Single payer.
18
We generally know that a universal health coverage plan paid with taxes, similar to many other countries, would solve many, if not all, of our health care coverage issues. The core reason is that the word 'universal' smacks of the so-called 'undeserving' getting something free from the 'deserving'. Medicare is essentially OK since for the most part the elderly are 'deserving', but Medicaid provides benefits primarily to the lazy who should take care of themselves just like the rest of us. It's the American Way!
6
Why 99% of all first world countries have a system which works and is affordable to the 100% of their population?? What is wrong with the US??
In Germany people laugh at you if you tell them I have to file bankruptcy as I was not able to pay my insurance bills!!
In Germany people laugh at you if you tell them I have to file bankruptcy as I was not able to pay my insurance bills!!
18
I don't understand why people don't get that this is GOVERNMENT healthcare! The insurance companies charge whatever they want and the govt "SUBSIDIZES" according to the bottom line of your tax return. The govt pays what the insurance company want. But the govt gets that money from ME and the few who actually pay federal taxes. I love it when Obama says, but don't worry, your subsidy will take care of it. I have friends who don't get subsidies, whose rates are increasing 100 % and who will go without. This is a perverse system, helping only the deadbeats who don't pay taxes and the corporations who reap the profits. So typical.
8
don't people realize that comparing universal health care with universal insurance coverage is tantamount to comparing apples and oranges? universal health care is single payer, AKA Medicare for all. universal coverage is simply more insurance by which to deny procedures, hike prices through the ceiling, pharma to play the heartless beast, to allow all providers to merely charge what they want. single payer is the only answer.......allot 5 years to bring zero-to-18 yr. olds into medicare while instituting a small VAT, the next 5 years to add 45-65 yrs old into medicare w/ respective VAT, and the last 5 years to bring in the rest. final VAT at 10%, all goods and services. 15 years for the health care industry to adapt. then we would be in line with the rest of the world, instead of our money-driven system that places profit over patient. as donald would say, SAD.
10
...Because the U.S. is dead last, by very far, in the underlying cost of health care.
4
Don't blame Obama. Don't blame insurance companies. Don't blame Koch Bros, Don't blame Hillary. Blame your bought out Congressman and the SOTUS. It is legal in this country to buy your own congressman if you have enough money. Congress goes to the highest bidders. Just like Trump they are all taking advantage of the system to our detriment. We vote for them and we suffer.
8
States with GOP governors and GOP legislators are far behind other states in implementing the Affordable Care Act. Why is it such a surprise that the program isn't working consistently?
5
Your survey results for Canada are incorrect. Why are you trying to make Canada sound like they have poor health care services? I have lived in Canada all my life. I have always received the care I have needed when I needed it. We have walk- in clinics everywhere in the city. You are given service and it is covered by our provincial health care. Broke a bone 2 months ago. Attended a minor injory clinic. Was looked at by a specialist, had xray, sat with Dr again, got cast, got next appt. and was out the door in under an hour. There was no charge for any of this. We pay taxes , we get health care. You should stop writing incorrect info about a country you seem to know so little about simply to make your point.
22
One aspect of the American for-profit system that is often overlooked is that it provides an incentive for over-care or even unnecessary care. For example, a massage therapist working in a clinic who is expected to refer an unofficial quota of patients for MRIs. Or, as my GP replied when I suggested that in the US I could have my elective ankle surgery done tomorrow, "I am sure you could, whether you needed it or not."
5
ACA absolutely needs reform/updates, but unless costs and pricing can be better negotiated and controlled in all aspects of the process with all healthcare companies involved (pharma, device, supply, hospitals, insurance) then we are just wasting our time. And insurance companies have proven with ACA that they do NOT know how to manage RISK. That's sad. When you throw in mandatory coverage for people with pre-existing conditions - most who couldn't even get health insurance before - then the insurance companies can't make it work profitably.
And WHY are many other advanced nations able to negotiate SO MUCH BETTER pricing for the same healthcare products and services? Why can I drive to Canada and get drugs at 50% cheaper prices than the same drugs here? Of course, it's because the healthcare lobby OWNS Congress and won't let America even discuss price controls of any sort. Their answer - 'competition will solve all the problems and keep costs low'. That doesn't work in healthcare. The reason we even went to ACA was because the free market wasn't working at controlling costs. And now ACA still doesn't.
Bottom Line: WHY are healthcare corporations allowed to make MOST of their profits on the backs of the American taxpayer? Why is the U.S. essentially subsidizing most all other nations' healthcare?
And WHY are many other advanced nations able to negotiate SO MUCH BETTER pricing for the same healthcare products and services? Why can I drive to Canada and get drugs at 50% cheaper prices than the same drugs here? Of course, it's because the healthcare lobby OWNS Congress and won't let America even discuss price controls of any sort. Their answer - 'competition will solve all the problems and keep costs low'. That doesn't work in healthcare. The reason we even went to ACA was because the free market wasn't working at controlling costs. And now ACA still doesn't.
Bottom Line: WHY are healthcare corporations allowed to make MOST of their profits on the backs of the American taxpayer? Why is the U.S. essentially subsidizing most all other nations' healthcare?
9
Note: The US trails many wealthy nations in just about every domestic category, and the problem is getting worse every year we continue to suffer under Republicans in charge of our nation.
8
Annual income for primary care physicians is at the bottom of the list along with pediatricians. Any surprise there are so few. There is a better doctor to patient ratio for a face-lift (plastic surgeon) than a PCP who will treat your pneumonia.
4
Lets see now.....why could we not have health care for all in the US? The answer is because there is no money to be made by big corporations if we have a system like more developed and caring nations. Everything in this country is about making money and our totally inept politicians who promise us great things are only mouthpieces for continuing the corporate gravy train. Americans tend to think we live in the greatest society on earth. Great societies take care of their own, both rich and poor.
18
Republicans failed to do anything about healthcare only because they take the industry's money. Republicans failed to do anything about painkiller over doses killing their own constituents but yet they are leaders. Republicans have failed to govern even-though they had the power. Political opportunist don't deserve power.
4
It is an absolute disgrace. This country's priorities are completely out of whack. Healthcare that is out of financial reach for so many. Failing public schools. College tuitions that leave students with debt for decades. We have the highest incarceration rate of the entire world. We spend more money on war than something like the next 10 countries, Combined.
I once saw a documentary...I think it was about healthcare in general, across the world...and when it got to the part about how France takes care of new parents, my jaw dropped. I can't recall how much time the new parents got off, or whether or not it was paid leave (likely it was a year of paid leave or something), but it even said the new mothers get a person to come in to help with the laundry each week, and numerous other benefits that parents in the US wouldn't even DREAM of getting from the govt or their insurance company.
I once saw a documentary...I think it was about healthcare in general, across the world...and when it got to the part about how France takes care of new parents, my jaw dropped. I can't recall how much time the new parents got off, or whether or not it was paid leave (likely it was a year of paid leave or something), but it even said the new mothers get a person to come in to help with the laundry each week, and numerous other benefits that parents in the US wouldn't even DREAM of getting from the govt or their insurance company.
11
I was surprised to see this article go on so long. The answer to the question posed in the headline can be answered very simply: "Because we spend all our money on the military."
That's it, folks. That's the difference between us and all those other developed countries. Don't let anyone tell you otherwise.
That's it, folks. That's the difference between us and all those other developed countries. Don't let anyone tell you otherwise.
10
The most serious problem with US health care - its high cost - is mentioned in this timely article, but no serious attempt at an explanation is offered. How about a follow-up from Mr. Carroll focused on this issue?
The shortage of affordable health care - not the shortage of primary care physicians -- is the reason Americans are suffering.
The shortage of affordable health care - not the shortage of primary care physicians -- is the reason Americans are suffering.
2
We need a single, national, nongovernmental , not-for-profit health insurance company funded by a value-added tax.
1
Stop pussyfooting around! Health care run by capitalism is the problem. That's why Obama took single payer "off the table" before fighting for it. "The American people wouldn't accept it, " he claimed. The insurance industry wouldn't accept it, he meant.
9
Total scam. Medicare for all, but medical industrial complex won't allow. Corporations rule.
6
A common thread in many of these comments is ignorance. That is, Americans just do not know how health care works here or elsewhere. And even if we did it is hard to compare apples and oranges. Many readers might remember how Japan was viewed in the 1980s -- "Japan as #1." Everyone was arguing we should imitate the way Japan did everything. First of all it was impossible. Then we found out that Japan had its own problems. Health care is a complicated issue that requires more than simplistic comparisons. We know medicine and health are social as much as scientific things. Most illnesses are minor or routine (many illnesses can be treated by nurse practitioners, backed up if necessary by physicians -- we might not need many more general practitioners, just more highly trained nurses, getting more bang for the buck). Many patients need good recovery conditions -- clean, relaxing places to rest. Simple rules reducing the pushing of sugar drinks and fries on already obese people, better education about food and health and exercise, etc. would take us a long way. And whether a company is for profit or not they can still pay their CEOs exorbitant salaries and build fancy buildings with expensive gadgets that are not needed. We need a full-scale attack on this, with reasonable people discussing it and Congress acting on it. The answer -- start voting for the right people and inform yourselves.
2
Start with free medical education so that doctors don't need to pay back, on average, $200,000 in loans. Then get rid of high salaried hospital administrators who currently have no training in medicine and little understanding that the practice of medicine IS NOT A BUSINESS. Create an EMR that allows for the communication of medical information without holding the doctor hostage to hundreds of view alerts on a daily basis. Provide adequate support staff to manage the day to day running of a doctors office and tend to less critical patient care needs. Stop building beautiful church-like mega-hospitals - it's medical care for crying out loud, not the cirque-du-soliel.
7
Doctors also need to be closely watched for honesty. First warning is always when they find something that requires pills and they instantly grab an introductory box from a company with their comment "here take these; really excellent" and give you a three month prescription. A week later you ask the drug store what the cost is and you fall through the roof because of ridicules cost even if you have good insurance. The other day I was told that some blood pressure pills would cost me $100/month - yeah right, and that while the same stuff with a different name would cost me $5/month. Many doctors are very much part of the medical corruption - always double check.
I'm surprised that Canada fares so badly. My primary care physician is part of a team. If I want to see her, I make an appointment, sometimes waiting up to two weeks or so. If I want to see someone right away, I show up when they open at 7 AM, and I'm first in line for the walk-in clinic, and the on-duty doctor sees me. I'm usually out of there by 7:30 AM. Canadian healthcare works for me.
16
Other countries have doctors, we have lawyers and businessmen.
6
I remember when Hillary so proudly told Bernie Sanders " We're not Denmark". That comment made me cringe, it was so naive, especially in regards to healthcare. We are not Denmark, but we are definitely looking up at them, not down.
12
I have an idea.
Let's require every individual who enters and serves in the military to have each hour of military training matched with a hour of medical care training.
It'll help us on the battlefield, and the when our people finish military service they'll be guaranteed jobs when they return to civilian life as health care providers!
Wait, does that make too much sense? If so, we'll never get congress to go for the idea. Oh well, too bad.
Let's require every individual who enters and serves in the military to have each hour of military training matched with a hour of medical care training.
It'll help us on the battlefield, and the when our people finish military service they'll be guaranteed jobs when they return to civilian life as health care providers!
Wait, does that make too much sense? If so, we'll never get congress to go for the idea. Oh well, too bad.
The biggest worry in all this is seeing a so called specialist, and possibly being prescribed one of the blockbuster drugs now available that can exceed 100,000.00 a year All the current variations of insurance run for cover. As for the ACA the base model is very questionable. Fine younger people who never would use the system if they don't pay for all those waiting in the wings for care who never had any care.
The ACA has failed. It was doomed from the start. We saved a few more lives ( maybe) at a tremendous cost, yet continue to ignore the problems you cite. You would think we would simply acknowledge what the rest of the industrialized world has done and move to a single payer system that lowers costs. But, the elites are in the way. Nero fiddles and Rome burns.
13
Get rid of the unethical and immoral insurance companies. Regulate through Medicare. Require the gov't to negotiate with big pharma to get the lowest costs for medication, and put the unethical pharmas out of business and you'll have good healthcare in America. What to Dothan with all the out of work swindlers? Who cares.
6
single payer! single payer! single payer!
It works! and is AFFORDABLE!
Like here in Austria where I have lived for 16 years. And oh, by the way, Austria tells pharma what the prices for drugs are not the other way around.
Insurance companies are a useless middle man society does not need.
It works! and is AFFORDABLE!
Like here in Austria where I have lived for 16 years. And oh, by the way, Austria tells pharma what the prices for drugs are not the other way around.
Insurance companies are a useless middle man society does not need.
12
Terrible system. If a madman wasn't the Repub. nominee, I might consider their side this time. Because I don't think much will change going w/HRC.
I just wrote WHouse.gov tonight to beg them to stop calling the ACA 'affordable.' Because for so many, it's not.
My next premium increase will certainly be a jolt. How I loathe Nov./Dec., now faced the add'l task of 'shopping' for lousy insurance from diminishing options and calculating the ever-escalating costs.
Fa-la-la.
I just wrote WHouse.gov tonight to beg them to stop calling the ACA 'affordable.' Because for so many, it's not.
My next premium increase will certainly be a jolt. How I loathe Nov./Dec., now faced the add'l task of 'shopping' for lousy insurance from diminishing options and calculating the ever-escalating costs.
Fa-la-la.
1
You can't have an pharmaceutical company's making millions, hospital corporations raking it in, insurance companies making huge profits where they can do stock buy backs and increasing dividends, and doctors and nurses making six figures, and have affordable health care. There just isn't enough money to go around from the people at the bottom. Many will and do very left out
7
One month after getting off 13 years of active duty with the U.S. Army I realized that we needed a single-payer National Healthcare System. I admitted a young boy at a new hospital that I had just acquired surgical privileges at in northeast Wisconsin, and in the PreOp holding area the head of anesthesia approached me holding the 3 year old's chart. He put the chart in my face and pointed to the boy's insurance information - Wisconsin Medicaid "welfare-patient". He the looked at me sternly and told me that if all I was going to do is to bring "this ****" to his hospital, I needn't ought to come there! So I soon learned it's ALL about the money in private practice in the U.S. A women internist once told me that the amount of respect that a healthcare corporation shows you is directly related to the amount of money you generate for them. I'm sick of this dehumanizing corporate computerized business model of medicine and therefore I announce my retirement after 41 years of practice tonight in the New York Times as of July 6, 2017.
10
I am 63, male, need no pharmaceuticals, have low blood pressure, walk several times a week, do yoga daily, don't smoke, am a vegetarian, and always pay my medical premiums in full and on time. Coventry of Missouri just dropped me from their 2017 Obamacare rolls. Maybe they need a special health care program for people like us who try to do EVERYTHING RIGHT AND STILL GET SCREWED BY THE GREEDY HEALTH INSURANCE INDUSTRY.
7
Unbrlievably, French citizens get 100% coverage, a single payer system- for service and for prescriptions. Americans simply do not have this.
4
>> The main intent of the Affordable Care Act was to expand the safety net (Medicaid), regulate the non-employer-based private insurance market (the insurance exchanges) and help people buy that insurance (subsidies) in order to reduce the number of Americans who are uninsured. <<
This is a ridiculous lie. It's rewriting intent. Obama sold us on lower prices ('affordable"), better quality, and better service and "not adding a dime to the deficit." Oh - and more people covered. Three of those four were a lie, and he knew it at the time, but maliciously lied to us anyway.
This is a ridiculous lie. It's rewriting intent. Obama sold us on lower prices ('affordable"), better quality, and better service and "not adding a dime to the deficit." Oh - and more people covered. Three of those four were a lie, and he knew it at the time, but maliciously lied to us anyway.
1
I live in New York and I'm self employed. I have decent health care as long as I never leave the state. One of the oddities of our new individual insurance is that as well as eliminating out of network coverage for single payers it also eradicated out of state coverage--a huge disadvantage for today's workforce of independent contractors, who are supposed to be able to travel for work at the drop of a hat. What do you do if you're working on a project in California and you get sick and the only place you're allowed to see a doctor is New York? There's only one group benefiting from this and it's not doctors or people. Wait--two groups: the insurance industry and their lobbyists. It's criminal, and insane.
7
Too much money at stake in the US system! Also, those who get the money have managed successfully to stop any significant improvement.
As far as Canada goes, with much less $ spent, no one in the country is without access to medical care, and no one needs to go bankrupt to pay the exorbitant fees that US medical establishment charges.
As far as Canada goes, with much less $ spent, no one in the country is without access to medical care, and no one needs to go bankrupt to pay the exorbitant fees that US medical establishment charges.
6
Emergency to a person who feels unwell can happen at anytime anywhere which should make it clear why emergency rooms are open to all people at all times. If all medical care were based on this system which forwards patients to specialists or releases them after being treated, our medical treatment would be streamlined and simplified. A social benefit shared and paid by all through taxes
Making money is not the function of medical practice.
Making money is not the function of medical practice.
2
The comparison to Europe is unfair. We cannot afford healthcare like European nations because we are their military. It's a lot easier to have a massive welfare state when you pay relatively little for defense. The real decision is whether to pull out military out of Europe and let them know they must defend themselves in order to have the billions we need for health care for all. That decision will never be made. The price we pay for dominating the global stage is a lack of free health care.
5
How about amending Obamacare to require that any physician who accepts payments for medical services from an insurance company cannot separately charge the patient for an additional amount. The require that any insurance company that pays money to a physician for providing medical care to a patient must be willing to open its network--an any willing provider law--and pay the same amount to all physicians for the same services provided. Then require insurers to pay physicians based on the number of years in practice--more experienced physicians get paid more. Or require medical practices to submit the cost sections of their tax returns to insurers, which then pay out a set percentage more than costs. Something to indirectly reduce the amount of money being paid to medical service providers by insurers.
1
Where to start. Have a public option, eliminate state lines to encourage more insurance competition. Have Bernie more actively shame Pharma and Insurance companies. Shame politicians who are in bed with them. For Mylan it worked to an extent. Shame worked for Wells Fargo. Shame needs to be more weaponized for majority positions so that we stop dealing as much with lying patronizing politicians.
3
The conundrum is that we do have the best healthcare in the world. However, we have one of the worst healthcare systems among the industrialized nations.
If you want the best surgeons and leading edge practices and technology, you come to the US. They are the best in the world.
However, when you measure the system as a whole, it performs poorly.
What is the reason? We have two systems, one for the rich and one for the poor. The system for the rich is world class. The system for the poor, below average.
Why? Because our politicians are bought and sold by the rich.
This is exactly the same reason we have the best schools in the world and a below average school system.
If you want the best surgeons and leading edge practices and technology, you come to the US. They are the best in the world.
However, when you measure the system as a whole, it performs poorly.
What is the reason? We have two systems, one for the rich and one for the poor. The system for the rich is world class. The system for the poor, below average.
Why? Because our politicians are bought and sold by the rich.
This is exactly the same reason we have the best schools in the world and a below average school system.
16
Comparing the health care systems of the other "wealthy nations" is apples to apples. Comparing the United States to any of those countries is apples to elephants.
In other "wealthy nations," the government long ago first decided health care was a basic right. Then they designed systems that deliver it to everyone. In the United States, there was no such decision. By default, health care is a privilege. And we have no "system," but a crazy quilt providing that privilege inadequately and inequitably.
