the world will be great. If you are not rich, the US system becomes a drag on your life and your family. Sick people will pay anything to not be sick, and the US system exploits this.

The frustration is that the amount of money involved is far too great for anyone to not want to take a slice of that action. Donkeys, Elephants and everyone in between has shown absolutely no interest in fixing this massive problem, just shuffling a couple of the pieces and trying to make it look like they are just good enough to vote for as opposed to the other person. The republican fixation with repealing Obamacare seems to be much more about earning their paychecks from lobbyists than providing a viable long term solution. And while the democrats talk a better game, they have shown no real interest in solving the underlying financial problems associated with healthcare.

The GOP make a very good point when they say that a country should run in the black not the red, but they also have no plan to make it happen. Cutting federal spending, just means that state spending goes up, and cutting state spending just means city spending goes up. So the family living in the burbs still ends up paying more every year. Anytime anyone suggests that healthcare companies make too much money, every politician’s head explodes with paid-for anger.

Until healthcare is considered a social right available to all and costs are controlled to make it affordable and of high quality nothing good can or will happen. And neither of the major parties have shown any sign of moving in that direction. Oh I know “socialism” is that big evil word, but insurance is a social mechanism, it demands high volume to make it work. If everyone pays in and only some need to use it, it’s cheaper per person, that’s just basic math. It’s not like there is some other type of math you can use to make it work differently.

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What the hell is going on with healthcare?

It seems to me that there is nothing more deeply personal than your health and that of the ones you love and care about. If you get sick, you don’t just ‘want’ to get better, it will become the most important thing in your life. It’s emotional, and will take precedent over everything else, and it should.

This means that any contract that you enter into about healthcare is loaded with stress and duress, and the basics of contract law are that any contract entered into under these conditions is not fair and equitable, and as such is not a fair contract. This may seem technical but it simply means that those papers a hospital or a doctor makes you sign saying that you are personally responsible for any costs not covered by your insurance shouldn’t be allowed. But yet they are.

The insurance companies, the hospitals, the lawyers and the doctors have created a special legal framework that is entirely weighted to their benefit.

And to add insult to this situation the American system means that the costs you are charged are list price, whereas the insurance companies get a massive discount on the bits they cover.

The costs of medical care in America are incredible, and the quality of the service is directly related to the amount of money you can pay.

Every doctor swears the Hippocratic oath. I’ve read this oath and frankly I feel that most US doctors are not living up to the spirit of the thing

Here’s a couple of sentences from the oath, they I’m sure your will agree are not the normal practice here in America :

“I will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

“I will prevent disease whenever I can, for prevention is preferable to cure.”

In this country today people die because they cannot afford to get timely treatment, others go bankrupt because the costs that are not covered by insurance companies consume their entire worth and then some. Millions of people don’t have adequate or even any coverage, either because they cannot qualify due to pre-existing conditions or just cannot afford the monthly costs and still be able to eat.

Some say that for these people there is always the option of going to the emergency room. Well there are two huge issues with this. Firstly the emergency room will just treat them to the point where they are not going to die on that particular day; this is not an answer to a problem, but a stop gap. And secondly the costs that are incurred by doing this are just passed onto the ones who do have insurance, as increased premiums which have the effect of making premiums higher and so making them ever less affordable, exacerbating the situation.

The issue (as I see it) is the huge amounts of money involved. No one wants to give up his or her part of this gravy train. But it is clearly unsustainable.

The concept of reform in healthcare driven by government seems to be the only way to break this logjam.

But the size of the powerbase involved has so far warped the political process beyond anything reasonable. They are many great improvements within the healthcare changes that President Obama has lead. But it is just a small step on a very long road, and some critical elements of any good plan are missing or just wrong.

The cost of healthcare is far too high, and the quality available (on average) is far too low. We need lower drug costs, medical services driven by results and not on a per service basis. And we need to trust that doctors are doing the best they can, by us accepting that suing doctors is not the first step in fixing a mistake.

Healthcare that helps avoid medical issues by preventative support has been proven to be the most cost effective and rewarding way to maximize the quality of life.

This is a very hard problem to solve, but it must be improved. When politicians use any change or proposed change as a political weapon, rather than trying to work together to find the best solution, they are failing everyone.

We all deserve better.

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