Wednesday, July 08, 2009


Healthcare in America stinks. We pay more than other civilized countries, and get worse results. We wouldn't accept this when buying a car, would we? Imagine comparing your car to your neighbors -- I paid twice what you did, and have twice as many repairs! What kind of value is that?

The problems are many. Too many people don't have any health insurance. Those of us who do have insurance pay too much for it, or are forced to buy plans that don't have enough coverage. (So-called high deductible plans.) If we go to change plans (when we move, or when we change jobs), many of us are denied coverage because of "pre-existing conditions." All too often the health insurance companies deny treatments and medicines recommended by our personal doctors. It all costs too much, as well -- we spend more per capita on healthcare than any other Western nation. And, despite the costs, the results are abysmal, no matter how they're measured.

Let's look at these points one by one.

Why, some might ask, must everyone have health insurance? What right does the government have dictating whether or not we have health insurance? If a person decides to not have insurance, why should I care? This one's really simple, as explained to me by my old doctor back in Indiana. He was for national health insurance, for this reason: "I don't want the guy next to me on the bus to have pneumonia." It's a selfish reason, but a good one. When everyone has good health care -- good preventative healthcare -- there will be fewer sick people around. And the fewer sick people around, the less likely it is I'll get sick from them. Ta-da! Beyond that, there's the simple humanitarian aspect; if somebody is sick or hurt, we should help them; who's paying for that service shouldn't enter into it. Think of it this way: If your child is sick or hurt, you want him to be cared for. It's not a matter of health plans and deductible and payments, you want your kid to get better. It's no more complex than that.

Then there's the paying for it. In years past, it didn't cost that much -- especially if you got healthcare through your employer. But costs keep going up and up and up, so that not having insurance might be the only option for those with low incomes. It's even a problem for employers, who are facing increasingly substantial costs for this employee perk. In fact, it may be the employers who finally push healthcare reform this go round; even the biggest corporations are getting on the bandwagon due to increasing costs. (In addition, our system is blatantly unfair; the poorest fifth of Americans spend 18% of their income on healthcare, while the richest fifth pay only about 3% of their incomes. That's not right.)

That said, those who have insurance as part of their jobs are the lucky ones. Go out on your own -- change jobs or move or whatever -- and you're likely to be turned down for coverage. It's the old "pre-existing condition" deal; if you're taking any type of medicine, even if that medicine helps to reduce your long-term medical costs, insurance companies don't want to pay for it. It gets worse the older you get; hell, at 50 years old, I am a pre-existing condition! So just qualifying for care (at reasonable rates) is a big issue these days.

Just having insurance doesn't guarantee you can get the care you need, however. How many of us have had their insurance companies deny some sort of treatment recommended by our personal physicians? Most, I'd wager. Every time my old doctor tweaked my medications, it would automatically be denied by my insurance company. EVERY SINGLE TIME. I've heard it said by people who work for insurance companies that they're instructed to automatically deny every claim the first time; even if they end up approving a second request, a certain percentage of people immediately give up, thus saving the insurance company from paying. That's cold, folks. I really don't need some minimum wage flunky in an insurance company cubicle overruling the advice from my personal physician.

So this overly bureaucratic system works hard to deny healthcare to millions, but despite that, it costs the country as a whole much more than it should. I suppose I could live with lousy service if it came cheap, but here in America we pay Rolls Royce rates for Kia quality. That's the gold ol' U.S of A., paying more than any other civilized nation. In 2000, the United States spent 13% of its gross domestic product on health expenditures. That's 22% more than the next most expensive nation, Germany (10.6%). Why are our costs so high? It's a combination of things. First, because so many people are uninsured or underinsured, they don't get proper preventative care, and they wait longer to see a doctor -- and this later, more emergency care costs more. Second, our system is a for-profit system, most health-related companies are public companies trying to meet quarterly profit goals for their investors. Third, these companies are heavy on the expensive management, and we all know how that works. Fourth, there is really no organized pressure to keep costs down, as there is in other countries; witness the lower costs for prescription medicines across the border in Canada. Fifth, there's the simple cost of bureaucracy; the administrative costs of private insurance run 16% of the total budget, while Medicare (that's a government-run program, for those keeping score) costs run only about 3%. (Ask your doctor how many people he has employed who do nothing but deal with insurance companies; you'll be shocked.)

The worst thing is, even paying so much for our healthcare, we get worse results than countries who pay much less. The statistics are overwhelming on this point. The WHO ranks the U.S. 32nd for infant survival and 24th for life expectancy; the Commonwealth Fund ranks us 15 out of 19 with respect to preventable deaths before the age of 75, and last in terms of both infant mortality and life expectancy. We pay more and get less in return. Would you accept this for anything else you buy in life?

So what is the solution? Well, it calls for a complete overhaul of our healthcare system -- not minor tweaks, as some might suggest. That means rethinking everything. We have to reinvent what we have; simply switching from paper records to electronic ones isn't the solution.

Our options, fortunately, are many. We're not the first country in the world to embrace national healthcare; in fact, we're just about the last. So we have the luxury of observing what other countries have done -- we can see what works and what doesn't. Take one from column A and two from column B, and build the best healthcare system in the world.

There are several approaches used in various countries around the world. One approach has the government run everything; the insurance companies go away, and all doctors and hospitals are government run. Another approach keeps doctors and hospitals private, but has all costs paid for by the government; again, no insurance companies are involved. A third approach keeps the insurance companies, but they're forced to provide low-cost coverage for all citizens; in return, they can upsell fancier (and more profitable) coverage to those who want it.

Each of these approaches has its pros and cons; none is 100% perfect. But all of these approaches cost less and get better results than we have today. Changing to any of these plans would be an improvement -- for all of us.

Big change has to happen, and happen fast. Unfortunately, we can do this only if our politicians have the willpower to do so -- which they don't seem to have. Right now, even the most populist politicians are sounding like rank and file conservatives, primarily because they're well funded by the healthcare lobby. The healthcare industry pours hundreds of millions of dollars into the coffers of politicians of both Democratic and Republican persuasions, with the result that few elected representatives are willing to embrace the total change that we need. "We must preserve the status quo," they cry, even if that status quo benefits only their big money donors. Us regular folks, who overwhelmingly embrace public healthcare, are left in the lurch.

This is the time for a populist uprising. All of us need to write our congresspeople and senators and president and make known how much we need and want dramatic change. Yes, we're talking public healthcare, and that will mean some disruption (mainly in the insurance industry, those fucking leeches), but it's what we want and need and must have. The insurance agency (and their well-paid lobbyists) be damned, we must force our elected official to do what is right and what is needed. This is no time for compromise (hear that, Mr. Obama?); this is time for action. Otherwise, the United States will continue to be the laughingstock of the world community, paying more and more to become less and less healthy. It's not right.

But that's just my opinion; reasonable minds may disagree.

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