The government provides health care to veterans, the elderly and disabled, and some of the poor. But everyone else privileged to receive health care gets it from a medical industry that has evolved to provide wealth care for corporate executives and shareholders rather than health care for patients (i.e., "medical loss.")
The ACA was a small band-aid that patched a few of the most egregious failings of the crazy quilt. But it did nothing to fix the real problem, which is the inherent inability of capitalism to provide universal coverage in "unprofitable" areas as well as "profitable" ones.
The ACA instead added the complexity of government bureaucracy to the only-in-America complexity of private health insurance (networks, copays, coinsurance, tiered formularies, prior authorization). Its failure is not surprising, even without Republican obstruction. The only real solution is to repeal it and replace it (and the rest of the crazy quilt) with Medicare For All.
In other "wealthy nations," the government long ago first decided health care was a basic right. Then they designed systems that deliver it to everyone. In the United States, there was no such decision. By default, health care is a privilege. And we have no "system," but a crazy quilt providing that privilege inadequately and inequitably.
The government provides health care to veterans, the elderly and disabled, and some of the poor. But everyone else privileged to receive health care gets it from a medical industry that has evolved to provide wealth care for corporate executives and shareholders rather than health care for patients (i.e., "medical loss.")
The ACA was a small band-aid that patched a few of the most egregious failings of the crazy quilt. But it did nothing to fix the real problem, which is the inherent inability of capitalism to provide universal coverage in "unprofitable" areas as well as "profitable" ones.
The ACA instead added the complexity of government bureaucracy to the only-in-America complexity of private health insurance (networks, copays, coinsurance, tiered formularies, prior authorization). Its failure is not surprising, even without Republican obstruction. The only real solution is to repeal it and replace it (and the rest of the crazy quilt) with Medicare For All.
20
Yes the US trails many countries as concerns access to health care. As long as that remains true then we will have unacceptable mortality rates that in part directly reflect any particular American subgroup's access to health care.
So New York Times, why not give us at least two careful presentations of what we in Universal Health Care countries, countries where the system is NOT an insurance based system.
I cannot tell you a data filled story about Sweden in 1500 characters, and yesterday I tried to give you a researcj based glimpse but that one has not passed review. This one is simpler.
If I need medicine I walk 400 meters to Apoteket at Valla Vårdcentral. There I buy my medicine at such low cost I do not bother with the subsidy offered.
One day in the forest a while back I fell and wound up with a very bloody but not broken arm. The next morning I walked those 400 meters, paid 100 crowns, and within 30 minutes was seen by a nurse who reviewed my injury, treated it and sent me on my way.
A couple of years ago I tripped just before a 5 km race, landing teeth first on a concrete riser. At the accident room, paid my 100 crowns, was treated with extraordinary skill, teeth put in place, lips stitched. Successive visits all the same 100 crowns each time. Now I have perfect upper incisors. Two original model, one constructed.
Exchange rate: About 8.5 SEK (crowns) to the USD. Figure it out. No insurance involved.
Only-NeverInSweden.blogspot.com
Dual citizen US SE
So New York Times, why not give us at least two careful presentations of what we in Universal Health Care countries, countries where the system is NOT an insurance based system.
I cannot tell you a data filled story about Sweden in 1500 characters, and yesterday I tried to give you a researcj based glimpse but that one has not passed review. This one is simpler.
If I need medicine I walk 400 meters to Apoteket at Valla Vårdcentral. There I buy my medicine at such low cost I do not bother with the subsidy offered.
One day in the forest a while back I fell and wound up with a very bloody but not broken arm. The next morning I walked those 400 meters, paid 100 crowns, and within 30 minutes was seen by a nurse who reviewed my injury, treated it and sent me on my way.
A couple of years ago I tripped just before a 5 km race, landing teeth first on a concrete riser. At the accident room, paid my 100 crowns, was treated with extraordinary skill, teeth put in place, lips stitched. Successive visits all the same 100 crowns each time. Now I have perfect upper incisors. Two original model, one constructed.
Exchange rate: About 8.5 SEK (crowns) to the USD. Figure it out. No insurance involved.
Only-NeverInSweden.blogspot.com
Dual citizen US SE
12
Your military is America. That's why you have the resources for health care for all. And Europeans have the gall to complain about 40 hour workweeks. What a joke
2
A National Single Payer system with more doctors and less drug company and medical industrial machinery.
More preventative care and less profits.
Less expensive and useless intervention in the last days/weeks of life.
More Hospice. Less Dirnking and Driving. Less Chemicals. More Healthy food.
It is fairly Simple.
More preventative care and less profits.
Less expensive and useless intervention in the last days/weeks of life.
More Hospice. Less Dirnking and Driving. Less Chemicals. More Healthy food.
It is fairly Simple.
6
What puzzles me the most that almost every study, healthcare or whatever else, ignores the fact that, due to our history of slavery and to our open border policy, well over 20% of our population lives under third world conditions and only the rest of us are first world people. I bet that for the latter kind we are very much competitive with any other country. I have experienced the healthcare system of several European countries. They were quite good but nowhere as excellent what I get here in the US. Costwise they were comparable except many of the healthcare costs in Europe are hidden in other types of taxes whereas here we pay for them directly out of pocket.
4
And yet the fraction of our Gross Nation Product that we spend on health care is almost twice as much as that of any other advanced country. Why?
7
Any discussion of rational medical care - a system that treats everyone at reasonable cost - will be as unsatisfying as this one if it doesn't face a simple fact - our system is completely irrational.
The European social democracies constructed health care systems that deliver better results (healthier people) at lower cost.
To copy them would be to admit that our "systems" are irrational and plagued by channeling vast profits to insurance companies and big pharma. It's a "system" designed for them, not for the patient.
Who is willing to confront this simple fact and propose a solution rather than nibbling around the edges?
The European social democracies constructed health care systems that deliver better results (healthier people) at lower cost.
To copy them would be to admit that our "systems" are irrational and plagued by channeling vast profits to insurance companies and big pharma. It's a "system" designed for them, not for the patient.
Who is willing to confront this simple fact and propose a solution rather than nibbling around the edges?
16
What we are seeing with the now approved rate increases is the insurance companies adjusting to the ACA since the ACA "risk corridor" fund was cut off by the Repubs in the House. The Repubs would prefer that the insurance companies just drop out of markets because that would lead to a complete failure of the ACA but they failed to stop the price increases. Americans will grumble but will adjust to the higher rates. I suspect the rates will rise again as more Americans opt in to insurance. Once we have everybody insured we will then know what the cost truly is. Then we can focus on the insurance companies and drug companies to bring pricing efficiencies. The plans with huge deductibles have to go. They should be income based. If you can't afford to shell out the deductible due to liquidity, you should not be allowed to buy such weak plans. Repubs can continue to try and make ACA fail but its not going to happen and the more they struggle in that quicksand the deeper they will sink as a party.
Let's start by capping costs on all health care, including pharmaceuticals and let the market compete down from those caps. Set realistic health insurance premiums that are in line with our economy and get the insurance companies out of the business of primary care. Out of each premium dollar a percentage should go to capitate primary care on a per head, per month basis paid directly to the provider for his or her panel of patients. This would be their budget for both overhead and income, and there would be no billing through third party payers. The remainder of the premium is to insure for costs that we individually cannot afford, which is no different than fire or liability insurance. Expand the use of health savings accounts to cover deductibles, and fund health insurance premiums as a payroll deduction akin to medicare or social security, but with pre tax dollars. For those uninsured, or underinsured the treasury should issue health care bonds with principle guaranteed and a reasonable tax exempt interest payment that encourages private investment in health care rather than stifling the economy through increasing taxes on employers. Finally, everyone should have the same insurance coverage, regardless whether it is single payer, or administered through third parties. Socialism you say? Hardly--fire, police, roads, utilities are public infrastructure and available to all and funded publicly. We would be shocked if we were asked to self insure for those public services
2
A Medicare public option could help alleviate many of the major issues with Obamacare. If everyone in the population were automatically included, the so-called insurance risk pool would be more widely spread out among all demographic and income groups. For example, young working males with no health issues would be in the risk pool along with older citizens with numerous health care problems. This is not happening now, as young professionals are avoiding the health exchanges simply by paying a paltry fine; the result is that a larger percentage of people buying from the exchanges have overall higher health-related costs, thus raising risk and premiums.
But here's a potential tweak: allow Medicare to offer a basic coverage plan, but then add on advantage plans to help with non-Medicare costs. These would be entirely optional, thus affording everyone the opportunity to pay for just what they need or want.
One more mandatory requirement: overturn the law preventing Medicare from negotiating drug prices. This is an unconscionable provision rammed into law by Congress in total thrall to Big Pharma.
But here's a potential tweak: allow Medicare to offer a basic coverage plan, but then add on advantage plans to help with non-Medicare costs. These would be entirely optional, thus affording everyone the opportunity to pay for just what they need or want.
One more mandatory requirement: overturn the law preventing Medicare from negotiating drug prices. This is an unconscionable provision rammed into law by Congress in total thrall to Big Pharma.
10
The only apparent answer to this problem is Medicare for all. I say this not as a political statement but as a statement informed by observation and history. Medicare has a low administrative cost and provides health insurance for millions. Other forms of insurance have no real way to protect against adverse selection, and high and duplicative overhead costs relative to administration, compliance and marketing. Indemnity insurance associated with employment started as a way to attract workers post WWII. Medicine was even more primitive than it is now. That was then, this is now. Time for a system that lines up with our social, scientific and medical realities.
11
We have decided as a nation that health care is a business, like groceries or housing; not an essential service, like education or roads. The fundamental issue is a moral one - as a society we should take care of the sick, not blame and punish them for being sick. In reality, the for-profit business model just cannot fit healthcare, because the 'consumer' is inherently less and less able to pay the as their demand/need increases. Obamacare was progress for some, but ultimately a deal with the devil. We will never fix the US health care system until we take the profit motive out of the equation.
18
Exactly right.
"Things" as the article seems to imply re. private corporate health insurance (assurance, maybe, to keep the status quo of CEO bonus obsession in eternal place), morphs in the actual case of ACA policy holders, from health care to insurance care. It's all about the US Gov't. refusal to consider the public "option" as far more superior to the private profit motive of the corporate juggernaut; which by the way, fears the competition that a truly single payer entity would guarantee real health care reform, not insurance "reform".
4
It's impossible to have an insurance system
that works on behalf of the people when the insurance system itself is based on only making money. The two don't match. This is why the system isn't working, because you have a system that is supposed help sick people, but instead it is only focused on capital gains. It is not until the system is fully engaged in the benefit of others that all the tricks and shenanigans will cease. Until then we will keep getting pulled in by lies and high premiums. Sad. We will never be able to match other generous countries who really take care of their citizens, because of greed and the inability to step down from it.
that works on behalf of the people when the insurance system itself is based on only making money. The two don't match. This is why the system isn't working, because you have a system that is supposed help sick people, but instead it is only focused on capital gains. It is not until the system is fully engaged in the benefit of others that all the tricks and shenanigans will cease. Until then we will keep getting pulled in by lies and high premiums. Sad. We will never be able to match other generous countries who really take care of their citizens, because of greed and the inability to step down from it.
15
There are countries around the world that offer private insurance-based universal care without excessive costs. They act to control the price of medical care itself, which we don't. In the US insurers pay the high bills and pass those costs on through premiums. Even with "discounts" they negotiate the care is still too costly. It is the high cost of medical care itself which is unique to our country, which has the most expensive system in the world.
8
I would like to know how much of our increased costs are due to American's being so overweight and inactive compared to many societies. Is all this the fault of the medical/insurance system, or do we simply have more medical problems due to our lifestyles?
4
Passing the ACA in conjunction with mandates directed at pay for performance, inter-operabiity of electronic health care records, and ever higher hurdles to be reimbursed coupled with the administrative and financial cost for providers to achieve those benchmarks has, and will continue to result in a progressive rationing of care through attrition of providers leaving medicine (particularly primary care). We now have consolidation of services under the umbrella of large integrated health care systems which are documentation focused for reimbursement reasons, but not patient centric. Those systems which are largely hospital based, will choose which markets to continue operating in, and it won't be those which are marginal now. Fewer independent physicians will reach compliance under these rules, and to avoid the economic and regulatory penalties will opt out of both CMS/Medicaid and third party insurer contracts . As a patient, It won't matter that you have an insurance card in your wallet--there is an ever greater chance you won't find a provider who will see you due to closed panels, even if they are enrolled as a contracted provider. As a consumer, your care will be out of network, and your first dollar responsibility will be crushing. Our health care system is breaking down at all levels. Physicians choose medicine to serve and care for our patients. We are in an era where the wedge driven between us and those we serve, will soon be the stake in our collective heart.
12
Aside from how we pay for care and how much providers are allowed to charge for care, the other side of this multifaceted problem is how unhealthy we are as a nation. Unless we cure the American disease, obesity, health problems that result from it -- diabetes, heart disease, osteoarthritis, and other diseases -- will continue to exact a toll on national spending for health care. And while that too is a complex problem, it will certainly not be resolved by simply adding a few more nutritional labels on our foods and increasing the number of public service announcements. Instead, we will need to conquer the other American scourge, obscene income inequality. When people do not eat well because they cannot afford high-quality foods, or because they live in red-lined areas that lack grocery stores in sufficient number, or because they must work two jobs at non-living wages to afford necessities of life, it will not matter whether we increase access to health care. This is a problem that extends far beyond how we provide and pay for access to care; it requires rethinking what it means to be American, and whether "Life, Liberty and the pursuit of Happiness" can really be achieved under the current social and economic conditions.
8
I feel like a lot of America's present problems can be explained in your motto; "Life, Liberty, and Pursuit of Happiness". Throughout most of your history, this worked, because your middle class had no memory of an equal society because there had never been one. But in the conditions created by the World Wars (upper class lost most of their property, North America was the only industrialized continent left standing), the lower classes got a taste of income equality. When these abnormal conditions slowly faded, and finally disappeared with the 2008 crash, the economy is now back at its "normal" state: massive income inequality issues. For perhaps one of the first major times in your country's history, the lower classes have memory of better times - and want them back, resulting in the rise of near-fascist demagogues such as Trump.
I subscribe a lot to these ideas, from the French economist Thomas Piketty, in his book on the issue of capitalism. The essential conclusions are that;
A. Massive government investment and subsidization (just like the programs instituted in the USA during WWII) is necessary to curb income inequality
B. Inequality is the normal state of any capitalist economy, the 20th century was an outlier, the 21st century so far is a return to normal
C. Socialism is not currently workable as a governmental system without either public responsibility and will to maintain it or a big surge in robotics technology, so for the time being we are stuck with capitalism
I subscribe a lot to these ideas, from the French economist Thomas Piketty, in his book on the issue of capitalism. The essential conclusions are that;
A. Massive government investment and subsidization (just like the programs instituted in the USA during WWII) is necessary to curb income inequality
B. Inequality is the normal state of any capitalist economy, the 20th century was an outlier, the 21st century so far is a return to normal
C. Socialism is not currently workable as a governmental system without either public responsibility and will to maintain it or a big surge in robotics technology, so for the time being we are stuck with capitalism
1
agree with all you said... but it's hard to belive you're in OK
Aaron Carroll notes several health care metrics in which the United States appears to outpace Canada. What he fails to note is that in order to slightly best Canada, we spend 18% of our GDP on health care, while Canada spends just 11%.
Mr Carroll fails to point out that all Canadians are covered by government health insurance, and that no one in Canada goes bankrupt due to medical bills. In contrast, at least before Obamacare, over half of all personal bankruptcies in the United States resulted from overwhelming medical expenses.
Should've pointed that out.
Mr Carroll fails to point out that all Canadians are covered by government health insurance, and that no one in Canada goes bankrupt due to medical bills. In contrast, at least before Obamacare, over half of all personal bankruptcies in the United States resulted from overwhelming medical expenses.
Should've pointed that out.
26
Some of the relevant points in comparisons to Canada. The Canadian Public system, everyone participates, and everyone has coverage. There is no shortage of patients, and the provincial governments have control of the supply. It is always a trade off to not oversupply care,(costs) , have just enough care to keep the natives from getting restless. While it might be difficult to get a same day appointment with a family physician, you can go Emergency room or out patient clinic, and get same day service. A few hour wait is expected. Once you are in the system for care, Canadian care is more than adequate, however all care and testing is rationed on a needs base, surgical wait times for non-emergency care can be 6-8 months, or longer. Plan to have a joint replacement way in advance, get in the queue early, is a point that cannot be over emphasized. Patients are told they are too young to have the surgery, and then a few decades later, they are told they are too old. Everyone gets care, no one goes Bankrupt because of a health care crisis. Fees are controled by all levels of Government, including drug prices. The only way the American system can survive financially over time is to gravitate towards a single payer system, with some Private options, It is just Economics 101.
14
The key insight presented in the article is the low number of primary care physicians per population vs other countries with better access. We need more medical schools, training more doctors, at much lower cost. Nurse practitioners and physicians' assistants are a step in the right direction.
6
The relatively low pay, respect and working conditions of primary care physicians vs. specialists is important in convincing ever fewer medical school graduates to reject the primary care option.
2
When "we" train doctors they go into big money specialties not general practice. General practitioners are the saints of our system and we do absolutely nothing to support them. It's a crime.
2
Limited access to healthcare, high premiums, high deductibles, child poverty, income and wealth equality and poor education in many areas. Big problems and not much is being done. An exceptional country?
10
The US population is not as homogenous as other developed countries. Life styles, education, cultures would play a big part in the healthcare system. It is very dangerous to compare healthcare systems from countries and cultures to one another.
Everything in our system is skewed and perverse. Medical school is too expensive, and passing in those costs via higher provider charges starts the great medical arms race.
Americans are used to having their costs subsidized by an employer or the government. This can't fly in a gig economy where health care is untethered from employment.
Our history of healthcare access and reimbursement is convoluted. Instead of starting from scratch we built our system on the insurance model and employment. It grew of it's own weight and the ACA really didn't solve anything--it added to the complexity.
Every other industrialized country begins with the premise that healthcare is a right. Everybody is covered. The single payer model is the only viable solution yet Americans won't accept it. Nobody wants to chip in till they're sick and and the employed don't want to give up their. Cadillac benefits. Until this country rejects our inability to achieve collective benefits, we will continue to fight over what's deemed essential in other counties.
Americans are used to having their costs subsidized by an employer or the government. This can't fly in a gig economy where health care is untethered from employment.
Our history of healthcare access and reimbursement is convoluted. Instead of starting from scratch we built our system on the insurance model and employment. It grew of it's own weight and the ACA really didn't solve anything--it added to the complexity.
Every other industrialized country begins with the premise that healthcare is a right. Everybody is covered. The single payer model is the only viable solution yet Americans won't accept it. Nobody wants to chip in till they're sick and and the employed don't want to give up their. Cadillac benefits. Until this country rejects our inability to achieve collective benefits, we will continue to fight over what's deemed essential in other counties.
