June 29, 2010
The rotten US health care system
Just last month I went for a routine physical examination followed up by routine blood tests and a bone density scan. According to my health insurance plan, all these were supposed to be fully covered. Of course, being a veteran of the bureaucratic health care system in the US, I know that nothing is 'routine' here and so before I did any of these things I had to spend some time making sure that I was going to a doctor covered by my insurance plan and that the blood-testing laboratory and the bone-density measuring facility were also covered procedures done by approved facilities.
After everything was over, I received bills charging me the full amount for both the blood tests and the bone density scans. This meant that I had to call the insurance company to find out what had gone wrong. After fighting my way through the thicket of the voice mail jungle to get a real live person, they said that one of the bills was due to an error by their processing office and the other was due to a wrong process code entered by the laboratory. (It fascinates me that these errors always seem to favor the insurance companies, never the patient.) So then I had to call the laboratory and tell them to re-submit the bill using the correct code.
Of course, I was not surprised this happened because I have had enough experience with the absurdly bureaucratic US system to know that this kind of hassle that patients go through is the norm. In fact, I fully expect that there will be more glitches and more bills requiring more phone calls from me. All this for relatively trivial and 'routine' processes. For other people, things are a lot worse. The wife of a friend of mine died after a long illness. In addition to dealing with his grief, he now has to deal with the enormously complicated details of who should be paying for what aspects of her care. Dealing with all the paperwork and bureaucracy is practically a full-time job.
Let's not mince words. The US has one of the lousiest health care systems in the developed world. (For my previous posts on this topic see here.) This is not just my opinion. It is supported by numerous studies, the latest of which finds that the US ranks at or near the bottom on most measures when compared to six other countries (Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom) in the quality of the health care its people receive. This will, of course, come as no surprise to those people who have paid close attention to this question and seen through the propaganda of the lucrative health industry and their bogus arguments about hip replacements and wait times and the like. (The organization Physicians for A National Health Program gives a lot of great information.)
A Business Week news report on the new study says:
Despite having the costliest health care system in the world, the United States is last or next-to-last in quality, efficiency, access to care, equity and the ability of its citizens to lead long, healthy, productive lives, according to a new report from the Commonwealth Fund, a Washington, D.C.-based private foundation focused on improving health care.
According to 2007 data included in the report, the U.S. spends the most on health care, at $7,290 per capita per year. That's almost twice the amount spent in Canada and nearly three times the rate of New Zealand, which spends the least.
The Netherlands, which has the highest-ranked health care system on the Commonwealth Fund list, spends only $3,837 per capita.
The report also debunks the most common sound-bite made by supporters of the US system, that supporters of single-payer don't really know how awful other systems are. The converse is true. People who have experienced health care in any of those other countries (like I have) are the ones who are amazed at how awful the US system is, because only they realize how much better it can be, and is elsewhere.
Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine, commented that "as a physician and public health practitioner, I have routinely spoken out in favor of health care reform in the U.S. The responses evoked have not always been kind. Prominent among the counterarguments has been: 'You should see what health care is like in other countries.'"
"This report utterly belies the notion that the former status quo for health care delivery in the U.S. was as good as it gets. Others have been doing better and we can, and should, too," he said.
In fact, the UK with its (gasp!) 'socialized medicine' turns out to be at or near the top.
U.S. patients with chronic conditions were the most likely to say they got the wrong drug or had to wait to learn of abnormal test results.
Overall Britain, whose nationalized healthcare system was widely derided by opponents of U.S. healthcare reform, ranks first, the Commonwealth team found.
An American physician now working in Canada gave the commencement address to newly minted doctors at the University of California at Irvine and he made some interesting comparisons with his experience working in the US.
It was interesting for me, as an American physician practicing in Canada, to see the recent negative depictions of the Canadian system in TV ads and lay media, depictions that bore absolutely no resemblance to the actual environment in which I practice daily. My reality is very different. I can see any patient and any patient can see me – total freedom of practice. My patients' parents have peace of mind regarding their children's health. If they change jobs or lose their job altogether in a bad economy, their children will still get the same care and see the same physicians. Micromanagement of daily practice has become a thing of the past for me. There are no contracts, authorizations, denials, appeals, reviews, forms to complete, IPA's, HMO's, or PPO's. Our Division's billing overhead is 1 %. My relationship with the hospital administration is defined by professional, not financial, standards. I have no allegiance to any corporate or government entity, nor does one ever get in between me and the patient. This environment, which some denigrate as the ever so scary system of "socialized medicine" allows for more patient autonomy and choice than was available to most of my patients in California. (my emphasis)
That is not at all to say that I practice in a medical utopia. There is no perfect health care system. The Canadian system has its own set of difficulties, challenges, and shortcomings, and Canadians are also looking to significantly reform their system. But as physicians, we have to enter the debate and we have to enter it objectively, salvaging it from the bias, misrepresentation, and demagoguery that has characterized it. Health care should not be a liberal or conservative issue, for disease, disability, and death do not recognize political affiliations.
As a socially conservative Christian myself, my belief that health care is a fundamental human right, and my efforts on behalf of single payer universal health coverage stem from my faith, and not despite it. My faith calls for personal morality, but also for societal morality – how do we treat the sick amongst us, the weak amongst us, the least amongst us?
Some form of single payer health care system (whether socialized or not) is what the US needs. Now.
POST SCRIPT: This is the best the US can do?
It amazes me that the corrupt, wasteful, and greedy health insurance industry in the US is what some people want to preserve.
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