Bitter Pill: Why Medical Bills Are Killing Us Health Care in the USA

I realize that health care in the UK is handled somewhat differently than in the US but I think many of you might find this article of interest anyway. The cost of health care is something that all countries struggle with. Time magazine just published this article which is the longest article Time has ever published. It is a fascinating look into why healthcare in the US is broken. PR

healthland.time.com/2013/02...

PS They reference a short video but I have not been able to get it to load.

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  • Many years ago I read a long analysis of the differences between USA and UK.

    It ended up suggesting that more people died from over-treatment in the USA than from under-treatment in the UK. So we were cheaper and safer. :-)

    Rod

  • Another long one...

    Having seen the cost of health insurance and treatment escalate far beyond inflation over my lifetime I'd argue that we're in a similar boat (if not yet quite so severe) here in Ireland and England.

    We've reached a scenario in Ireland where the system is breaking down - runaway costs in the system and escalating premiums mean that most private health insurance policies don't even cover many treatments - only the top plans that come at astronomic cost. Even those with public entitlement are starting with cutbacks to struggle to access treatment - waiting lists are getting longer and longer.

    So much (in the US, never mind here) for free market conditions keeping stuff under control.

    It's flat wrong that medicine should be run on a for profit basis.

    Is it any wonder that quite apart from runaway cost that over treatment is the norm, and that the system feels little obligation to respond to the needs and cares of the customer too?

    How has it evolved so that a career as a doctor (certainly as a consultant) has become an effective pathway to riches?

    That's before we add corporatisation of the industry and all that entails, the cost of drugs/the profits made by pharmaceuticals who are part of the industry, and the not unrelated disinterest of most in medicine and related research (excluding a committed few) in the real objective (which has to be the achievement of healthy populations/working themselves out of a job), and in those illnesses that are unlikely to deliver profit?

    It'd be a bit better if most of the treatments delivered were at least effective in resolving the illnesses that are targeted......

    We tend to lose sight of the big picture.

    I'd argue that there are some fundamental drivers in the situation (and no doubt many more):

    1. Our own fear - the readiness of most to grasp at straws when faced with death and illness makes us fair game.

    2. The above corporatisation/transformation of the medicine into a profit driven industry - it has left little room for altruism.

    3. The presumption of most working in the industry that they somehow are entitled to a slice of what has become a very fat pie indeed.

    4. The 'doctor knows best' authoritarian scenario which society doesn't just permit, but has actually enshrined in law and popular culture.

    5. The playing of the 'after all we do for you'/altruism card by those working in the system, and by those marketing medicine. (medicine spends scary amounts on infomercials that promote this and the related 'trust us, we can fix it' presumption - most of those little pages where you look up information on conditions and they trot out candied platitudes for example)

    6. The advent of medical insurance.

    7. Public health systems like the NHS.

    Joint the dots - can you imagine a more perfect storm? You couldn't pull it off if you were to set out to design an overall system that freed 'service' providers from the normal price, service quality and other obligations to its customers. From the need to deliver what is (implicitly if not explicitly) contracted with the patient.

    We'll grab whatever we're offered, and the system feeds on this - driven by the self interest of those working in it - and helped greatly by elimination of the possibility of any normal two way doctor patient relationship, and by removal of the actual cost of treatments and of any obvious need to be concerned about it from patient awareness. (insurance, and public health systems have this effect).

    Even bodies like the insurance companies and those running public health systems - whom it might be imagined would apply pressure to reduce costs - in practice don't do so. If you're a bureaucrat or his politician boss then responsibility for bigger budgets means more power, a bigger title and a bigger salary. More jobs for the boys. It's only taxpayer's money after all.

    If you are an insurer and are freed by public fear of illness from any reasonable cap on the premia you can charge for policies you don't care about the cost or medical effectiveness of the service delivered. All you care is that the punters keep on buying policies to the highest cost they can afford - that way your earnings and profit are maximised.

    It's unfortunately not going to change until we collectively start to wake up - until the behaviour of all of the players right through the system (us punters included) starts to reflect some care (not just compassion, but also practical wisdom) both for ourselves, and for our fellow man.

    It's in the end probably good news - but self interest driven systems like these inevitably contain the seeds of their own destruction. Modern western health care seems likely to collapse - and soon too. It's eating it's own seed corn, and we're right at the limit....

    ian

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