33
You are sooo right Christine. If our lawmakers would set aside their prejudices and simply look at how other countries administer health care through a single payer system it would be a real eye opener. The US spends 10 times more for healthcare than the second highest country, yet we get only a portion of what other countries get in actual services. Our infant mortality is lower than some undeveloped countries. There is no excuse for this. The culprits: Big Pharma, tort reform, greedy insurance companies, and greedy physicians. I have been a nurse for 40 years and it sickens me to see and hear of people who die when they cannot afford their medical care. It is not a "Great America" that allows this to happen.
12
agreed
1
How is it that we have one-fifth of the primary physicians as many in the developed world. At the behest of the AMA and other physicians' groups our government artificially lowers and suppresses the supply of physicians. This has been gained by successfully lobbying the government to make it very difficult for foreign trained physicians to get a U.S. medical license. Our government allows relatively free flow of low-paid workers immigrating into the U.S., workers who undermine the working classes, while regulating and restricting immigration that threatens the jobs of one percenters.
16
I live in CA and part of Kaiser. They seem to have no trouble bringing in physicians from other countries. It is near impossible to find one from our country. I've been with Kaiser most of my adult life, & have seen this change over time. Through perseverance & traveling further than I would like to, I I have one of the last, from the US & educated here. Of course I don't always get to see him. If I need an immediate apt. I have to take who I can get. I have never been happy. I don't know if it is cultural differences, or something gets lost in translation, but I always feel I've wasted my time and/or have been talked down to & over. I'm being seen for the dread "IBS", my symptoms were not improving & I was having regular migraines. MY dr was out of town & I had to make an apt with who I could get. I was told that my tests looked fine (I knew that) I was told to take OTC NSAID's & I didn't have to worry about their safety. Really? When my IBS was at least partly due to being on them longterm following surgery. I told her this & she just got irritated with me, wouldn't help, & said you need to wait until your DR gets back. Just one example of many.
Which government agency, specifically, does this?
One reason for more primary care physicians in Germany is that their education is free and the amount they can charge is much more limited through regulations. But keep in mind, it is not a single payer system. It is competitive and has a market structure.
The two things that are not optional: every income has to pay a fixed percentage up to a certain cap (like capped social security contributions) and in return your family is fully covered, even if you only work part time in a low income job. There is thus a "social" element, or let's call it: love your neighbor like yourself.
The two things that are not optional: every income has to pay a fixed percentage up to a certain cap (like capped social security contributions) and in return your family is fully covered, even if you only work part time in a low income job. There is thus a "social" element, or let's call it: love your neighbor like yourself.
15
Education is free through the first degree (now a bachelors', formerly the Diplom) but I'm pretty sure there are fees beyond that. Also, there are areas in Germany, especially rural areas in the east, that also are suffering from a shortage of primary physicians, because they don't want to live in these areas where the pay may be lower and the leisure time offerings less stimulating. I'm guessing that in the USA the primary physician shortage is also geographically and demographically unbalanced and for the same reasons.
As you say, Germany's is not a single payer system.
As you say, Germany's is not a single payer system.
If the costs continue to increase at some point there will be rioting in America and at that point a complete overhaul of the entire system will take place.
We cannot continue with these endless increases without bankrupting working Americans.
Most importantly we must demand that Americans take responsibility for their health through proper diet and exercise otherwise they will face increased premiums. It is not the responsibility of the taxpayers to provide healthcare to those that live a self destructive lifestyle.
We cannot continue with these endless increases without bankrupting working Americans.
Most importantly we must demand that Americans take responsibility for their health through proper diet and exercise otherwise they will face increased premiums. It is not the responsibility of the taxpayers to provide healthcare to those that live a self destructive lifestyle.
9
Not that individuals bear no responsibility in their food, activity choices, but there are unconscionable advertising, unsafe neighborhoods and
food deserts. To take on advertising toxins, just remember the tobacco wars waged over deades. In California, we're still fighting them with a state wide vote to increase tobacco taxes. JAMA just published findings that a third of all cancer deaths and a third of all deaths from coronary artery disease in the US, are attributable to tobacco. And SF, along with other US, cities is voting on taxing sodas, another product oversold until it too is deadly.
When there's money to be made from overselling a product, the public will be manipulated into overconsumption. And, while I don't like policing, there is reason to limit drug dealers, be their product heroin or tobacco or super sized sugar products.
food deserts. To take on advertising toxins, just remember the tobacco wars waged over deades. In California, we're still fighting them with a state wide vote to increase tobacco taxes. JAMA just published findings that a third of all cancer deaths and a third of all deaths from coronary artery disease in the US, are attributable to tobacco. And SF, along with other US, cities is voting on taxing sodas, another product oversold until it too is deadly.
When there's money to be made from overselling a product, the public will be manipulated into overconsumption. And, while I don't like policing, there is reason to limit drug dealers, be their product heroin or tobacco or super sized sugar products.
1
I keep hearing talk of rioting for this or that. Not going to happen. Everyone is too busy trying to make ends meet, and/or glued to their "Smart" devices. No we will all go further into debt.
1
"Yet years after the Affordable Care Act was passed, Americans are still litigating whether to return to the previous system"
Only special interests are litigating to return to the former system. Americans want single payer.
Only special interests are litigating to return to the former system. Americans want single payer.
45
America is supposedly the richest nation on earth. So why can't we provide decent health care for everyone? Other less-rich countries manage to.
Why do we accept our expensive, inefficient health care "system"? (Why do we accept 33,000 gun deaths a year? Why don't we upgrade our infrastructure? Why don't we have better public transportation? Affordable higher education? Why do the rich pay so little in taxes? And on and on.)
"Socialist" is considered a dirty word in America. Yet those "socialist" European countries are doing better than we are in all of these areas. What arrogance we have to dismiss them and claim we are better.
Why do we accept our expensive, inefficient health care "system"? (Why do we accept 33,000 gun deaths a year? Why don't we upgrade our infrastructure? Why don't we have better public transportation? Affordable higher education? Why do the rich pay so little in taxes? And on and on.)
"Socialist" is considered a dirty word in America. Yet those "socialist" European countries are doing better than we are in all of these areas. What arrogance we have to dismiss them and claim we are better.
44
The Europeans you speak of assume that organizing health care is a normal function of government. Citizens assume that they will all get about the same quality of treatment.
A large part of the USA does not want the government to be involved in anything, let alone their health care. There are huge socioeconomic divides in the country and those better off assume they will see better doctors and go to better hospitals. They certainly don't want to pay taxes to bring the others up to their level.
The party which controls Congress has no interest in equality in healthcare....the dreaded "socialism."
A large part of the USA does not want the government to be involved in anything, let alone their health care. There are huge socioeconomic divides in the country and those better off assume they will see better doctors and go to better hospitals. They certainly don't want to pay taxes to bring the others up to their level.
The party which controls Congress has no interest in equality in healthcare....the dreaded "socialism."
10
Not all of us dismiss those countries success. But unfortunately there is a large enough group of American's, who don't seem to be able to think beyond what they're fed. And what they're fed is designed to keep things just the way they are. Big Govt = BAD.
1
Solution to the access problem is so simple. Let the federal government insures all Americans. All working Americans, instead of paying health insurance premium on their employer's provided plans, will pay taxes into a healthcare funds. Employers, being relieved from providing health insurance, will also pay taxes into this healthcare funds. Being the main health insurance provider, the federal government will be able to control costs and improve care including preventive care. For Americans who want more than the government's plan, they can buy supplemental plans from the market.
Alas, this vision of healthcare for Americans will never happen because healthcare in America is a for profit business. Everyone involves in healthcare profits from it except Americans. And politicians from Obama to Clinton are so coward and beholden to the healthcare industry to dare propose this solution.
Alas, this vision of healthcare for Americans will never happen because healthcare in America is a for profit business. Everyone involves in healthcare profits from it except Americans. And politicians from Obama to Clinton are so coward and beholden to the healthcare industry to dare propose this solution.
21
what you say makes sense, but there's a big swath of Americans who do not trust in nor believe in the federal government; they'd prefer to eliminate it all together ND sink into a jungle of anarchy in which nobodywould be blessed to stop them from clawing their way to the top on the backs of fellow citizens. that attitude is where change has to start. looking at you, GOP
1
Americans will go nuts on a single-payer plan, because we are so used to having not to wait for care and having care, regardless of the cost. Rationing of health care is part of a single-payer system, one that cannot be avoided. That said, I believe we should implement a single-payer system, and that Americans would just have to adjust to it. Also, we need to curb the pay of doctors, nurses, and the costs that hospitals charge. They're way higher than in other industrialized countries, and the AMA also shamelessly limits the number of residencies permitted in the U.S., cutting out so many people who could be good doctors. We should also increase the number of nurse practitioners and physician's assistants, who can tend to a lot of people with uncomplicated, basic illnesses like sore throats, sinus infections and viruses like shingles. Let's hope we attack this problem on all fronts, and not just lambast the insurers.
21
Reading an article before commenting does help. "We are so used to having not to wait for care and having care, regardless of the cost" it precisely the myth that the article addresses. Americans have very bad access to their doctors and even the rich ones forego medical procedures because of cost at much higher rates than anyone in other rich countries, not to mention that US insurance companies seem much more likely to refuse to approve a procedure than single payer.
In one way or another, healthcare is, indeed, always rationed. Only the very wealthy can afford to pay out-of-pocket for their every whim. But reality just confirms common sense - private for-profit insurers ration care much more aggressively than a public, not-for-profit system that is directy answerable to the citizens and voters.
If a single-payer system introduced "death panels", the voter outcry would be so deafening that politicians would be forced to stop them immediately or face the panels themselves. What happens when the organization refusing care is one of many private for-profit companies? What do you do, politely ask Wall Street to stop buying their shares?
In one way or another, healthcare is, indeed, always rationed. Only the very wealthy can afford to pay out-of-pocket for their every whim. But reality just confirms common sense - private for-profit insurers ration care much more aggressively than a public, not-for-profit system that is directy answerable to the citizens and voters.
If a single-payer system introduced "death panels", the voter outcry would be so deafening that politicians would be forced to stop them immediately or face the panels themselves. What happens when the organization refusing care is one of many private for-profit companies? What do you do, politely ask Wall Street to stop buying their shares?
4
The voters have been asking the legislators to be subject to all the various "solutions" they have devised for us for many years now, to no avail.
My patients rely on me to use evidence to help them. Evidence on health care delivery from 37 other nations is clear: profit is not compatible with quality or value. Data also indicate the majority of Americans agree. The health care lobby, via politicians and the media, has denied U.S. citizens what all other developed nations in the world have--single payer. It's time to stop debating whether we adopt it, and use the evidence to create the best single payer system in the world.
54
One thing that is almost always missing in these discussions about heath care is a break down of where the money is going. What percentage is profit and overhead for insurance companies ? What percentage is for the pharmaceutical industry? How much is paid to hospital administrators? How much goes to the manufacturers of hospital equipment? The medical industrial complex has lobbied Congress to preserve its share of the pie, and the Affordable Care Act did little, if anything to alter this in order to contain costs.
Meanwhile, physicians salaries are a tiny percentage of the cost of health care. Why don't you have more primary care physicians ...because after investing 4 years of college, 4 years of medical school, doing a residency of 3-4 years (at least), not to mention the cost of tuition, a physician has the privilege of working long hours, being poorly paid and being at the mercy of insurance companies and the government. Add to this, every day working under the specter of being sued for any bad outcome, regardless of how well one does their job . Furthermore, physicians because of their hippocratic oath to "do no harm" are prevented from unionizing and striking. The very people who are charged with providing care to patients have the least amount of input into the process of delivering health care.
Meanwhile, physicians salaries are a tiny percentage of the cost of health care. Why don't you have more primary care physicians ...because after investing 4 years of college, 4 years of medical school, doing a residency of 3-4 years (at least), not to mention the cost of tuition, a physician has the privilege of working long hours, being poorly paid and being at the mercy of insurance companies and the government. Add to this, every day working under the specter of being sued for any bad outcome, regardless of how well one does their job . Furthermore, physicians because of their hippocratic oath to "do no harm" are prevented from unionizing and striking. The very people who are charged with providing care to patients have the least amount of input into the process of delivering health care.
32
Anyone who looks at our system objectively comes away with an understanding that this is an evolutionary gaffe. The entire system is built on a false premise, and that is employer-based health insurance. In today's economy where we no longer have long-term employees, but many independent contractors, job-hoppers, unemployed, retired, et. al. the system no longer functions effectively, to say the least. Further far to high a percentage of our health care dollar goes to non-health care related activities. We must reduce the dollars going to insurance companies, Madison Avenue, lawyers, administrators and funnel more money to doctors, nurses and hospitals. There are models out there in other countries that work quite well, and we must find a way to stop pretending like the USA is so exceptional that we cannot emulate corporations and copy "best practices" throughout the world. In order to do that we have to have politicians who are intelligent, honest and not beholden to special interests. That is our "health care problem."
24
Many other countries have more people insured (Europe and Canada) but is it better insurance? Anyone I know who has experienced both the US and the European systems of healthcare would choose the US system.
2
What are you smoking? The Carpet? Who do you know? Only the very rich?
I understand Canadian health care is better than USA, but ok, that's heresay. I can confirm French and German health care is cheaper, better in the sense more people can get care free or cheap, thus more people get treatment on time. After 42 years of working and living in France, I have paid out of pocket exactly Zilch for my health care. My American brother pays thru the nose, my American friends pay hundreds per month for insurance that is not insurance,with the high deductibles, only catastrophic insurance. Doctors in Europe work for the patients health, Doctors in USA seem to work for profit from the first hand stories I've heard. You should speak to some Europeans before writing such baloney.
I understand Canadian health care is better than USA, but ok, that's heresay. I can confirm French and German health care is cheaper, better in the sense more people can get care free or cheap, thus more people get treatment on time. After 42 years of working and living in France, I have paid out of pocket exactly Zilch for my health care. My American brother pays thru the nose, my American friends pay hundreds per month for insurance that is not insurance,with the high deductibles, only catastrophic insurance. Doctors in Europe work for the patients health, Doctors in USA seem to work for profit from the first hand stories I've heard. You should speak to some Europeans before writing such baloney.
58
I am a physician at the Ivy league medical center down the road from you. I oversee global clinical trials and have spent time living in the EU. I can assure you that the quality of medical care in the EU and Canada is on par with that in the USA, and may even be better than what is available in the USA. I have also acted as a medical expert, on behalf of patients (plaintiffs) in US malpractice cases. There is plenty of malpractice in the fee for service medical economy we have. I've yet to meet a European or Canadian, and I've met plenty, who would prefer the US system of health care.
25
Not me. I had a heart attack in the U.K., where I lived 17 years. The initial care was fantastic. Less than 45 minutes from arrival to having a stent emplaced. Paperwork consisted of giving my name and address, from which my Nation Insurance number could be obtained. In the months following: (1) ten weeks of physical therapy (weekly group exercise sessions at which heart rate/BP were monitored); (2) 6 months of monitoring by a cardiologist; (3) free medication for life (had I remained in the U.K.). No co-pay and no expenditure on my part at all.
After moving to the USA, I was covered by my wife's corporate plan, requiring that I confront the insurance bureaucracy. Co-pays, paperwork, finding doctors taking both patients and plans have made the routine patient experience worse and more frustrating in the USA than in the U.K.
I laugh when I hear the phase "greatest health care in the world". The US medical technology is top notch and perhaps more widely available geographically, but not better than other 1st world countries. However, I could easily see that the burden of paperwork and the co-pay nickel-and-diming dissuades low-income patients from initially seeking help and actually filling prescriptions. No country's health care system is perfect, but at least in other places there is a consensus the health care ought to be universal and they can work to improve it. In the USA, no such consensus exist, so we go nowhere and prices rise.
After moving to the USA, I was covered by my wife's corporate plan, requiring that I confront the insurance bureaucracy. Co-pays, paperwork, finding doctors taking both patients and plans have made the routine patient experience worse and more frustrating in the USA than in the U.K.
I laugh when I hear the phase "greatest health care in the world". The US medical technology is top notch and perhaps more widely available geographically, but not better than other 1st world countries. However, I could easily see that the burden of paperwork and the co-pay nickel-and-diming dissuades low-income patients from initially seeking help and actually filling prescriptions. No country's health care system is perfect, but at least in other places there is a consensus the health care ought to be universal and they can work to improve it. In the USA, no such consensus exist, so we go nowhere and prices rise.
12
I think this article is overly harsh on the Canadian system. In fact looking through the referenced report, the Canadian system scores are comparable with most other European and Scandinavian systems. The Times has cherry-picked two categories where Canada scored last (but not by much): wait times.
In my experience, wait times are inversely proportional to urgency. For elective (non-urgent) surgeries, Canadians can wait a few months (sometimes a year) for the free version, or can pay for the surgery at a private clinic in the US. We get the best of both worlds. Most people wait for the free service.
If you look at outcomes, Canada is at or near the top in cancer survival, life expectancy, and this, at less than half of the per capita cost of the US.
It ain't perfect, but it's free, and it's there when you need it. Most Canadians are extremely proud of their public health care system.
In my experience, wait times are inversely proportional to urgency. For elective (non-urgent) surgeries, Canadians can wait a few months (sometimes a year) for the free version, or can pay for the surgery at a private clinic in the US. We get the best of both worlds. Most people wait for the free service.
If you look at outcomes, Canada is at or near the top in cancer survival, life expectancy, and this, at less than half of the per capita cost of the US.
It ain't perfect, but it's free, and it's there when you need it. Most Canadians are extremely proud of their public health care system.
43
With regard to Canadians being able to see our healthcare provider same day or next day, or being able to get after hours treatment, from my personal experience, that has not been problematic. If my own physician is unavailable, I have been able to see someone else in the practice or go to a clinic and not have to pay anything.
When urgent care is needed, again, from experience and observations, it is given in a timely fashion. It is true that for non-urgent cases we might have to wait, but that seems fair, given the amount that we pay for our health care on an individual basis. In my case, it is in the low hundreds per year as compared to the thousands per year that my American friends pay for their insurance.
Scandinavian and most European countries seem to have healthcare systems that work better than ours, however, I am grateful to live in Canada and have the system that we do have, even knowing that it can be improved. In most studies our healthcare system fairs well and the population has better outcomes than the general American population, so cherry picking two areas mentioned in the article where we do slightly worse than the US is not telling the whole story. Those areas are not indicative of the healthcare situation in Canada as a whole.
It is shocking that the United States, a wealthy nation, has such a pathetic and expensive health care system and that there are still individuals who are not able to get decent, affordable care.
When urgent care is needed, again, from experience and observations, it is given in a timely fashion. It is true that for non-urgent cases we might have to wait, but that seems fair, given the amount that we pay for our health care on an individual basis. In my case, it is in the low hundreds per year as compared to the thousands per year that my American friends pay for their insurance.
Scandinavian and most European countries seem to have healthcare systems that work better than ours, however, I am grateful to live in Canada and have the system that we do have, even knowing that it can be improved. In most studies our healthcare system fairs well and the population has better outcomes than the general American population, so cherry picking two areas mentioned in the article where we do slightly worse than the US is not telling the whole story. Those areas are not indicative of the healthcare situation in Canada as a whole.
It is shocking that the United States, a wealthy nation, has such a pathetic and expensive health care system and that there are still individuals who are not able to get decent, affordable care.
