General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsWhere's the Outrage over Our Failed Health Care System?
It really needs no comment from me
By Philip Caper, M.D.
For the next few months well be bombarded by messages from the Obama administration urging people, especially young, healthy people, to sign up for insurance provided under the Affordable Care Act. Without them, premiums for that insurance will soon climb to unaffordable levels.
Well also hear plenty of noise from the ACAs opponents. It will be hard to get any other health policy messages across during the upcoming PR blitz.
But there are some other important and noteworthy things going on in the policy world. Perhaps the most important is the growing interest in the origins of the high costs of medical care in the U.S., now about double that of other wealthy countries.
That interest has been fueled by the ACA. By requiring many Americans to buy private health insurance, the federal government is now obliged to see to it that insurance remains affordable. Whether they are actually able to do so remains to be seen.
Because of that, both government and the lay media have now joined academicians in paying a lot more attention to the costs of medical care in the U.S. and how they compare to those in other countries. That attention was jump-started last March by a Time Magazine article titled Bitter Pill by journalist Stephen Brill, who looked at hospital charges and their causes. He concluded that while many of those paying the bills suffered badly from the high costs, those selling health care products and services were prospering, helping to create an island of affluence for themselves and a sea of poverty for everybody else.
That was followed by Medicares public release of the prices it was being charged in various regions throughout the country, revealing huge variations without any persuasive explanation as to why these variations should exist.
More recently, the New York Times has published an ongoing series by Elizabeth Rosenthal examining the costs of medical care for various procedures throughout the U.S., and comparing them with those in other countries. So far she has examined three common types of care: colonoscopy, pregnancy and hip replacement. In each case, she found prices in the U.S. were both variable and extremely high by international standards, some up to 10 times the prices for comparable care in other countries. When asked why, one expert commented, Theyre charging these prices because they can.
In other words, as economist George Akerlof predicted in his Nobel Prize-winning paper Selling Lemons, in a market where the sellers have a great deal of information (and therefore power) and the buyers have little or none, the buyers (most of us) are being ripped off big time.
In most countries that have enacted programs of universal health care, two things have taken place. First, health care prices were restrained so as to keep their national programs affordable. Profiteering from illness is not allowed.
Second, the importance of medical care in maintaining a healthy population was put in perspective. Medical care can be very effective in fixing whats already broken, but not very effective in preventing the breakage in the first place.
What are now called the social determinants of health turn out to be much more important than medical care in maintaining a populations health. They include lifestyle factors such as a healthy diet; exercise; restraint in the use of substances such as alcohol, tobacco and other drugs; and the presence of robust social policies that help minimize excessive disparities of wealth and income within the national population.
Although the ACA does move the ball toward the goal of universal health care, we are still a long way from scoring. It attempts to curb some of the worst abuses of the health insurance industry, but it doesnt eliminate the incentives to try them anyway. It will leave many people out, and although it makes some efforts to control overall costs and promote healthy living, many experts believe those efforts are inadequate.
As Akerlof predicted, the medical-industrial complex is becoming increasingly corrupt. It is now one of our largest and most profitable industries. Much (but not all) of what it is doing is legal, but it has lost its moorings and is forgetting about its health care mission in the pursuit of profits and growth.
The MBAs have taken over. We are all paying the price.
I dont blame only the corporate health care providers, pharmaceutical and device manufacturers and insurance industry. After all, they are just doing what they are supposed to do for their stakeholders profit and grow.
I also blame all the rest of us for letting it happen. What we are witnessing is a massive failure of public policy that is not permitted in any other wealthy country. It is being enabled by the timidity of experts in academia and the media, who are paid to be truth-tellers but who until very recently ignored the elephant in the room rampant corporatism that is subverting the interests of most of the American public and the mission of our health care system. I blame the passivity of a public that consistently permits our politicians to fail to do their jobs to protect our interests.
Wheres the outrage?
Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.
Loudly
(2,436 posts)If you have an aptitude for the life sciences and a calling to heal, then you're who I want in it.
kestrel91316
(51,666 posts)It's how they support themselves. It's called EMPLOYMENT.
I don't want somebody who feels they have a calling but isn't competent - I want somebody who loves the work AND has some self respect and a desire to avoid homelessness.
If we had single payer, however, the government would lay the law down on those who charge far more than their colleagues.
JoeyT
(6,785 posts)It's probably one of the reasons we rank #37 in health care outcomes.
Under our current system, it doesn't really matter how competent a potential doctor is. What matters is their ability to afford to become one. Competence doesn't really factor into the equation. There are thousands of potential great doctors that are plumbers, or janitors, or ditch diggers because they couldn't afford $30-$50k a year to become one.
Mojorabbit
(16,020 posts)When he graduated he had huge debt. It took almost 15 years to pay it off.
Nuclear Unicorn
(19,497 posts)He should kiss the ground of the nation that allows him to subordinate his knowledge and experience to insurance actuaries and system-exploiters! That he should want to see any profit for his family, I think, says just about all we need to know about him!
