Sunday, February 15, 2015

229. The health care system is broke

The American healthcare is so overwhelming and so polarizing that it is a difficult subject to tackle in a short column. However, it is so awful that it needs discussion and cannot be ignored.

It doesn’t matter how you look at it—before Obamacare, after Obamacare, or maybe even after the repeal of Obamacare—our healthcare system is a mess. It’s confusing, expensive, profit-driven, unorganized and political. Despite the hard work of many healthcare professionals, the system itself is about everything other than humanity.

A good place to start is an article I’ve had on my bookshelf for a couple of years entitled “Bitter Pill: Why Medical Bills Are Killing Us,” by Steven Brill. The article caused such a stir that he recently finished a book with a similar title, “America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System.”

It’s a must read and considers the simply ridiculous billing practices and medical costs of medical providers. From $83,900 for a cancer treatment plan and initial doses of chemotherapy to $1.50 for a single Advil or $74 for a roll of gauze, we’ve probably all looked with disbelief at the billing detail and are thankful that we have insurance.  It’s absurd to the point that almost everyone must have health insurance—which is dedicated to negotiating a “reasonable” rate.

You’ve probably noticed that medical providers won’t even give you a glancing smile until you’ve turned over your medical insurance card. Next, they have to update your information—they need to know where to find you to pay what insurance doesn’t.

Medical decisions are made in conjunction with insurance providers who make those decisions from behind a desk and according to the patient’s health insurance plan. It’s not always whether a patient needs a test or procedure, it’s whether an insurance company will approve it.

Hospital CEOs often make seven figure salaries, with a conscious that somehow reconciles the humanity of healthcare and those in need, and the well-being of their employees, with their own greed. They whine about uncompensated care, while protesting Obamacare provisions that require everyone to carry health insurance.

If you have good insurance and can afford to pay your premiums and deductibles, the insurance system is manageable providing that nothing really serious goes wrong. However, for the poor and underinsured trying to navigate the health care systems can be devastating. The Brill article notes that medical bills are responsible for a significant portion of personal bankruptcies.

I had two relatively small medical procedures late year that combined were billed for over $5,000. In addition, physical therapy was billed at a ridiculous $185 per session. Insurance companies negotiated a rate at about 80% of that and my costs were a few hundred. The uninsured, however, would have been on the hook for the entire bill, close to $7,000. Few can afford that.

Brill also journeys through the healthcare system from a “follow the money,” perspective. Ridiculous medical costs are a result of profit-driven system supported by lobbyists and political interest. Healthcare lobbies, such as those for pharmaceuticals, medical equipment and insurance companies pollute the system at the expense of sensible, affordable healthcare.

This cost trickle down to employers, who have now have a legal responsibility—depending on size and revenue—to provide health insurance to employees. Obamacare makes it more difficult to dodge this responsibility, despite the threat from employers.

However, just as car insurance is not meant to pay for oil changes, healthcare insurance was never meant to pay for every blood test. But the out-of-control costs of medical services have left this burden on employers as the only feasible payer source for the majority of Americans. Healthcare costs are out of control.

In its current state, it’s an unsustainable system. If everyone played fairly, and was willing to earn a modest living, there would be no need for Obamacare. However, there is not enough money to protect everyone’s financial interest. Employers cannot afford to pay rising insurance premiums—neither can average citizens. Employees are not receiving raises; that money is going to cover the cost of health insurance premiums. Hospitals, doctors, insurance providers, medical equipment manufactures and pharmaceutical companies are absorbing employee raises.

The only reasonable solution is national healthcare. One insurance system, with profit largely removed from the equation—with reasonable salaries, consistent and fair services and fewer burdens on employers. For many countries, it works just fine.

Conversely, the scariest future is the obsessive Republican intent to repeal Obamacare. And then what—back to what was even worse?

I have long favored national healthcare. It’s about people and being there for each other. If I were so blessed to never need my medical insurance, I would be glad to continue to pay my premiums to help others. That’s the way insurance is supposed to work.

No comments:

Post a Comment