14
please note that patients with Medicaid have better coverage in their home state then patients with private insurance. Some ways to fix the system: open up the federal employee insurance plans to everyone as competion to private insurers, with continuing subsidies depending on income. identify the younger worried well and bombard them with letters and social media about what happens without insurance coverage. a 27 year old is most likely to have trauma and that helicopter ride to a trauma Center is not cheap. partial federal loan forgiveness to doctors who become family doctors without requiring them to serve rural populations. Medical school can cost 200 000 and being a family doctor does not pay well enough to pay off the loans. Last, force insurers to pay them more per office visit and home visits.
13
My husband and I went from Employer insurance (that was so expensive, which such high deductibles and copays that we couldn't afford to pay use it. This year we were able to switch to Medicare and a Medicare HMO with no premium, no deductibles (except on drugs, so we are moving them to Walmart), coverage for medical hardware (except hearing aids). Thursday I get my second eye done for cataracts. Cost so far for the basic surgery $250 an eye for the surgical day care center. We chose to go with special implantable lenses that also fix my astigmatism as glasses were not anymore, they were $1,495 each. The lenses (even the basic ones) cure nearsightedness. So, the eye done was 20/1000 (I could see at 20 feet what others see at 1000), now it is 20/25, considered just about perfect. Instead of paying several hundred dollars a year for glasses (only the basic exam covered), I will not need new glasses. I may need reading glasses as I get older.
We were informed by our PCP that Medicare prefers us to see him (on their nickel 3 to 4 times a year. Instead of once every 3 to 4 years. We put off my surgeries until I qualified for Medicare. So I spent several years not driving, not watching TV, reading (that hurt). The reading I was able to do was on my computer, as I could make the print bigger and the background whiter. I had to give up my hobbies. I lived basically I non life.
The Canadian plan all this would have been done years ago at about the same out of pocket cost.
We were informed by our PCP that Medicare prefers us to see him (on their nickel 3 to 4 times a year. Instead of once every 3 to 4 years. We put off my surgeries until I qualified for Medicare. So I spent several years not driving, not watching TV, reading (that hurt). The reading I was able to do was on my computer, as I could make the print bigger and the background whiter. I had to give up my hobbies. I lived basically I non life.
The Canadian plan all this would have been done years ago at about the same out of pocket cost.
13
So many people have so much to say about his issue, but I never see anything about the market fallacy that dominates much of the American healthcare discussion. Other commenters have pointed out how the market system is undercut by what amounts to corporate welfare for drug companies, medical device manufacturers, etc. What I want to add is this: If the market is so effective in sorting the good from the bad, it should easily be able to survive in the face on a government-sponsored single-payer program. Obviously, so many seem to think, private healthcare would outperform single-payer healthcare in every respect. So obviously those who can pay the costs would do so willingly and private healthcare would flourish. And yet the companies who profit most from the current system seem willing to burn the world down if that's what it takes to stop us from adopting single-payer. Could anyone explain that to me??? I spend most of my year in a country with both private and government controlled single-payer. Single-payer has won the day by a large margin, but a private system survives for those who want five-star accommodations.
30
Why the U.S. Still Trails Many Wealthy Nations in Access to Care: we believe in disparity between the rich and the poor. In my opinion, we almost worship it. Rich = good, deserving, superior, and attractive; poor = bad, undeserving, inferior and repulsive. Many believe that one day they will join the rich, and they want 'the rich' to exist when they get there. Meanwhile, others' suffering is of little interest.
38
For-profit insurance companies, reimbursing for-profit completely unregulated hospital systems, supplying drugs and devices from for-profit biotech companies. Obamacare is noble in intent. But any further attempt to radicalize health care delivery in the US, whether it's a universal single payer system or otherwise, would still need to address the fundamental issues of fairness when it comes to health care costs. In the absence of that, and as long as hospitals charge $10 for Tylenol and $15 for hospital socks this will be an indefinite issue.
12
One problem was that Obama did not have the experience to negotiate with the Republicans. There was a majority of Democrats in the Senate and more could have been accomplished. A Single Payer option, expansion of medicare... so now it has to be fixed. Not torn down.
18
Even with more experience the Republicans would not have 'negotiated' with President Obama. They have just spent the last 8 years saying NO every time the President says 'yes'. Only if he had threatened to veto a better insurance plan would they have jumped on the bandwagon and over ridden a veto just to throw a moneywrench into the works. They haven't cared about the regular people of this country in over 8 years, but, these last 8 have proved that they are a sullen, nasty, stupid bunch of imbeciles. To actually fix (and it does need fixing, even if I've finally aged out of it) ObamaCare we must unseat all Republicans who care not for us. If they attempt to act like the uncaring idiots they have been I suggest we stop paying them for every day they don't work, including all those days of 'vacation' they get that includes a month (at least) off in the summer, around the holidays, and all those extra long weekends. They no longer have to travel to their home state by horse and buggy anymore, so lets stop giving them the time off to travel that way. Unless they sign up to actually travel home by horse and buggy. With their own horse and buggy.
1
The US should have switched to a single payer healthcare system ages ago. Time and time again conservatives have fought against doing so crying its socialism. They conveniently forget that Medicare and Medicaid and Social Security are government programs.
While the ACA is far from perfect, ( President Obama admitted from the very beginning of the laws implementation that it would need fixes), Republicans have fought tooth and nail to to so. All they want to do is repeal it and return to the old system which was worse.
While the ACA is far from perfect, ( President Obama admitted from the very beginning of the laws implementation that it would need fixes), Republicans have fought tooth and nail to to so. All they want to do is repeal it and return to the old system which was worse.
27
The U.S. healthcare system leads the way in several areas:
Billions in profit for pharmaceutical companies.
Billions in profit for health care providers.
Billions in profit for insurance providers.
It is impossible to fix an inherently immoral health care industry.
Billions in profit for pharmaceutical companies.
Billions in profit for health care providers.
Billions in profit for insurance providers.
It is impossible to fix an inherently immoral health care industry.
85
Impossible only with a Republicon dominated Congress.
Maybe the problem is the fact that we make it near impossible for our very best students to attend medical school in this country. More doctors, more access. Great student migrate to the US to attend college but many/most our kids -- good students -- have to leave the US to get a medical degree. It's absurd and dissuades potential students from attending medical school.
10
Here's the thing. We received notice yesterday that our out of pocket insurance premiums would go up from around $250 to just under $500. The total plan, under Select Health, costs just over $1200, and the subsidy is around $700. Last year, we accessed our insurance not once -- not once -- in part because the deductible is $5000, and any visit to the doctor is yet another out of pocket expense that we cannot afford. The only ones who seem to benefit from the improved access to insurance are the corporate providers, insofar as the insurance provides some protection for them against our bankruptcy should we have serious medical issues, and of course Select Health. On a day to day basis, the insurance is pretty much useless to me and my family except that, again, we won't be denied care should there be a catastrophe and we avoid the tax penalty. Yes, the system needs to be overhauled, completely, and just to be clear, though I live in one of the reddest of red states, I believe the conservative propositions go even further to protect corporate providers and enhance the insurers' profits. The overhaul must include a "public option," though I can hear my neighbors (one of whom is on medicaid, another of whom has VA benefits, another of whom is on disability) bemoaning yet another government "take over."
52
Make Congress use the same insurance. Since government employees do not qualify for Medicare or Social Security, they should be able to keep the government insurance.
Make all of congress live like us.
Make all of congress live like us.
8
Here's where the US ranks first; and which greatly contributes to rising expenditures, insurance costs and overuse of medical tests; malpractice suits. All those other countries to which US health care is constantly compared have nothing comparable in legal system to which trial lawyers have unlimited access to honey pots of gold in malpractice suits. At least 10% to 15% of medical care in the US is purely for defensive purpose against suit. That's over $200 billion for wasted use. Of course democrats - who receive many many millions of campaign contribution from trial lawyers - will do nothing to fix this disease.
8
This is an absolute myth. The entire medical liability system, including the legal system and the practice of defensive medicine, is estimated to be 2.4% of total health care spending--hardly a terribly significant contributor to the overall cost of healthcare. Moreover, medical error is the 3rd leading cause of death in the U.S.--behind heart disease and cancer--killing more than 250,000 annually.
18
your comment is nothing more than a faux news talking point- malpractice is a conservative red herring to distract racists from the uncomfortable truth about minorities not having health care. Pre emptive litigation insurance is a tiny percentage of health care costs, not the absurd figure of 15%.
Your source on 15 percent?
This suit argument often is left undocumented.
Thanks!!
This suit argument often is left undocumented.
Thanks!!
The elephant in the room is the insurance companies. They add layer upon layer of unnecessary costs to the equation, and increase their profits by denying coverage. It appears that the countries that offer better healthcare than the USA are all countries that offer socialized medicine. If the tax burden was spread evenly across the citizenry, and the middlemen were eliminated, costs would be better controlled and America could start catching up to the rest of the world. Unfortunately, our lawmakers are bought and paid for by the health insurance and drug companies.
55
Spot on Ken.
1
Because the Party of Abraham Lincoln has betrayed his leadership and promise, that all men are created equal and entitled to justice -- in the courtroom, on the street. Had Lincoln been returned to us 100 years after the Civil War, he would have said they all are entitled to equality in the care they receive for their ills and the price they must pay for it.
15
Of course, we need a single-payer system, which covers everyone. Bernie was right about that. However, in our current climate with the GOP controlling the House, it is simply not possible. The GOP hankers to move to a system of vouchers. If folks think the ACA system is expensive and getting more so (all of healthcare goes up and up), vouchers would be a path, over time, to completely get the government out of healthcare assistance. Vouchers would over the years cover less and less of actual costs.
Many folks use the increasing cost of healthcare under the ACA as an excuse to want to dismantle it. Those folks, though, are often securely covered by employers themselves. Too many of our citizens want wait times decreased for themselves at the expense of others and are perfectly happy to have some with no insurance so that they themselves are not inconveniences.
Many folks use the increasing cost of healthcare under the ACA as an excuse to want to dismantle it. Those folks, though, are often securely covered by employers themselves. Too many of our citizens want wait times decreased for themselves at the expense of others and are perfectly happy to have some with no insurance so that they themselves are not inconveniences.
15
Is health care a human right? If it is, single payer is the easiest and most equitable system. If not, continue to pay for emergency rooms through premiums to treat the poor poorly in the wealthiest country in the world.
9
The problems are compounded by the fact that federal efforts are inept at best. Implementation of the ACA has worsened the quality and availability of care for everyone by imposing enormous new requirements for documentation, certification and registration as well as imposing disasterously bad electronic health records. So the # insured may be up but the value has further depreciated badly. Any effective solution seems nearly out of reach.
12
I like the new requirements. My family doctor got dragged into the electronic era kicking and screaming. It was a rough road for him, but now he is approaching the sophistication of the various specialists that I see. I can now order an expired prescription refill online with the pharmacy, check my test results, or make an appointment, that would have required several phone calls and everyone's time in the past. When my mother was taken to the hospital recently, they had her past MRI's in her electronic folder to compare the new one to immediately., and that proved useful. And as an individual, I have a substantial insurance plan (with no subsidy) where before all individual plans available were severely lacking. If the Democrats win both Houses of Congress, we can make it better. If the GOP keeps the House, and they veer from their prior obstructionism, we'll have to include a lot of things that punish poor people or sick people to make the GOP happy.
3
"Implementation of the ACA has worsened the quality and availability of care [by] imposing [disastrously] bad electronic health records." There's another misplaced jab at the ACA. The EHR rules came from the HITECH act of 2009, not the ACA.
So much talk about expanding insurance, so little talk about controlling costs. And so little willingness to take the difficult steps that would impact costs. When our local hospital recently announced plans for a $550 million expansion, in part so they could do away with those archaic double rooms for single rooms all over, everybody cheered the rising standards of care. Few wondered what this invisible hand might do the escalation of premiums. Multiply that one hand by a million others across the country, and there’s a chain linked against doing much about cost.
14
Other countries may have better access to see a doctor but their ability to get surgery or higher end treatment is limited. I am not saying that we should not try to make our system better but when we look at systems in other countries we need to do an apples to apples comparison or we will just recreate problems that the other countries have. We need to have a group of people look at what the goals of a healthcare system are and then plot out how to achieve the goals, take costs into effect, reevaluate and come up with a better plan. Once this process is complete then share the results and try to get implementation. It is not going to be quick or easy but quick and easy is not going to work.
7
I agree completely. Statistically the greatest expenses in healthcare occur at the end of an elderly persons life. Doctors are trained to preserve life at all costs but all to often little regard is given to the chances of success in a given path of treatment or in the quality of life that the patient will have after the procedures are taken. We need to have an honest conversation about end of life treatments and allow families and patients to make informed decisions about palliative care options available. Having seen my mother languish in suffering at the end of her life only to pass away, I want to avoid that for me.
5
"Other countries" is a bit general, don't you think? "Some countries" might work with your assertion, but I can assure you, after more than 20 years of top-notch health care in Asia at prices almost any American would consider impossibly low, "higher end treatment" is less limited in some countries than in the States.
This needs to be very carefully looked at. My mother had a bowel obstruction, had surgery to repair it. She said she'd not do it again. A year later she had another one. She refused an operation. They warned her it would kill her, and be a horribly painful way to die. She finally gave in. She died a couple months later. The day she was scheduled to come home. Since doctors are not allowed by law to give patients who are at the end of their lives enough pain meds to keep them comfortable (they might get addicted, as if that matters at that point), more expensive surgery was needed. I think I would prefer enough medication so I would be comfortable, than surgery that would not allow me to live longer in good health. I'm 65 and I am seriously looking ahead. I would like to die sober and clean, but not in agony. But, we are so afraid of 'addicting' people to anything (Mom worried about getting 'addicted' to oxygen, we told her 'damn it Mom, if you must be addicted to something, make it oxygen!') that we make those with conditions that are inimical to life, they are going to die, suffer because a younger person would get addicted and that is not a good thing. And you younger people wonder why assisted suicide is becoming more popular among those of us who are older.
1
There are too many problems that combine to cause the mess that is healthcare in the US to detail in the allotted space. There is excessive price gouging, phony accounting, defensive medicine and other things that impact every aspect of the problem.
If Medical School costs a King's Ransom many new Doctors simply cannot afford to go to small towns- their choices limited by finances. Likewise, new PA and Advanced Practice Nursing Programs have rocketed up in price. It looks like Universities are price gouging and that is a big factor in the debt accumulated by young MDs, DOs, PAs and APNs.
Drug and medical equipment prices are simply out of control. The EpiPen episode shows how a hundred year old medicine & over 50 year old Pentagon injection technology can be turned into a financial gold mine for greedy Pharma. My mother's Multiple Myeloma shows a variant of Thalidomide- a drug once so cheap it was sold over the counter in Europe for nausea- is priced about $8,000 a month. My insurance statement shows the price gouging going on with Lisinopril and Levothyroxine which are both drugs long ago generic and not expensive to make, yet the price is ridiculous.
We need a complete overhaul of not only the structure but the very thinking behind wellness and the treatment of illness, injury and disease. The greed is destroying the old system and is not viable under any good new model. If citizens saw the true margins on equipment & drugs they would be in the streets with pitchforks.
If Medical School costs a King's Ransom many new Doctors simply cannot afford to go to small towns- their choices limited by finances. Likewise, new PA and Advanced Practice Nursing Programs have rocketed up in price. It looks like Universities are price gouging and that is a big factor in the debt accumulated by young MDs, DOs, PAs and APNs.
Drug and medical equipment prices are simply out of control. The EpiPen episode shows how a hundred year old medicine & over 50 year old Pentagon injection technology can be turned into a financial gold mine for greedy Pharma. My mother's Multiple Myeloma shows a variant of Thalidomide- a drug once so cheap it was sold over the counter in Europe for nausea- is priced about $8,000 a month. My insurance statement shows the price gouging going on with Lisinopril and Levothyroxine which are both drugs long ago generic and not expensive to make, yet the price is ridiculous.
We need a complete overhaul of not only the structure but the very thinking behind wellness and the treatment of illness, injury and disease. The greed is destroying the old system and is not viable under any good new model. If citizens saw the true margins on equipment & drugs they would be in the streets with pitchforks.
33
Greed is the key. In America it seems absolutely every aspect of our lives must be subject to the profit motive. That is not the case in a number of more enlightened societies. Those who knowingly profit off the misery of others can hardly be considered civilized.
29
Health care is a business, and a very successful one. It competes for a share of the G.D.P., and because health care is a necessary product, it can and has won that competition. Health care costs so much here because of competition and the free market, and because of its natural advantage as more necessary than anything but the most basic food and shelter.
In theory, competition between entities within health care should control prices, but the health care market is structured so that this does not happen. If the health care entities as a group win the competition with the rest of the economy, the pie for which they sometimes ferociously compete is bigger, so that all do well and some do better than others. They all know this and avoid anything approaching a price war. Prices are set not by the market but by negotiated deals and discounts, so that no one knows or cares the real cost of anything, but all are expert on what can be charged for it. This is far from free enterprise, but is defended as if it were.
The competition that exists does not lower prices; instead, it creates jobs in advertising, marketing, sales, financing, promotion, and plan design, and paying for these jobs drives up prices. In many ways our health care system is a jobs and profits program, and health is merely the excuse.
In theory, competition between entities within health care should control prices, but the health care market is structured so that this does not happen. If the health care entities as a group win the competition with the rest of the economy, the pie for which they sometimes ferociously compete is bigger, so that all do well and some do better than others. They all know this and avoid anything approaching a price war. Prices are set not by the market but by negotiated deals and discounts, so that no one knows or cares the real cost of anything, but all are expert on what can be charged for it. This is far from free enterprise, but is defended as if it were.
The competition that exists does not lower prices; instead, it creates jobs in advertising, marketing, sales, financing, promotion, and plan design, and paying for these jobs drives up prices. In many ways our health care system is a jobs and profits program, and health is merely the excuse.
33
Healthcare may have become a business, but the practice of medicine is not a business and never should have become one. Hospital administrators, a role that used to be filled by physicians at a little more than physician salary (not what you'd think) is now done by business people with no medical training at two to four times the salary of physicians. Similar to academia where universities are now being run by high salaried business people. And there is no benefit (despite the belief that we "need" the best administrator at the highest cost) to having business people administrate hospitals (or universities, for that matter), except to the administrator making the giant salary.
34
So very true. And now we watch in dismay the results. Both of these "service professions" are dying, or at least the service part is, one of the main reasons fewer young people look upon medicine and education as professions in which they can make the world a better place. Or at least this seems to be so in America. Some Asian countries, on the other hand, have no difficulty at all attracting the best and brightest to these fields. Just one more way in which Asia is rising as the USA falls.
3
I agree with what you are saying but competition is not the solution. If you are having a heart attack, you don't have time to shop around for the best price. Socialized medicine is a better approach but it can also lead to rationing access to services. In general global capitalism is not competitive. Most industries are dominated by a few big companies that control the lion's share of the market. They don't compete so much as collude with each other to keep prices artificially high and divide the spoils. Our entire system is broken.
1
I find some of the comments here to be incredulous.
ACA is good but obviously not good enough. We need to reform it by providing folks 'incentive' and educate 'em that they are indeed vulnerable and should sign up for health care by all means.
