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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