Egalitarian Thug
(12,448 posts)of a binary world. "If doctors can't be rich, nobody would do it" was, not too long ago, the province of the RW wackos. Now it is apparently "common knowledge".
Harmony Blue
(3,978 posts)but right now I do have a lot of worries how this will pan out.
tularetom
(23,664 posts)I can remember the first time I heard that "health care accounts for 16% of the GDP in America", and asking myself why that could be, and more importantly, why those who were reporting it were not outraged that such a thing would be true.
That's been 20 years ago, and while the situation has only gotten worse, the liberal media has still failed to tell us that it just isn't right, or even tell us why.
Everybody needs to read this.
Scuba
(53,475 posts)Sending our precious healthcare dollars to fatten the wallets of corporate investors on Wall Street and in London, Tokyo and Hong Kong isn't just bad fiscal policy, it's immoral.
KoKo
(84,711 posts)As Akerlof predicted, the medical-industrial complex is becoming increasingly corrupt. It is now one of our largest and most profitable industries. Much (but not all) of what it is doing is legal, but it has lost its moorings and is forgetting about its health care mission in the pursuit of profits and growth.
The MBAs have taken over. We are all paying the price.
90-percent
(6,828 posts)The entirety of the Institutions we depend on for a fair and just society have been totally corrupted.
Our entire societies life essence is being extracted by the I got mine by screwing you crowd.
-90% Jimmy
scheming daemons
(25,487 posts)Le Taz Hot
(22,271 posts)liberal_at_heart
(12,081 posts)things, education being the most important to me. The defunding of our educational system was the last straw for me, so yes we can be upset about the NSA scandal and still pay attention to all the other outrages as well.
DisgustipatedinCA
(12,530 posts)uponit7771
(90,304 posts)...action on protecting peoples right to live and to vote
hunter
(38,304 posts)Absolutely, "the medical-industrial complex" is corrupt.
The core of the rot is the health insurance industry. The greater the flow of money they control, the more they can siphon off. Skyrocketing hospital CEO pay? They don't care, pass it on to the customer. Skyrocketing pharmaceutical costs? They don't care, pass it on to the customer. Specialists raising rates? They don't care, pass it on to the customer.
And insurance companies are very good at shedding patients with chronic illnesses who are no longer profitable to them. Can't pay the premium 'cause you are too sick to work? Get lost in the paperwork because your lifesaving medications makes your head fuzzy and your family life has been disrupted? Well ain't that too bad... join the ranks of the uninsured.
The core medical providers -- nurses, physicians assistants, primary care physicians, the people who clean up shit and vomit and blood -- their incomes are not increasing, their standard of living is not improving. It's the fat cats sitting in offices, the money manipulators who are sucking up the money.
roamer65
(36,744 posts)It is a very sizable beginning toward breaking the link between health insurance and employment. Especially in states that adopt the Medicaid expansion. Health insurance availability should not be dictated by your employment status. In October 2014, I will look at what is available on the exchange and if I can get one with better coverage then I will ditch my employer's coverage.
liberal_at_heart
(12,081 posts)it will be harder than ever to get them out of health care.
MisterP
(23,730 posts)and then suddenly it will no longer mean "everyone has health care" or "no ACA, no democracy" (as we saw in the LA Times)
but it'll be a fait accompli
felix_numinous
(5,198 posts)no one should be surprised people seek alternatives, which include safe and unsafe treatments. It's their own fucking fault.
My most recent bill for a meet and greet and a CT and lab work? $11,000.
hfojvt
(37,573 posts)because there is no discussion
http://www.democraticunderground.com/10023465891
Although your thread is doing far, far better than mine did. Kudos for that
Skittles
(153,122 posts)thanks
KG
(28,751 posts)Demo_Chris
(6,234 posts)Jasana
(490 posts)I'm also disabled and during my last 24 hour hospitalization, I was left in my own urine for 2 hours, 2 medication errors happened and in the end, I was charged for medication I didn't take and also charged hundreds of dollars for occupational therapy I never received. I tried fighting it but Medicare paid most of the bill even though I alerted the fraud department. Your tax dollars at work for the Hospital Industrial Complex. As if the MIC wasn't bad enough.
MindPilot
(12,693 posts)Allow Kaiser to operate nation-wide.
My contribution is a whopping $55 per month. Co-pay is $25. No Co-pay for any well-care (flu shots, BP checks, routine physical) I can have a procedure done near my house and get the stitches out (no co-pay for that either) at a facility near my work. Most everything happens in one building. the best part is you know exactly what it is going to cost: $25. None of this crap of getting bills from a dozen different places for weeks after your "visit".
I know some have had bad experiences with them--nobody's perfect--but from what I've seen, the Kaiser model is a very cost effective way to deliver a lot of care to a lot of people. And doing it about as hassle-free as one can expect from a medical provider.
gopiscrap
(23,726 posts)where is the outrage!
senseandsensibility
(16,933 posts)And if it doesn't help them, why would the corporate media cover it? Simple, really.