The author mentions of some industrialized countries. What industrialized countries are we talking about here? Take for example, Germany or maybe the U.K which of course has NHS. Look at the size of the country and the scale of their respective populations. (60 million, 80 million respectively) You can't replicate the same old system here in the States with a population of 320+ million. Also we are 2.5 times the entire EU combined in area, with a myriad of states offering up their own procedures, processes & entitlements. So the universal health care simply ain't gonna happen here with this level of complexity, population demands. Want insurance? Get a job. Want insurance? Start a business. Want insurance? GET rich enough to buy your insurance yourself by contributing something meaningful to society.
You can't force the socialist "welfare-state" policies on a country that is supposedly the cradle of capitalism. You want free entitlement to all of the good stuff free without doing anything just by being a citizen and pay 45-50% of taxes? Feel free to relocate to Scandinavia.
"It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest" - Samuelson
ACA is good but obviously not good enough. We need to reform it by providing folks 'incentive' and educate 'em that they are indeed vulnerable and should sign up for health care by all means.
The author mentions of some industrialized countries. What industrialized countries are we talking about here? Take for example, Germany or maybe the U.K which of course has NHS. Look at the size of the country and the scale of their respective populations. (60 million, 80 million respectively) You can't replicate the same old system here in the States with a population of 320+ million. Also we are 2.5 times the entire EU combined in area, with a myriad of states offering up their own procedures, processes & entitlements. So the universal health care simply ain't gonna happen here with this level of complexity, population demands. Want insurance? Get a job. Want insurance? Start a business. Want insurance? GET rich enough to buy your insurance yourself by contributing something meaningful to society.
You can't force the socialist "welfare-state" policies on a country that is supposedly the cradle of capitalism. You want free entitlement to all of the good stuff free without doing anything just by being a citizen and pay 45-50% of taxes? Feel free to relocate to Scandinavia.
"It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest" - Samuelson
5
You claim the US population is too numerous, the land mass too large for a "socialist" healthcare system to work here. The same claims made before the passage of Medicare. How foolish those claims do look today. Medicare provides security to millions of senior citizens and can be expanded to cover all or at least provide an affordable public option. It makes no sense to continue the fantasy that healthcare is best served by a rich pay, poor die system.
23
Hogwash. Medicare provides excellent coverage for millions of Americans at a fraction of the overhead cost of private health insurance. I speak from experience. Have you ever heard anyone complain about his or her Medicare coverage? Even the many physicians I know prefer Medicare to private health insurance, because, although they may receive less payment for their services with Medicare, at least they can count on getting paid! Private health insurance companies employ an army of people just to deny benefit claims.
We can & should provide universal coverage like Medicare for all Americans.
We can & should provide universal coverage like Medicare for all Americans.
15
This argument does not hold water. States do not dictate medical procedures, MDs do this. You are confusing the two systems. The issue at hand is thinking that medical care should only be available to those with enough money. The reality is that everyone needs access to medical care and your ability to pay does not change this. The truth is, that universal medical care can be available to all, regardless of our ability to pay. We are held hostage by very wealthy companies who in turn support the re-election of politicians who maintain the status quo. This does not mean the status quo is consistent with reality.
9
If I've got it right the US population has in polls and for decades prefered a single payer ("socialized") health care system, with a substantial majority of around 70 percent. It seems as if executing some real democracy is all it takes to solve the entire problem.
OK, I'm intentionally naive. The real rulers are not the people. In Europe we have our Plutos too, but we have cut their sharp teeth now and then. Frequent popular uprisings are known since at least the Middle Ages, and more recently we have had militant labor movements powerful enough to at least participate in shaping the society. Thus our healthcare system based more on solidarity than on money (although neo-liberalism for 30 years now has tried push us backwards in history again).
OK, I'm intentionally naive. The real rulers are not the people. In Europe we have our Plutos too, but we have cut their sharp teeth now and then. Frequent popular uprisings are known since at least the Middle Ages, and more recently we have had militant labor movements powerful enough to at least participate in shaping the society. Thus our healthcare system based more on solidarity than on money (although neo-liberalism for 30 years now has tried push us backwards in history again).
11
We have universal healthcare in Canada, and depending where you live, you might be unhappy with it. For instance, in Quebec, at least half a million (out of 7 million) don't have a doctor. And most of those who do can't see theirs in case of emergency.
Until next January, we have to pay extra for what should be free. For instance, a dermatologist (and try to find one) will charge a lot extra for anything he does. And you have to pay cash. But for that privilege, you will wait many months for an appointment. In most instances, you can wait up to 2 years for an operation.
In need of urgent care, be prepared to wait an average of 12 hours in your local hospital before being seen.
Think that Quebec has the highest tax rates in North America.
Sales tax are over 15% and look up, if you are so inclined, the income tax rates. Food is more expensive, corruption is rampant and roads are worthy of a third world country.
If you look at other countries who have free healthcare, they all have endemic problems. I am all for it, but then you have to rein in the costs,
I.e. the bureaucracy etc. the best option is to start by regulating the cost of care per say, meaning what physicians and hospitals can charge. While you are at it, regulate what pharmaceutical can charge. Good luck with that. You see, you can't.
The best way is for a French system, with certain caveats. But then again, it is costly, and not perfect.
Until next January, we have to pay extra for what should be free. For instance, a dermatologist (and try to find one) will charge a lot extra for anything he does. And you have to pay cash. But for that privilege, you will wait many months for an appointment. In most instances, you can wait up to 2 years for an operation.
In need of urgent care, be prepared to wait an average of 12 hours in your local hospital before being seen.
Think that Quebec has the highest tax rates in North America.
Sales tax are over 15% and look up, if you are so inclined, the income tax rates. Food is more expensive, corruption is rampant and roads are worthy of a third world country.
If you look at other countries who have free healthcare, they all have endemic problems. I am all for it, but then you have to rein in the costs,
I.e. the bureaucracy etc. the best option is to start by regulating the cost of care per say, meaning what physicians and hospitals can charge. While you are at it, regulate what pharmaceutical can charge. Good luck with that. You see, you can't.
The best way is for a French system, with certain caveats. But then again, it is costly, and not perfect.
5
Yes, the French system is definitely worth consideration, but there are many other varieties of universal healthcare in the world, some of the best in Asia. Those systems should also be studied carefully. The penchant of many Americans to consider only Western systems is far too limiting.
2
Quebec's system does reflect the Canadian system as a whole and many of the issues you discuss don't exist in other provinces.
In Victoria, I can usually get an appointment with my GP within a day or two. If I can't wait, I can choose to see the on-call docs at the same clinic by waiting (20 min-2.5 hrs) of go to any of the many walk-in clinics in the city (there seems to be one every few blocks here) and after I'm seen by that clinic's MD, the report is sent to my regular G.P. Everything is computerized and very efficient and I am never charged for anything. Whatever the doctor orders, the patient gets. There are no middlemen needed to approve the test or procedure. I think the reason why people might overuse the ER however, is because some clinics are not open late and some close or operate for half-days on Sundays and holidays. For a small monthly premium everything is covered (except dental, optical, etc). The maximum a single person can pay in B.C is $75 C or $58 USD per month and the maximum for a family is $150 C or about $115 USD per month. Canadians are proud of their universal healthcare system and rightly so. No one is denied coverage based on financial circumstances. It is free for those making under $22,000 C. A homeless person in Canada can and will get the same care as a wealthy person if they should fall ill and Canadians would not want it any other way.
26
It's true that wait times in Canada (sometimes even to see your family physician, and certainly for specialists and nonessential surgeries) can be frustrating. But if it's a condition that's at all serious, wait times are minimal in my experience. For non-serious issues an appointment with a nurse at my provider is usually available on the same, or next, day. Really critical care - emergency heart surgery, cancer treatment, etc. - is provided promptly. And it's important to remember that all essential care is basically free at point of service, with overall outcomes similar (and sometimes better) than in the US despite spending far less per capita.
There is certainly some dissatisfaction with care among Canadians, but the principle of a single-payer system, where everyone gets looked after on the basis of need and regardless of income, is pretty much sacrosanct politically. There could be an appetite for a certain amount of private care, but politically people would have to be completely convinced that the public system would not gradually be eroded, and no one's ever been able to provide that assurance. There is a clear nervousness that any privatization of our system would start to open the door to the kind of expensive, and unequal, system that is so visible in the US. That fear has made any significant privatization of our system an absolute political non-starter for almost 50 years, despite health care being a major issue in virtually every election.
There is certainly some dissatisfaction with care among Canadians, but the principle of a single-payer system, where everyone gets looked after on the basis of need and regardless of income, is pretty much sacrosanct politically. There could be an appetite for a certain amount of private care, but politically people would have to be completely convinced that the public system would not gradually be eroded, and no one's ever been able to provide that assurance. There is a clear nervousness that any privatization of our system would start to open the door to the kind of expensive, and unequal, system that is so visible in the US. That fear has made any significant privatization of our system an absolute political non-starter for almost 50 years, despite health care being a major issue in virtually every election.
20
We need a health care system that ELIMINATES for-profit corporations from the mix. We cannot sustain these constant increases in both the cost to individuals for health care premiums AND the costs of co-pays and non-covered services. Insurance companies provide Health Care Prevention. We need health care services. The two simply don't mix. If some people prefer for profit health companies to provide their services, by all means, let them have it. The great majority of us would prefer to have a single payer system. We want ALL of the money (save the 5% or so to administrative costs) to go directly to providing us care. No more marketing, no more advertising, no more decisions made by for-profit employees who know nothing about health care. We need a system that works for all of us. The current one simply fails to be effective.
21
We need to pay primary care physicians more money. The discrepancy in pay is radically unfair. Also, primary care docs with proper training can do a lot of procedures that mostly specialists do here. We need to make it worth it to do primary care, home visits and monitor procedures that some physicians do, for profit. Sure, many highly trained specialist such as Neuro surgeons should be paid more because of the intensity and skills required. The doc in our town making the most money does sleep medicine and makes well over a million a year and works 3-4 days a week. Seriously, why is she making more money that ICU docs, and other more stressful specialities? The sleep techs do the majority of the work, stay up all night.
10
We need to have many more primary care physicians, not pay them more. As stated in this article, America has one fifth the number of primary care physicians as France and Germany, and as a result, physicians charge much too much. So ask yourself "why are there so few physicians in the the U.S. compared to other countries" and you will eventually find this simple answer: the doctors' union (i.e., the AMA) and physicians' greed.
3
Strange logic, Fred. Clearly the salaries paid in each specialty create incentives (or disincentives) to go into those specialties. GPs and internists who do not perform procedures have been underpaid in the States for the better part of the last quarter century. This is why we have a shortage of GPs, not some nefarious plot by the AMA. Likewise, as per one of the comments above, some specialists make absurd amounts of money simply because they perform procedures or provide services they have persuaded insurers to pay handsomely for. Unless you are advocating a Soviet-style command economy, you cannot compel people - even medical school students - to pursue practices that they do not perceive as attractive financially.
3
The average pay of a GP in the US is $161K. The emergency room doctors probably make more than $200K. The neurosurgeons average more than $400K.
If we really pay doctors this much, how can we possibly afford medical care?
If we really pay doctors this much, how can we possibly afford medical care?
1
Mr Carroll, your sentence "Americans still have a greater percent of the population uninsured than pretty much any other industrialized nation in the world" is a stunning disservice to American readers unfamiliar with other industrialized nations in the world. There, health care is not a matter of insurance (something you need to buy if you want coverage), but is one of the fundamental services the nation provides its people (something you are entitled to just for being a human being). Everyone in these nations has full, unconditional right (practically a constitutional right) to full health care for a nominal or no co-pay. No prior conditions exceptions!, no maximum limits! It is also stunning to watch the US from abroad make such a big deal of the ACA which, compared to all other industrialized nations, is the mountain that gave birth to a mouse. The cost for universal, state-managed health care in these nations is, what, 1 or 2% of tax rate? (Looking at the average income tax rates seems to suggest that.) How much would 1 or 2% of higher tax rate really cost to Americans? I bet that today health insurance and lack thereof really cost lots more than 1 or 2% of their income. A serious analysis on these financials is really overdue. It is time to open discourse in America that universal public health care is one of the pillars of a modern, civilized nation. "44m people with no insurance and 38m with inadequate insurance" (PBS) is not modern nor civilized, ACA or not ACA.
21
Ms. Celesti, you hit the nail on the head, which is taxes. Americans have been misled to believe that we're being taxed to death, that we cannot afford to take care of our citizenry because we're all being crushed by taxation. It's bunk, but far too many who believe it. And we allow ultra-wealthy individuals and wildly successful corporations to avoid taxation while demanding that we eliminate the "unaffordable" social-safety net. Americans also have a knee-jerk reaction to "socialism," forgetting, of course, that the US in many ways already is a "socialist" country and that most of us like those benefits.
11
Celesti,
I find your argument lacking merit in certain areas. What industrialized countries are we talking about here? Take for example, Germany or maybe the U.K which of course has NHS. Look at the size of the country and the scale of their respective populations. (60 million, 80 million respectively) You can't replicate the same old system here in the States with a population of 320+ million. Also we are 2.5 times the entire EU combined in area, with a myriad of states offering up their own procedures, processes & entitlements. So the universal health care simply ain't gonna happen here with this level of complexity, population demands. Want insurance? Get a job. Want insurance? Start a business. Want insurance? GET rich enough to buy your insurance by doing something.
You can't force the socialist "welfare-state" policies on a country that is supposedly the cradle of capitalism. You want free entitlement to all of the good stuff free without doing anything just by being a citizen? Feel free to relocate to Scandinavia.
"It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest" - Samuelson
I find your argument lacking merit in certain areas. What industrialized countries are we talking about here? Take for example, Germany or maybe the U.K which of course has NHS. Look at the size of the country and the scale of their respective populations. (60 million, 80 million respectively) You can't replicate the same old system here in the States with a population of 320+ million. Also we are 2.5 times the entire EU combined in area, with a myriad of states offering up their own procedures, processes & entitlements. So the universal health care simply ain't gonna happen here with this level of complexity, population demands. Want insurance? Get a job. Want insurance? Start a business. Want insurance? GET rich enough to buy your insurance by doing something.
You can't force the socialist "welfare-state" policies on a country that is supposedly the cradle of capitalism. You want free entitlement to all of the good stuff free without doing anything just by being a citizen? Feel free to relocate to Scandinavia.
"It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest" - Samuelson
That's a very hoary old chestnut, I can't see any logical impediment to scaling up the health systems of European countries to cover the USA, the only thing lacking is the political will and the power of the for profit health lobby.
2
I recall that when private corporations got into the business of "healthcare"
most professionals in Medicine and Surgery were faced with steadily rising costs for everything they needed in their private practices.
Health care is now definitely viewed as an income stream for businessmen of every stripe, rather than the complicated profession it once was.
Even well-laid plans seem to collect profiteering speculators at the expense of all professionals and professions.
most professionals in Medicine and Surgery were faced with steadily rising costs for everything they needed in their private practices.
Health care is now definitely viewed as an income stream for businessmen of every stripe, rather than the complicated profession it once was.
Even well-laid plans seem to collect profiteering speculators at the expense of all professionals and professions.
5
In a perfect world, a group of politicians would work together on the healthcare improvement project, just like a company might work on a project to improve customer service. They would find out the needs of different stakeholders - citizens, healthcare workers, government, taxpayers - compare different systems, listing their strengths and weaknesses, and come up with a plan that best met the needs of all. There are plenty of fairly decent systems out there that could be emulated, not all of them are the same, and not all of them have a single-payer system.
You can say as many bad things you want about the healthcare systems in other countries, but even with their faults many of them are - for the average, middle-class citizen - superior to the healthcare system in the U.S. For instance, most Germans would never say that the German healthcare system is perfect, but it's still a mystery to them why Americans put up with the terrible faults of their own system - from high copayments for things such as childbirth, to being chained to a job in order to have health insurance, to not being able to keep your doctor if you have to switch plans.
You can say as many bad things you want about the healthcare systems in other countries, but even with their faults many of them are - for the average, middle-class citizen - superior to the healthcare system in the U.S. For instance, most Germans would never say that the German healthcare system is perfect, but it's still a mystery to them why Americans put up with the terrible faults of their own system - from high copayments for things such as childbirth, to being chained to a job in order to have health insurance, to not being able to keep your doctor if you have to switch plans.
11
Yatta, yatta, yatta,
It's the same old story: too few insured, too few able to see a doctor because they are too few doctors, and too few doctors willing to accept what the insurance company or Medicare pays.
These problems will persist as long we think of healthcare as a commodity and continue to look for "market solutions".
Medicare for All, private insurance as a Medi-gap back-up, and free college, med school, and a livable stipend for all would be doctors in exchange for working in community hospitals and clinics for a set number of years.
It's the same old story: too few insured, too few able to see a doctor because they are too few doctors, and too few doctors willing to accept what the insurance company or Medicare pays.
These problems will persist as long we think of healthcare as a commodity and continue to look for "market solutions".
Medicare for All, private insurance as a Medi-gap back-up, and free college, med school, and a livable stipend for all would be doctors in exchange for working in community hospitals and clinics for a set number of years.
15
Emergency rooms and facilities are easily accessible in France. At least in the cities I know. Not sure about small cities or villages. But I can vouch for better access here than I had in New Orleans. And it's covered in my case because I have a work history here. If that weren't the case, at least it would be affordable. And yes, it is top-notch. Please, America - push for a single-payer option. It works everywhere else in the civilized world!
21
Why do these health care articles never look at Asian countries? Everything is Europe centric. Japan has one of the better models - a general level of care for all where it matters - at the primary and preventative care level. Medication costs are held down by the government. This is not to say Japan's model is perfect, far from it. But you don't hear of people avoiding care or filling prescriptions because of cost. I suspect the problem with the US model has more to do with no history of benign paternalism enforced from above and an idealized nonsensical view of independence and profit driven principles.
10
On the one hand, you're not going to get rid of the "idealized nonsensical view of independence" or the "profit driven principles" because they're integral to the American sense of identity.
On the other hand, Japan is a poor comparison because the population is far more restrained in food consumption and tends to consume far higher quality food (including many vegetables).
Perhaps the ideal comparison country, for culture, corpulence and general contrariness is the UK.
On the other hand, Japan is a poor comparison because the population is far more restrained in food consumption and tends to consume far higher quality food (including many vegetables).
Perhaps the ideal comparison country, for culture, corpulence and general contrariness is the UK.
4
When comparing wait times to those in Canada, it is important to consider costs as well. We pay $136CDN (about $102 US) per month, for a couple. Families are a little more. Rates are going up next year, but I believe with the aging population and new treatments that is fair. Low income families are subsidized.
This covers all physician services, including specialists, lab tests, but not optometry. Seniors and young children have some additional inclusions.
Prescriptions are not included - annual deductibles are based on income.
All Hospital services, medications, cancer treatments,lab tests, MRI, CAT, X-ray and surgery, are included in our general taxes, but private/semi private rooms have a modest up charge -unless private is required for medical reasons. There is a nominal fee to prevent abuse of emergency rooms.
As said earlier, it I s a kind of triage system, for doctors appointments as well as surgeries. If you have a COPD flare up, you could be in the same day. Prescription renewals, they request at least week's notice.
For unexpected non emergencies, there are 4 walk in clinics within 10 minutes of my home, where I can see a doctor by waiting 15 minutes to an hour or so. There is even an app to tell you how long the wait will be at each one!
Elective surgery may have a wait time of several months. That includes hip replacements and cataract surgeries, and creates anguish amongst seniors.
So, not perfect, but definitely affordable.
This covers all physician services, including specialists, lab tests, but not optometry. Seniors and young children have some additional inclusions.
Prescriptions are not included - annual deductibles are based on income.
All Hospital services, medications, cancer treatments,lab tests, MRI, CAT, X-ray and surgery, are included in our general taxes, but private/semi private rooms have a modest up charge -unless private is required for medical reasons. There is a nominal fee to prevent abuse of emergency rooms.
As said earlier, it I s a kind of triage system, for doctors appointments as well as surgeries. If you have a COPD flare up, you could be in the same day. Prescription renewals, they request at least week's notice.
For unexpected non emergencies, there are 4 walk in clinics within 10 minutes of my home, where I can see a doctor by waiting 15 minutes to an hour or so. There is even an app to tell you how long the wait will be at each one!
Elective surgery may have a wait time of several months. That includes hip replacements and cataract surgeries, and creates anguish amongst seniors.
So, not perfect, but definitely affordable.
17
I'll take the Canadian system any day over the corporate US system. It's not health care; it's catastrophic care. Must include a public option in Obamacare care reform.
Medicare for all. Private care, few regulations, no drug price regulation, depending on per profit companies, allowing excess payments to specialists all contribute. Single payer, government care is the only answer. Drug prices 6X chaeper in those countries, most visits and procedures 50% cheaper. and they have better scores on almost all aspects of medical care. The numbers and reasons why we need this and why we can do it can be found at letusbeawarefolks.blogspot.com-will single payer work.
12
The way to fix the primary care shortage is to make it universally covered for all Americans either through private clinics, community health centers, or employer-based clinics, and disentangle it from health insurance, which should only be for services that would be financially catastrophic for patients, like all other types of insurance. Second, subsidize primary care training, forgiving med student loans for all trainees who choose primary care careers. This would make primary care much more attractive to med students, residents, nurse practitioners, PAs, and even specialists, since they would be debt free, and not have to deal with insurance paperwork and regulatory compliance burden, allowing them to focus on direct patient care.
9
As long as health care is a for-profit concern, and that concern demands that all profits be maximized, we are going to struggle along with a patch quilt system that benefits only the health careindustries, especially the drug companies and the makers of medical devices, two industries that have among the top five profit margins in the United States. For example, why is Medicare forbidden by law from using its size and leverage to bargain or lower drug prices? Isn't that the American Way?I think we all know the answer to that. Just think how much more efficient our system would be without lobbyists from very sector, for whom the patient's needs are hardly if ever taken into consideration
21
My doctors have a full-time person in their office who handles insurance and billing. That's not healthcare, but it is a cost. The insurance company that provides my healthcare coverage has thousands of employees, many of whom do nothing but evaluate cases and try to find reasons to deny things that the doctors think are medically necessary.
Some relatives live in a state whose governor, motivated by ideology, refused federal funds to subsidize Medicaid patients, so these relatives can't afford health insurance of any sort.
And you wonder why health care is so costly in the United States? And why there are people who still can't pay for insurance policies or doctor's bills?
Some relatives live in a state whose governor, motivated by ideology, refused federal funds to subsidize Medicaid patients, so these relatives can't afford health insurance of any sort.
And you wonder why health care is so costly in the United States? And why there are people who still can't pay for insurance policies or doctor's bills?
23
People outside of Canada don't get what we here understand; that we're prepared to make the compromises that are inherent with our systems, particularly health care.
I get that it sounds terrible that I can't see my designated health care provider that day, or the next for something unless it's acute, unusual, and causing immediate distress. In that case, if I can't get into my provider's clinic (because her time is fully committed), they'll recommend that I go to "emerg". There, I'll be triaged, and ultimately be examined and treated in accordance with my issue as compared to the others present. Sometimes I've been ushered straight in, sometimes I've had to wait for several hours. In each case however, if further examination - medical imaging in its variety of forms, medication or splinting, stitches, blood work - is required, I'm slotted into the next available space (never more than a couple of hours) and treated accordingly. Whatever is required is logged into "the system" and any health care provider who subsequently looks into what's transpired with me can see what was done, what the results of test etc were, and how it was left. It's up to me if I choose to fulfill or take the meds (if) recommended and follow-up further if required. But I've never seen a bill for what I've described, whether in the office, or "emerg". Nor has my wife for the birth of our kids (one via Caesarian) or any other procedure that was needed.
It's not perfect, but I can make it work.
I get that it sounds terrible that I can't see my designated health care provider that day, or the next for something unless it's acute, unusual, and causing immediate distress. In that case, if I can't get into my provider's clinic (because her time is fully committed), they'll recommend that I go to "emerg". There, I'll be triaged, and ultimately be examined and treated in accordance with my issue as compared to the others present. Sometimes I've been ushered straight in, sometimes I've had to wait for several hours. In each case however, if further examination - medical imaging in its variety of forms, medication or splinting, stitches, blood work - is required, I'm slotted into the next available space (never more than a couple of hours) and treated accordingly. Whatever is required is logged into "the system" and any health care provider who subsequently looks into what's transpired with me can see what was done, what the results of test etc were, and how it was left. It's up to me if I choose to fulfill or take the meds (if) recommended and follow-up further if required. But I've never seen a bill for what I've described, whether in the office, or "emerg". Nor has my wife for the birth of our kids (one via Caesarian) or any other procedure that was needed.
It's not perfect, but I can make it work.
18
Right on,Brian J !
1
The truth is that we spend much of our healthcare dollar supporting very rich insurance and pharmaceutical companies, period. We need to go to a single payer system where our good MDs, nurses and other providers can do the work they were trained to do. We need to provide our medical research scientists with the funding they need to advance medicine through research. There is enough funding available, the issue is some very wealthy executives and their stockholders take off with these funds leaving the system, the providers and patients scrambling for crumbs.
18
Our healthcare system needs work. Wouldn't it be great to do a thorough analysis, a fact-based, data-driven, apolitical assessment by experts and consumers, to determine goals and possibilities? We would be fools to just import a system from another country, because we are not like other countries, in so many ways.
We are not a tiny speck of a nation such as Sweden or Denmark where the citizens are able to rub shoulders with elected leaders and look them straight in the eye -- they are as many as 6,000 miles away, virtually unreachable, nor do they really know us or where we live. So much for accountability.
We are a highly diverse population, not a monoculture like those Scandinavian nations, and we have the issues of inner cities and the southern states where poverty and violence and the attendant health risks draw down national life expectancy and infant survival rates.
As a nation we are a fat people and have been that way longer than other nations, having blazed the trail in that category. Maybe we also rely on cars more, which comes with its own distinctive health risks and outcomes.
My point is, rather than simply assume we can successfully plug-and-play the healthcare system of some other nation, let's really drill down first and talk about what OUR citizenry needs and wants, what we are willing to pay for, and what would be the best option(s) for delivering the care and funding it.
We are not a tiny speck of a nation such as Sweden or Denmark where the citizens are able to rub shoulders with elected leaders and look them straight in the eye -- they are as many as 6,000 miles away, virtually unreachable, nor do they really know us or where we live. So much for accountability.
We are a highly diverse population, not a monoculture like those Scandinavian nations, and we have the issues of inner cities and the southern states where poverty and violence and the attendant health risks draw down national life expectancy and infant survival rates.
As a nation we are a fat people and have been that way longer than other nations, having blazed the trail in that category. Maybe we also rely on cars more, which comes with its own distinctive health risks and outcomes.
My point is, rather than simply assume we can successfully plug-and-play the healthcare system of some other nation, let's really drill down first and talk about what OUR citizenry needs and wants, what we are willing to pay for, and what would be the best option(s) for delivering the care and funding it.
4
The problem with US healthcare is profit. Should I profit from your grief, or you from mine? Corporate executives seem to think so. Make no mistake -- it is not the almighty shareholder who is driving this. It is management in collusion with "Wall Street". Good luck to changing that.
We have a system that works pretty well for those enrolled. It's called Medicare.
There is a fundamental flaw in our healthcare system: it's for-profit based. In other sectors of the economy demand is regulated by cost: if something is priced too high, demand falls and the price will be lowered until demand rises. But with healthcare, this model is skewed. People will pay whatever they possibly can to gain access to healthcare - in other words, regardless if the price is too high, demand will remain high, or at least high enough to return fat profits. Sure, some will be unable to afford the care they need, but as they drop out of the market, their "lost profit potential" is made up for by others who can afford the costs. There is no incentive, as in other products. to reduce costs.
One answer would be to get rid of all insurance, and make people pay out of their own pockets. This would likely drive costs down, but still not enough to allow most people to afford care.
The only viable alternative is to provide insurance for everyone - Medicare For All. Until we accept this fact, our health "care" system will remain broken.
One answer would be to get rid of all insurance, and make people pay out of their own pockets. This would likely drive costs down, but still not enough to allow most people to afford care.
The only viable alternative is to provide insurance for everyone - Medicare For All. Until we accept this fact, our health "care" system will remain broken.
15
Couldn't agree more, and find it really unfair somehow that western Europe, Scandinavia provide essentially single payer full service medical care for their citizens, while most Americans struggle to find any health care insurance.
And the burden on American seniors is terrible: why should someone on Medicare have to worry, struggle, and ultimately not be able to afford a high quality hearing aid, or get annual quality vision exams and glasses???
And the burden on American seniors is terrible: why should someone on Medicare have to worry, struggle, and ultimately not be able to afford a high quality hearing aid, or get annual quality vision exams and glasses???
7
I would like to quote David Souter:
“What I worry about is, when problems are not addressed and the people do not know who is responsible … some one person will come forward and say, ‘Give me total power and I will solve this problem,’” ... http://to.pbs.org/2dQqiTI
Dr. Carroll, you have outlined the problems that have yet to be addressed, yet failed to point out who is responsible. Saying "Americans" are still litigating whether to go back to the previous system is a major cop out. Americans?. There is one political party in this country who's definition of healthcare reform is finding ways for healthy people to avoid subisidizing sick ones, as can be seen for every proposal they have, from expanding health savings accounts to allowing insurers to skirt state regulations by allowing competition "across state lines", to encouraging young people to avoid buying health insurance and opposing a mandate to buy insurance, to rejecting raising taxes to fund healthcare for poorer people to refusing to expand medicaid. There was one party that refused to take part in healthcare reform, refused to cast one vote in favor of it and is litigating it at every opportunity. They are not called the "American" party, they are called the "Republican" party, and they keep lying to people when they say they have better solutions, but because only a few people are willing to say that, those people are labeled as shrill and partisan. Stop giving cover to these people and say the truth.
“What I worry about is, when problems are not addressed and the people do not know who is responsible … some one person will come forward and say, ‘Give me total power and I will solve this problem,’” ... http://to.pbs.org/2dQqiTI
Dr. Carroll, you have outlined the problems that have yet to be addressed, yet failed to point out who is responsible. Saying "Americans" are still litigating whether to go back to the previous system is a major cop out. Americans?. There is one political party in this country who's definition of healthcare reform is finding ways for healthy people to avoid subisidizing sick ones, as can be seen for every proposal they have, from expanding health savings accounts to allowing insurers to skirt state regulations by allowing competition "across state lines", to encouraging young people to avoid buying health insurance and opposing a mandate to buy insurance, to rejecting raising taxes to fund healthcare for poorer people to refusing to expand medicaid. There was one party that refused to take part in healthcare reform, refused to cast one vote in favor of it and is litigating it at every opportunity. They are not called the "American" party, they are called the "Republican" party, and they keep lying to people when they say they have better solutions, but because only a few people are willing to say that, those people are labeled as shrill and partisan. Stop giving cover to these people and say the truth.
17
Healthcare costs are much too high and results are not as good as they could be. There is not enough competition and healthcare is a natural monopoly and should be offered as a common good by an agency created by the Federal Government.
From what I have experienced with Medicare, my feelings are that it is a great service and very efficient. If we could enact Medicare for All, eliminate Medicaid, and the participation of both States and private insurers in the system, we would be much better off and the wellness of our society would improve.
To take care of everyone, Medicare would need to be expanded. Where would the money come from: socialized lower costs of healthcare professionals, a variety of public clinics and diagnostic and treatment centers, with salaried personnel.
The education of healthcare professionals and salaries would be similar to uniformed military personnel. Compensation would be determined by rank, awarded for performance, and expertise. The system we have is evidence that private sector healthcare delivery, and with steadily increasing cost as a share of the economy, does not work.
Costs were rising prior to Obamacare and the hybrid system does not held down costs. The system will not heal itself, so government must intervene. This means an expansion of the payroll deduction for Medicare. I think it must be expanded and treated as a progressive payroll tax on all Americans. This new system must be phased in. In a decade or so.
From what I have experienced with Medicare, my feelings are that it is a great service and very efficient. If we could enact Medicare for All, eliminate Medicaid, and the participation of both States and private insurers in the system, we would be much better off and the wellness of our society would improve.
To take care of everyone, Medicare would need to be expanded. Where would the money come from: socialized lower costs of healthcare professionals, a variety of public clinics and diagnostic and treatment centers, with salaried personnel.
The education of healthcare professionals and salaries would be similar to uniformed military personnel. Compensation would be determined by rank, awarded for performance, and expertise. The system we have is evidence that private sector healthcare delivery, and with steadily increasing cost as a share of the economy, does not work.
Costs were rising prior to Obamacare and the hybrid system does not held down costs. The system will not heal itself, so government must intervene. This means an expansion of the payroll deduction for Medicare. I think it must be expanded and treated as a progressive payroll tax on all Americans. This new system must be phased in. In a decade or so.
10
Medicare for All would be end the current multi-layered hybrid system. The "trick" to fund it would be to have all the current dollars spent for health insurance (essentially all the money going to private insurance companies, Medicaid, and other government healthcare, programs except the VA) go into funding Medicare for ALL.
It's an old adage in business: if you want to save money, cut out the middleman. That middleman is insurance companies. They've got to go.
It's an old adage in business: if you want to save money, cut out the middleman. That middleman is insurance companies. They've got to go.
1
The Obama administration went to great lengths to silence citizens who were calling for a public health insurance option. They were intent on pleasing the insurance industry.
Hillary Clinton will not be one iota better.
Without a strong grass-roots movement nothing will happen. Corporate Democrats have nothing to gain from universal health care, but they have a lot of campaign contributions from insurance executives to lose.
Hillary Clinton will not be one iota better.
Without a strong grass-roots movement nothing will happen. Corporate Democrats have nothing to gain from universal health care, but they have a lot of campaign contributions from insurance executives to lose.
10
True (the latter), but I recall hearing Barak himself pushing health exchanges "with a public option to keep the others honest," which, if true, puts the blame on blue-dog Democrats intimidated by the uniformly intransigent Republican opposition of the time.
Here's hoping that Bernie Sanders and Elizabeth Warren will prevail on Clinton administration to implement effective, AFFORDABLE single payer. It is terrible to know that older people have to sometimes bankrupt themselves to get needed healthcare.
1
Hillary Clinton had to be loyal to President Obama. She may favor more radical changes. What she can achieve mainly depends from Congress though.
As a physician-scientist who works and oversees a group of fairly well-paid subspecialists, I can tell you that many a doc will eventually give in to a single payer system. The current course we are on is not sustainable. Also, the journalists never discuss the fact that we have so few physicians conducting basic biomedical research because it's not practical. Every voter should know that in passing the ACA our republican friends have held the health and human services annual appropriations hostage. This is denying funds to the CDC, NIh, etc. Consequently many Americans don't realize how grossly medical research has been underfunded in this country for the past 13 years. We are also exporting or outsourcing such work to china, Japan, Singapore, and Korea. This is never discussed in election debates. Medical education is also ridiculously costly. Big pharma has capitalized on research discoveries made in university labs and less likely by big pharma. The ACA has problems no question. However so did Medicare years following its inception. All of this would require adults in congress to get to work. Notice I said adults.
79
While Dr. Carroll knows a lot about health issues, he knows much less about healthcare as a comparative social policy issue. In his comparison, he either didn't know or chose not to mention that the U.S. has the most market-oriented private system, which is what causes it to be the most expensive on a per capita basis in the world. That includes its doctors being the highest paid in the world. Add to that the charges of private for-profit pharmaceutical companies, hospitals, and insurance companies. The only way this system can continue and achieve full health care coverage at reasonable cost will be if there is serious government regulation to bring the prices down to the levels in other industrialized countries.
21
It's incredibly tiresome to see established evidence relitigated over and over again: most highly developed countries provide better health care outcomes at far lower cost than the US, and they do so with a single payer system.
This is as well established as the fact that the earth moves around the sun. (Hint: these countries don't waste untold billions on direct-to-consumer advertising by pharma & insurance companies, or on executive pay, or on massive overhead and denial-of-coverage machineries for dozens of private insurers.)
You would think that Republicans, who are all about competition, would learn from the global competition that is beating us hands down in this respect. But no: if the facts don't fit their theory, the facts must be wrong. At the cost of hundreds of thousands of lives, and of billions of dollars, year after year after year after year. SAD! (As you-know-who would say.)
This is as well established as the fact that the earth moves around the sun. (Hint: these countries don't waste untold billions on direct-to-consumer advertising by pharma & insurance companies, or on executive pay, or on massive overhead and denial-of-coverage machineries for dozens of private insurers.)
You would think that Republicans, who are all about competition, would learn from the global competition that is beating us hands down in this respect. But no: if the facts don't fit their theory, the facts must be wrong. At the cost of hundreds of thousands of lives, and of billions of dollars, year after year after year after year. SAD! (As you-know-who would say.)
28
We must learn from our neighbors to the North and the Europeans. Since post-WWII they present us a half century study of how it's done. The problem, as author T R Reid wrote, is that we must decide on one system and stick with it. What Reid wrote is that the US has a mishmash of plans, some borrowed from the UK (Tricare) another more Swiss-like, and so on. Each blends varied pieces of other countries plans, and that's the rub.
Instead of a pick and choose approach, from an assortment of many different programs, we need to do the opposite. The sum of all health care programs is not greater than the individual health care system.
Hillary's single payer option is a step in the right direction. Bernie's proposal for universal health care went even further. We would do better with both. If Republicans had not been so obstructive, promising to work with President Obama when their intentions were to do the complete opposite, actually sabotaging the PPACA to ensure its failure, blame Barack, then repeal it, then win the 2016 election.
Didn't quite work out that way except of course we the people got left holding the bag. Now it will be up to Hillary. Maybe this time we will see the light. We can have what other nations have, if we want it. Oppose Republicans who tell you it's pie-in-the-sky. It's not, they're fibbing.
Other countries, far less great as we, can do it. Why can't we?
DD
Manhattan
Instead of a pick and choose approach, from an assortment of many different programs, we need to do the opposite. The sum of all health care programs is not greater than the individual health care system.
Hillary's single payer option is a step in the right direction. Bernie's proposal for universal health care went even further. We would do better with both. If Republicans had not been so obstructive, promising to work with President Obama when their intentions were to do the complete opposite, actually sabotaging the PPACA to ensure its failure, blame Barack, then repeal it, then win the 2016 election.
Didn't quite work out that way except of course we the people got left holding the bag. Now it will be up to Hillary. Maybe this time we will see the light. We can have what other nations have, if we want it. Oppose Republicans who tell you it's pie-in-the-sky. It's not, they're fibbing.
Other countries, far less great as we, can do it. Why can't we?
DD
Manhattan
10
One problem as well is that in large clinics primary care doctors can get paid for the size of their "panel" ( the number of patients they have who list them as their primary doctor ). There is no added incentive then for the primary doctor to see their patients when they get sick as they have already been paid, and the doctor's schedule is now full with other "panel" patients, so the patient loses out in this "musical chairs" appointment system & has to use the ER or Urgent Care. The primary care doctor still gets paid for not seeing these patients.
4
Trails... that puts it generously! At age 36 just over 10 years ago, I returned to the United States after having worked in Europe where I received excellent medical care a little cost.
Having a pre-existing condition I could not buy health insurance for any price. So I took a contract to hire position with a Fortune 500 company with the goal of getting health insurance as soon as possible. Two months before I was ultimately hired I broke my hip. The first question the paramedics asked me before picking me up off the ice was "Do you have health Insurance?" Thank goodness I lied. The orthopedic surgeon told me after the surgery that had I not lied, I would have lost my leg.
Instead, having lied that fateful day, I have my leg and I have since hiked in the Himalaya. I also lost my life savings paying the medical bills. America's healthcare should be compared to the third world. It is a disgrace in the country as wealthy as ours.
Having a pre-existing condition I could not buy health insurance for any price. So I took a contract to hire position with a Fortune 500 company with the goal of getting health insurance as soon as possible. Two months before I was ultimately hired I broke my hip. The first question the paramedics asked me before picking me up off the ice was "Do you have health Insurance?" Thank goodness I lied. The orthopedic surgeon told me after the surgery that had I not lied, I would have lost my leg.
Instead, having lied that fateful day, I have my leg and I have since hiked in the Himalaya. I also lost my life savings paying the medical bills. America's healthcare should be compared to the third world. It is a disgrace in the country as wealthy as ours.
83
I flat-out do not believe the excellent Seattle healthcare community would violate federal law and turn away an emergency patient for any reason, especially ability to pay. Regardless, I am glad you received good care, were able to pay for it and still be able to afford international recreational travel.
5
Judy,
In forty years of medical practice, if I had a buck for every time I have seen this happen, I could pay current Med school tuition. Belief and disbelief both pale before reality.
In forty years of medical practice, if I had a buck for every time I have seen this happen, I could pay current Med school tuition. Belief and disbelief both pale before reality.
9
When, oh when, will those who suffer most from our nation's economic and financial arrangements even begin to acknowledge that we might profit from the social-democratic experiments already successfully run in more enlightened countries.
I recently heard the following on public radio: If you want to live the American dream, double your prospects of doing so by moving to Canada!
No wonder Liz Cheney is such a critic of the public airways!
I recently heard the following on public radio: If you want to live the American dream, double your prospects of doing so by moving to Canada!
No wonder Liz Cheney is such a critic of the public airways!
12
The rest of the advanced world has come to the conclusion that health care by its very nature is a public utility -- not the equivalent of the art market or the commodities exchange. By cost and successful outcomes, it seems they are proving their point. The question is how much longer will it take for the US to catch on? I'm waiting for champions of the free market to suggest the military should be totally privatized and that life insurance companies should be deregulated. Don't hold your breath on either. Even Republicans aren't that stupid.
8
But the military has been privatized to a considerable extent in terms of support services, etc.--and remember all the private contractors providing transportation services and security in Iraq?
A key dimension is missed on the US Canada comparison, namely that the US spends over 17 percent of GDP while Canada only spends in the 10.2 percent range on health care. The differential does not seem to have substantially changed since the passing of Obamacare. Canadians are healthier and live longer. So the big question is: are the variables or factors noted in the article particularly useful, and do they justify the cost differential? Alternatively, what services could the single payer system in Canada provide if we were willing to have health care consume 17 percent of the GDP.
10
It's not that we can't have a discussion. It's that the insurance lobby and Big Pharma hold unchecked power. Being required to buy insurance is like being required to do business with the Mafia. They raise rates and deny care. They can make changes unilaterally anytime but we wait till open season.
16
In my opinion the American health care system is a legalized extortion racket, with multiple points of wealth extraction.
It is an absolute disgrace.
It is an absolute disgrace.
68
As someone who has extensive experience in the US and Canadian systems I am here to tell you that it isn't even close, that Canada's is better for the poor and ordinary working people.
Can I get a same day appointment with my GP? No, I cannot, and who cares? I will see one of her colleagues the same day, and it will cost me nothing out of pocket.
Can I get a same day appointment with my GP? No, I cannot, and who cares? I will see one of her colleagues the same day, and it will cost me nothing out of pocket.
33
There is no way the American health care can be fixed without breaking a lot of rice bowls. It's generating too much money for too many powerful people. We have to pry it away from them to fix it. Fat chance.
7
Every other industrialized country (except Switzerland) has something like single payer. Basically every one of them, including Canada, beats the US on life expectancy, covers everyone, and does it much more cheaply than the US.
The economics are simple: people cannot shop on price for healthcare, for a variety of reasons, so there is no downward pressure on prices. If there's no downward pressure on prices, and you die if you don't pay, then you get expensive health care. Single payer systems have the government negotiate with drug companies and providers on behalf of citizens, which keeps costs down.
Look at prop 61 in California, where the state wants to peg drug prices by those paid by the VA. The pharmaceutical industry is spending $100 million lobbying against this, which should tell you that they will lose over $100m if it passes. VA prices are not low by international standards, which should let you know how messed up the system currently is.
The economics are simple: people cannot shop on price for healthcare, for a variety of reasons, so there is no downward pressure on prices. If there's no downward pressure on prices, and you die if you don't pay, then you get expensive health care. Single payer systems have the government negotiate with drug companies and providers on behalf of citizens, which keeps costs down.
Look at prop 61 in California, where the state wants to peg drug prices by those paid by the VA. The pharmaceutical industry is spending $100 million lobbying against this, which should tell you that they will lose over $100m if it passes. VA prices are not low by international standards, which should let you know how messed up the system currently is.
55
People who understand health care finance would never design a system like the ACA. It was a political compromise. The concept that is that somehow "competition" would lower costs. Health insurance is really pretty simple: you get claims from providers and pay them. That was the way it was when health insurance started as a social movement (Blue Cross and Blue Shield) during the depression. Everybody paid the same price. You summed up all the claims, divided by the number of people and you had a premium. But it changed when people figured out you could make more money by selecting healthier people compared to your competitors Then we went through a revolution in care delivery and education. Costs exploded. Fast forward to today and you have huge health systems that dominate markets and can demand higher and higher prices without much demonstration of improvement of outcomes. All the ACA really did was eliminate risk selection and provide subsidies to lower income people. It did not, nor was it designed to, address health care cost inflation which is a delivery system problem. Until we get a single reimbursement system that controls the increase in health care costs for all payers, we will not get this problem solved.
13
Why is this still an issue? 20 years and more the complaints have been the same. Health insurance is a racket and a shakedown - you have to pay because the alternative is unthinkable, but god forbid you should actually need it. I appreciate the ACA's attempt to address some of the glaring problems with our system, but I hate the bone it tossed to insurance companies.
Single payer! For goodness sake, there's a reason the rest of the world does it that way! ALSO - make it real insurance, for real emergencies or chronic conditions - the way car insurance works. People could pay for ordinary and predictable expenses. If regular people were paying, that would be an incentive to force prices back into the normal realm instead of they hyperinflated stratosphere to which insurance has driven them.
Single payer! For goodness sake, there's a reason the rest of the world does it that way! ALSO - make it real insurance, for real emergencies or chronic conditions - the way car insurance works. People could pay for ordinary and predictable expenses. If regular people were paying, that would be an incentive to force prices back into the normal realm instead of they hyperinflated stratosphere to which insurance has driven them.
37
Lower numbers of physicians = ability to charge higher prices.
Average income of US GP: $161K
Average income of US specialist MD: $230K
Now look at how doctors in Europe compare:
http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-othe....
Specialists in Germany: $77K! That's 1/3 of what specialists make in the US.
That's how they can have reasonable costs for the medical plans, which are not single-payer, but a system of medical insurance similar in some ways to the ACA, only you can chose a much more basic plan than the ACA allows.
Average income of US GP: $161K
Average income of US specialist MD: $230K
Now look at how doctors in Europe compare:
http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-othe....
Specialists in Germany: $77K! That's 1/3 of what specialists make in the US.
That's how they can have reasonable costs for the medical plans, which are not single-payer, but a system of medical insurance similar in some ways to the ACA, only you can chose a much more basic plan than the ACA allows.
5
With health care at over 15% of GDP now, that's a lot of high paying jobs that are not going down without a well funded fight.
8
Jonathan- you must also consider the $330,000 in medical school debt and lost wages from 12 plus years of post grad training, American doctors must fund their own pensions, & pay for their own (!) medical insurance, and in general work far more hours than their European counterparts (certainly compared to UK, France )
Friom Today's NY TImes
"Some Health Plan Costs Will Rise Sharply, U.S. Says"
"Premiums for midlevel plans under the Affordable Care Act will rise by an average of 25 percent next year, and some consumers will find much fewer insurance options, all but ensuring that the next president will need to alter the health law significantly."
Yes, the next President will have reform on her plate. Good luck with a Republican Congress.
More generally, it is incomprehensible how poorly the ACA was thought out by the Obama administration given the numerous examples of successful insurance plans abroad.
Fir example the Germans have Unversal Health Insurance since 1883 - one could surely assume they worked out the kinks by now,
But we are dealing with American exceptionalism, not invented here, and an aloof President who firmly believes he is the smartest guy in the room.
http://www.theatlantic.com/health/archive/2014/04/what-american-healthca...
"Some Health Plan Costs Will Rise Sharply, U.S. Says"
"Premiums for midlevel plans under the Affordable Care Act will rise by an average of 25 percent next year, and some consumers will find much fewer insurance options, all but ensuring that the next president will need to alter the health law significantly."
Yes, the next President will have reform on her plate. Good luck with a Republican Congress.
More generally, it is incomprehensible how poorly the ACA was thought out by the Obama administration given the numerous examples of successful insurance plans abroad.
Fir example the Germans have Unversal Health Insurance since 1883 - one could surely assume they worked out the kinks by now,
But we are dealing with American exceptionalism, not invented here, and an aloof President who firmly believes he is the smartest guy in the room.
http://www.theatlantic.com/health/archive/2014/04/what-american-healthca...
5
Germany has a compulsory insurance system similar to the ACA. Their real secret is very low salaries for doctors. Germany doctors make about 35% of what doctors in the US make.
2
Doctors in private practice make good money in Germany. Hospital employed physicians can still enjoy a good life, as education is free. There are less discrepancies between specialist income and primary care physicians.
16
Obama pushed through the plan he could get passed. Seven or eight years ago, single payer was NOT on the table. No way, no how would that have passed. Blame the Republicans, not Obama.
14
I never have trouble getting a same day appt with my primary care physician. On the other hand, I don't care who I see in her office. I'm part of a PPO. If I see a participating doctor I pay a $20 co-pay. The couple of times I've needed to see someone and realized it was after office hours, then I can go to a participating urgent care center. That costs more $80 co-pay but still less than an ER. And if you feel bad enough, you'll pay it.
I have more trouble getting same day appts with a dentist. Again, part of a PPO. Horrors. Things like a broken front tooth (made to wait all day until the end of the day, then when she would see me wouldn't treat me (referred me to her "friend" but I had to wait until the next day. The one I did end up going to but nervously looked at her mother in law (or office mgr., who knows) asking if I could afford to pay $300 for a temporary crown (YES!!) and I had dental coverage. Then when returning for the perm crown, all financial arrangements made I thought - insurance confirmed they would pay and I had my portion and they had assured me that we were all straight on the amount owed - they tried to force me to pay not only my part but the insurance company's as well - up front - before they would even see me
No, I've been fortunate on the medical part. It's the dental stuff that scares me
I have more trouble getting same day appts with a dentist. Again, part of a PPO. Horrors. Things like a broken front tooth (made to wait all day until the end of the day, then when she would see me wouldn't treat me (referred me to her "friend" but I had to wait until the next day. The one I did end up going to but nervously looked at her mother in law (or office mgr., who knows) asking if I could afford to pay $300 for a temporary crown (YES!!) and I had dental coverage. Then when returning for the perm crown, all financial arrangements made I thought - insurance confirmed they would pay and I had my portion and they had assured me that we were all straight on the amount owed - they tried to force me to pay not only my part but the insurance company's as well - up front - before they would even see me
No, I've been fortunate on the medical part. It's the dental stuff that scares me
3
"Many are still unhappy with Obamacare."
Most unhappy Americans are clueless whiners.
The G.O.P. alternative health insurance plan is that THERE IS NO PLAN.
The G.O.P. plan is to repeal Obamacare and replace it with NOTHING>
Most unhappy Americans are clueless whiners.
The G.O.P. alternative health insurance plan is that THERE IS NO PLAN.
The G.O.P. plan is to repeal Obamacare and replace it with NOTHING>
80
Having been through both US and Canadian health systems, there are pros and cons to both, but the most significant issue is glaring and obvious: cost.
We pay high taxes in the province of Quebec, but I can sleep well at night because I don't have to worry about paying $250+/month to maintain a health insurance, or that I'd have to shell out $9000 in deductibles out of my own pocket before my health insurance starts kicking in, only to realize that you're not even covered 100% until you reach your out of pocket maximum. Even then, there are contingencies.
Thankfully, I'm a healthy person and have rarely needed to go to the clinic. I don't have a PCP, but I've been satisfied with the numerous walk-in clinics, and have made the rounds in minor ER at the hospitals. The worst part is the wait, but can't really complain about anything else. I never paid more than $30 for prescriptions and never forked a dime over x-rays and other tests that I know have cost me thousands in the US.
ACA does not address the high cost of health care in the US, hence it fails American patients. It doesn't help to reduce the outrageous price gouging hospitals, doctors, and pharmaceuticals have set up. You're covered by insurance? Great! You still have to pay $600 for epipens. We get ours for $100.
As long as the healthcare industry keeps up with these outrageous prices, you will continue to have poor healthcare across the country.
We pay high taxes in the province of Quebec, but I can sleep well at night because I don't have to worry about paying $250+/month to maintain a health insurance, or that I'd have to shell out $9000 in deductibles out of my own pocket before my health insurance starts kicking in, only to realize that you're not even covered 100% until you reach your out of pocket maximum. Even then, there are contingencies.
Thankfully, I'm a healthy person and have rarely needed to go to the clinic. I don't have a PCP, but I've been satisfied with the numerous walk-in clinics, and have made the rounds in minor ER at the hospitals. The worst part is the wait, but can't really complain about anything else. I never paid more than $30 for prescriptions and never forked a dime over x-rays and other tests that I know have cost me thousands in the US.
ACA does not address the high cost of health care in the US, hence it fails American patients. It doesn't help to reduce the outrageous price gouging hospitals, doctors, and pharmaceuticals have set up. You're covered by insurance? Great! You still have to pay $600 for epipens. We get ours for $100.
As long as the healthcare industry keeps up with these outrageous prices, you will continue to have poor healthcare across the country.
60
ACA was supposed to contain costs and make health care affordable. It did bring coverage to 20 million but 30 million remain uninsured. Data indicate that the bad outweighs the good. It’s too expensive, unsustainable, overly complex and bureaucratic. Even worse, it’s a gift to private insurers and other corporate stakeholders and profiteers in the medical-industrial complex, (eg the health costs for a family of 4 covered by an average employer PPO are now $25,000!). We could save $500 billion a year by enacting a nonprofit, single-payer, Medicare for All national health insurance program. Those savings would be enough to guarantee everyone high-quality care, with no cost sharing, on a sustainable basis.
25
This is easy as it relates to everything else and that is legalized bribery in our government. If they need something they just call up their lobbyist and when the representative shows up their wants are communicated and the respective party gets another cash infusion. Until that's fixed our whole system of government will be run by the corporatists or shadow government.
7
I had facial skin cancer that the local surgeon tried to remove, but failed to remove totally, as subsequent tests showed.
By then , it had spread, underneath the skin so extensively that I was tolld it would require a specialist, a cosmetic surgeon to deal with it .
That when I learned that no cosmetic surgeon within travel range in my State (NYS) would accept Medicare patients. None.
I had to travel out of State, 200 miles, to find someone willing to do it.
Health insurance, even under Medicare for all, does NOT equal health care access.
By then , it had spread, underneath the skin so extensively that I was tolld it would require a specialist, a cosmetic surgeon to deal with it .
That when I learned that no cosmetic surgeon within travel range in my State (NYS) would accept Medicare patients. None.
I had to travel out of State, 200 miles, to find someone willing to do it.
Health insurance, even under Medicare for all, does NOT equal health care access.
21
i had an extensive basal cell cancer just under my eye that was removed by a MOHs surgeon which left a large wound. I then that same day had reconstructive surgery by a Oculoplastic surgeon. Both surgeries were paid for by Medicare plus my gap insurance. I had no problem arranging for both surgeries at UCLA Hospital. I would think that any large city teaching hospital would have equally good and accessible surgeons, including in New York state.
2
I do have health insurance but the copays and exemptions have risen to the point where I won't make an appointment to see a doctor until I feel the situation is life threatening.
Perhaps that was the point of the Obama reform. If it was, it succeeded
Perhaps that was the point of the Obama reform. If it was, it succeeded
11
There is little emphasis on prevention, regular wellness checkups in most of the US systems. A little prevention and caring go a long way toward a healthy population!
One wonders why Congress does not simply open to all interested citizens the excellent group plan available to their own family members and to all federal employees? It is identical to, and underwritten by, the same suppliers who manage the health care plans that our largest companies sponsor for their own employees. Nothing radically new needed! Simply extend use of what already is there. Improve it, to allow coverage for the less affluent, via some separate funding which we also already have via Medicaid.
One other long-overdue improvement would be to make all premiums fully deductible on our income tax.
Come on Congress folks get with it!
One other long-overdue improvement would be to make all premiums fully deductible on our income tax.
Come on Congress folks get with it!
24
Re "Americans are still litigating whether to return to the previous system" and "Access was/is a problem ..." - is it really a question (at least in some people's minds) of giving "access" to the "wrong" people?
3
Are you referring to undocumented aliens? If so, it's much cheaper to give them good primary care through a nurse practitioner than it is to wait until they fall into an emergency room with a systemic disease. remember - intensive care can cost $40-80,000 a day. Yes, A DAY. You can hire a full-time nurse practitioner to manage basic preventive and interventional care for thousands of "wrong" people for $80,000/year and maybe avoid 50+ systemic cases out of an underserved base of 3-4,000. This is why community-based public health, which is woefully underfunded n the US, makes such a critical contribution to the system from everyone's perspective. The math is pretty simple. The "wrong" people are already here. They are not going to travel home for major medical problems so, unless you want to pay for them through your premiums, do the smart thing. Keep in mind that about 50% of undocumented workers pay taxes.
7
Healthcare system bleeding us to death by design: http://www.centerforhealthjournalism.org/2016/10/22/us-healthcare-system...
1
Until the wealthy pay their 35% taxes, without loopholes, and the money is wisely used to fund the true needs of our entire nation, we will never solve this problem. The US is already sliding downward, and it is corporations, wealthy, and Republicans who are to blame. Your vote can make the big difference in whether we stay, or whether we go.
15
Actually, there is so much waste and overuse in the health system that you could find an overhaul by just making it rational. Focus #1: obesity. If you find that there is an upfront shortage and want to make the right people pay, tax cigarettes, high-calorie foods and manageable obesity through the roof. I am not defending the inequities of the tax and wealth situation in America, but taxing the rich and the corporations doesn't do anything to address the nation's real health issues.
3
You might want to make fast friends with the office biller, because there’s some discretion involved in insurance coding.
3
I really think that the NY Times needs to revise their style sheet to require all articles to write health insurance as "health insurance." Yes, I have "employer based" "health insurance" that cost ME around $4,000/year in premiums and a $5,000 yearly deductible. Almost everyone else I know has a similar plan. So, yeah, I have "access," if I want to pay extra for it, but I can't always do it. Really, we are third world in our health care system. We shouldn't be compared to "other industrialized nations" since it really is no comparison.
46
Paolo--Any info on how much you make, how old you are, how many are insured, PPO or HMO? Considering that a minor heart attack could cost you about $130-150,000, $9000/yr sounds like it could save you from bankruptcy. If more well, young people would sign on, premiums would be lower. What ever happened to the penalties for not having insurance?
6
The biggest availability problem stems from greed. Most physicians think they are a superior class that deserves extremely high compensation.
12
"Yet years after the Affordable Care Act was passed, Americans are still litigating whether to return to the previous system."
Are you kidding me. You mean the previous system in which we can be denied a policy for having a history of hangnails?
Are you kidding me. You mean the previous system in which we can be denied a policy for having a history of hangnails?
26
Dr. Carroll,
You claimed that the United States has a shortage of primary-care doctors, but you didn't account for the reasons. The main one is that they are poorly paid compared with specialists, such as surgeons, who make millions of dollars a year. These surgeons practice a kind of industrial or factory medicine. One eye surgeon in the Boston area claims he has performed 50,000 cataract operations. He does one every 10-15 minutes, turning every other responsibility--aftercare, follow-up,eye-testing to about 20 assistants and under-doctors. Like any for-profit CEO, he vigorously advertises his services, including the selling of glasses and other eye-ware.
Factory medicine seems the wave of the future for doctors who perform procedures, such as surgery, radiology, CT-scans. The doctors who are pioneering factory medicine are the Alfred P. Sloans of the medical world.
Is this what American medicine--the medicine of great doctors, such as William Osler, William H. Welch, Harvey Cushing, Walter Dandy, and Sidney Farber--has come to?
You claimed that the United States has a shortage of primary-care doctors, but you didn't account for the reasons. The main one is that they are poorly paid compared with specialists, such as surgeons, who make millions of dollars a year. These surgeons practice a kind of industrial or factory medicine. One eye surgeon in the Boston area claims he has performed 50,000 cataract operations. He does one every 10-15 minutes, turning every other responsibility--aftercare, follow-up,eye-testing to about 20 assistants and under-doctors. Like any for-profit CEO, he vigorously advertises his services, including the selling of glasses and other eye-ware.
Factory medicine seems the wave of the future for doctors who perform procedures, such as surgery, radiology, CT-scans. The doctors who are pioneering factory medicine are the Alfred P. Sloans of the medical world.
Is this what American medicine--the medicine of great doctors, such as William Osler, William H. Welch, Harvey Cushing, Walter Dandy, and Sidney Farber--has come to?
17
Poorly paid? The average earnings of a GP in the US are $161K. That's about 4.5 times the average salary of all workers. How much do you think they should be paid? And if they make so much money, how can their patients possibly afford to pay them?
4
For those of you who love the public option (universal government run healthcare), my guess is that none of you have experienced healthcare from the VA. The inefficiency and indifference is monumental - especially in management all the way to the top. Tragecially, it has been this way for all of my adult life. (Vietnam vet)
Unlike many of you responding, I am certain a market based/universal alternative to ACA can achieve all of goals of serving the uninsured and prior illness patients with more patient centered care at a lower cost. Just imagine if drug companies were required to sell in the US at the "favored nation" lowest price. What if geographical barriers to insurance companies were eliminated overnight. Why are all patients old enough to drive have a chip inserted in the body that could provide 90% of the information that every doctor now has to duplicate. Patient information would be automatically update in the checkout process.
The 20 million who are now served under ACA can continue with government subsidies with this program managed by each state. No one falls through the cracks.
Sadly, under ACA we are paying $100 billion to fix a $20 billion problem. Eighty percent of US population is receiving worse care at sharply higher prices. Can America do better?
Unlike many of you responding, I am certain a market based/universal alternative to ACA can achieve all of goals of serving the uninsured and prior illness patients with more patient centered care at a lower cost. Just imagine if drug companies were required to sell in the US at the "favored nation" lowest price. What if geographical barriers to insurance companies were eliminated overnight. Why are all patients old enough to drive have a chip inserted in the body that could provide 90% of the information that every doctor now has to duplicate. Patient information would be automatically update in the checkout process.
The 20 million who are now served under ACA can continue with government subsidies with this program managed by each state. No one falls through the cracks.
Sadly, under ACA we are paying $100 billion to fix a $20 billion problem. Eighty percent of US population is receiving worse care at sharply higher prices. Can America do better?
1
Richard - The VA is an anomaly. The range of problems it treats and the bureaucracy it uses to manage is surreal and does not compare to the general health system. If you want to compare to a government system, compare to Medicare which is the largest public payor, offers a number of different plans for people and enjoys a high level of satisfaction among beneficiaries. It is also the wellspring for innovation in health insurance in the US - the commercial health plans have been following Medicare's lead since the 80's. Hillary's idea to open up a plan through Medicare is sound.
14
Physicians are not attracted to primary care because the rates paid by Medicare and private insurers are much less than for specialty practices. Even podiatrists earn more than primary care doctors despite lacking a medical degree. A major reason for the disparity is the effectiveness of lobbying by physician groups. Another factor is the mortality risk of various diseases, especially for cancer and cardiac diseases. The future will see a large increase in the use of nurse practitioners, replacing primary care physicians.
9
One of the major means of rationing care in the US is co-pays and out of pocket (OOP) expenses. These have been assuming greater and greater importance for the insured, even before the ACA. But these means of shifting costs from insurers to patients frequently amount to punishing people for becoming ill.
"For 2017, your out-of-pocket maximum can be no more than $7,150 for an individual plan and $14,300 for a family plan before marketplace subsidies."
http://obamacarefacts.com/health-insurance/out-of-pocket-maximum/
Just think of what that means for a chronic condition. That's $7,150 this year, on top of premiums, $7,150 next year and so on. That's back breaking expenses, on top of being ill.
Greatest health care system in the world, people!!
"For 2017, your out-of-pocket maximum can be no more than $7,150 for an individual plan and $14,300 for a family plan before marketplace subsidies."
http://obamacarefacts.com/health-insurance/out-of-pocket-maximum/
Just think of what that means for a chronic condition. That's $7,150 this year, on top of premiums, $7,150 next year and so on. That's back breaking expenses, on top of being ill.
Greatest health care system in the world, people!!
12
I look forward to the addition of the public option to the ACA so that the private sector insurance companies have to compete with the government to serve patients, since we know from the past that having no such competition means high prices and refusal of coverage to sick, vulnerable people, all based on a worship of greed.
9
Lots of comments talking about price gouging, but no one seems to be focusing on physicians and their guild. Although many physicians will be quick to say that they are aren't making that much money, especially if they are relatively young and still trying pay student loans, the heart of the medical system is the doctor-patient relationship, and in the U.S. that is structured so that physicians can, at least potentially, make lots of money. This in turn requires severely restricting access to medical training, in order keep the number of physicians per 1000 people as low as possible.
What aids and abets this is the false notion that medical practice is enormously challenging from a cognitive point of view and that physicians must be extra bright. Too few people want to recognize that this is nonsense, in part because the placebo factor in the doctor-patient relationship encourages us to see our physicians as very special people. Measured on any relevant scale, from intelligence to empathy, they are not.
The American Medical Association and our winner-take-all society are in cahoots to keep the medical-industrial complex from changing in any significant way.
What aids and abets this is the false notion that medical practice is enormously challenging from a cognitive point of view and that physicians must be extra bright. Too few people want to recognize that this is nonsense, in part because the placebo factor in the doctor-patient relationship encourages us to see our physicians as very special people. Measured on any relevant scale, from intelligence to empathy, they are not.
The American Medical Association and our winner-take-all society are in cahoots to keep the medical-industrial complex from changing in any significant way.
14
"This in turn requires severely restricting access to medical training, in order keep the number of physicians per 1000 people as low as possible."
The number of physicians per 1000 people in the US has risen by 25% since 1992, and is far higher than it was back in the 60s. You can check out the 1992-2015 data at the OECD. You can also compare physicians per 1000 in the US to other countries using OECD data. If you do you will find that the US has exactly the same number of physicians per 1000 as Canada (2.6 in both countries) and more than Japan (2.3). The UK has slightly more physicians per 1000 (2.8). And yet all those countries spend far less per capita on health care than the US does so it doesn't seem as though physicians per 1000 is a good measure of how much health should cost.
Restricting the number of physicians does not drive up health care costs. In fact, in the US, the greater the number of physicians in an area, the greater the costs of health care. There's a lot that could be done to reduce the difference in health care spending between the US and other countries, but driving up physician supply, given the reality of the health care system in the US, will drive up costs and not improve outcomes.
The number of physicians per 1000 people in the US has risen by 25% since 1992, and is far higher than it was back in the 60s. You can check out the 1992-2015 data at the OECD. You can also compare physicians per 1000 in the US to other countries using OECD data. If you do you will find that the US has exactly the same number of physicians per 1000 as Canada (2.6 in both countries) and more than Japan (2.3). The UK has slightly more physicians per 1000 (2.8). And yet all those countries spend far less per capita on health care than the US does so it doesn't seem as though physicians per 1000 is a good measure of how much health should cost.
Restricting the number of physicians does not drive up health care costs. In fact, in the US, the greater the number of physicians in an area, the greater the costs of health care. There's a lot that could be done to reduce the difference in health care spending between the US and other countries, but driving up physician supply, given the reality of the health care system in the US, will drive up costs and not improve outcomes.
2
Geez.
Offensive is a kind way to describe my feeling towards this person.
I'm not crying or looking for sympathy but some clarification is needed:
You do need to be smart to be a doctor.
Doctors pretty much sacrifice their youth to their training. I had 10 years of training AFTER college. And college did require effort to get into medical school. I was 32 years old when got my first job.
Dr burnout is extremely high due to the very stressful decisions which must be made and very long hours a busy doctor works. It's not easy. Ask my wife and kids.
The primary care world is very difficult and underpaid. There is a reason there is a shortage.
The doctor patient relationship is what keeps me from quitting. It is intimate, intense, rewarding, frustrating, intellectually challenging and NOT something that I look at to manipulate for profit like this numskull implies.
So many people ,and this person specifically, feel that paying the physicians less is the answer. Good luck with that. The future will be doctors from across the world with unpronounceable names, second string medical students and team of nurses and PA's making critical decisions about your health. No thanks.
Too much of the health care dollar is spent not giving health care. Insurance companies are the problem. Single payer system that pays healthcare providers well could work. Get the profit out of the insurance companies and give it back to the patients and healthcare workers, not to the CEO of big insurance.
Offensive is a kind way to describe my feeling towards this person.
I'm not crying or looking for sympathy but some clarification is needed:
You do need to be smart to be a doctor.
Doctors pretty much sacrifice their youth to their training. I had 10 years of training AFTER college. And college did require effort to get into medical school. I was 32 years old when got my first job.
Dr burnout is extremely high due to the very stressful decisions which must be made and very long hours a busy doctor works. It's not easy. Ask my wife and kids.
The primary care world is very difficult and underpaid. There is a reason there is a shortage.
The doctor patient relationship is what keeps me from quitting. It is intimate, intense, rewarding, frustrating, intellectually challenging and NOT something that I look at to manipulate for profit like this numskull implies.
So many people ,and this person specifically, feel that paying the physicians less is the answer. Good luck with that. The future will be doctors from across the world with unpronounceable names, second string medical students and team of nurses and PA's making critical decisions about your health. No thanks.
Too much of the health care dollar is spent not giving health care. Insurance companies are the problem. Single payer system that pays healthcare providers well could work. Get the profit out of the insurance companies and give it back to the patients and healthcare workers, not to the CEO of big insurance.
8
You do not need to be exceptionally smart to be a physician. You need to be a good test taker to get into medical school, but that is something different.
You are burned out because your patient load is too high. That calls for more physicians, not fewer.
No doctors think they order tests and procedures except in the patient's interest, but every impartial study shows that they order vastly more tests and procedures than are medically required.
The horrible future you forecast of "doctors from across the world with unpronounceable names," etc., is already here. And I've had an Ivy League trained physician with an easy-for-me-to-pronounce WASP name and and an Ivy League trained surgeon at a NYC medical center try to railroad me into surgery I didn't need.
By your reasoning, the graduates of, say, St. George's University Medical School in the Caribbean should be able to provide medical care on a par with graduates of U.S. medical schools. Yet the graduates of St. George's, which was founded to cater to those who couldn't make the cut at U.S. medical schools, have in recent years passed the U.S. Medical Licensing Exam at rates higher than that of any U.S. school.
You are burned out because your patient load is too high. That calls for more physicians, not fewer.
No doctors think they order tests and procedures except in the patient's interest, but every impartial study shows that they order vastly more tests and procedures than are medically required.
The horrible future you forecast of "doctors from across the world with unpronounceable names," etc., is already here. And I've had an Ivy League trained physician with an easy-for-me-to-pronounce WASP name and and an Ivy League trained surgeon at a NYC medical center try to railroad me into surgery I didn't need.
By your reasoning, the graduates of, say, St. George's University Medical School in the Caribbean should be able to provide medical care on a par with graduates of U.S. medical schools. Yet the graduates of St. George's, which was founded to cater to those who couldn't make the cut at U.S. medical schools, have in recent years passed the U.S. Medical Licensing Exam at rates higher than that of any U.S. school.
3
I had a recent experience that illustrated how a huge part of the problem is the pharmaceutical companies raping and pillaging American consumers. A branded drug I could purchase while living in Asia for $7/tablet costs $70/tablet here. The exact same branded drug marketed here in a different shaped tablet for another more serious health need costs 3X more. The same generic drug marketed at only the second application costs $2.50. It reminds me of purchasing identical "international" versions of college textbooks by US publishers and having them shipped back here for a lot less that purchasing locally. For some reason US consumers get to be the world's suckers.
43
Blame politics for not setting the price.
1
As an expatriate American I ask myself what, if anything, it was about the original design of the country that has led to today's calous, profit conscious, attitude toward measuring everything by the bottom line.
The first thing that comes to mind is the so called original sin of slave ownership that was allowed in the Constitution despite its obvious immorality. Founding fathers like Washington and Jefferson owned slaves which were of enormous value in that day's economy. Slavery was not outlawed by the framers because it was too profitable to give up.
What this means is that the country's founding was governed by greed on day one as a basic principal for what the United States stood for. This one driving value has persisted in the mindset of Americans and has never been seriously modified or cast aside by future generations.
Even though capitalism was invented by the Dutch, Americans embraced it with undying love and have no interest in a divorce from profit.
This greed based value is so insidious to the genetic makeup of America, no outside force, including humanitarian caring for those in need can, can shake it loose from the nation's raison d'etre!
The first thing that comes to mind is the so called original sin of slave ownership that was allowed in the Constitution despite its obvious immorality. Founding fathers like Washington and Jefferson owned slaves which were of enormous value in that day's economy. Slavery was not outlawed by the framers because it was too profitable to give up.
What this means is that the country's founding was governed by greed on day one as a basic principal for what the United States stood for. This one driving value has persisted in the mindset of Americans and has never been seriously modified or cast aside by future generations.
Even though capitalism was invented by the Dutch, Americans embraced it with undying love and have no interest in a divorce from profit.
This greed based value is so insidious to the genetic makeup of America, no outside force, including humanitarian caring for those in need can, can shake it loose from the nation's raison d'etre!
94
Michael, mon ami,
Greed is not all that the USA is about. It is, however, all that many of our citizens are about. And our national mythology says that greed is good, since Calvin alleged that wealth was a sign of election and favor by God. While slavery, was a powerful component, note that Calvinists and slaves arrived at about the same time.
Greed is not all that the USA is about. It is, however, all that many of our citizens are about. And our national mythology says that greed is good, since Calvin alleged that wealth was a sign of election and favor by God. While slavery, was a powerful component, note that Calvinists and slaves arrived at about the same time.
2
Old Jack Carter joke: "under capitalism, man exploits man. Under Communism, the reverse."
Everyone's a critic. It never ends.
Everyone's a critic. It never ends.
1
Launching national healthcare systems tend to be plagued with flaws. The Affordable Care Act is no exception. The inexcusable logic and speed issues that threatened the roll-out of HealthCare.gov are history. Despite the GOP and lobbyist roadblocks posed prior and since Obamacare enactment, progress was on substance, especially for the most vulnerable. Although no country has the perfect system, we can learn from each other. Pioneered by Dr. Julio Frenk (WHO public-health authority, former Dean of Harvard School of Public Health and U. of Miami’s President), Mexico's Medicare, is modest by international standards but resilient in providing free universal access to more citizens than its U.S. counterpart. Since adopting an ethical triage approach, both Canada and France have substantially improved the quality, capacity and response time of delivery for most patients especially high-priority cases.
This country is blessed with some of world's leading practitioners and strategists who are esteemed throughout the healthcare world. Barry Bloom, Lynn Eckhert, Paul Farmer, Julio Frenk, Margaret Hamburg, Jim Kim, Carol Nadelson, Meir Stampfer and Michelle Williams come my mind. I am sure many more could be cited by better-qualified comenters. Mrs. Clinton, whose aborted initiative of the nineties, incubated the current system, is no stranger to health care. If elected, I am confident she will tap into this vast reservoir to harness the immense potential of the public-health system.
This country is blessed with some of world's leading practitioners and strategists who are esteemed throughout the healthcare world. Barry Bloom, Lynn Eckhert, Paul Farmer, Julio Frenk, Margaret Hamburg, Jim Kim, Carol Nadelson, Meir Stampfer and Michelle Williams come my mind. I am sure many more could be cited by better-qualified comenters. Mrs. Clinton, whose aborted initiative of the nineties, incubated the current system, is no stranger to health care. If elected, I am confident she will tap into this vast reservoir to harness the immense potential of the public-health system.
10
The physician shortage in the U.S. will continue as the cost of medical training increases. Two recent visits to my local ER included treatment by a physician assistant (P.A.) and a registered nurse (R.N.) - I never saw an M.D. Unfortunately, I was misdiagnosed in the first visit by the P.A. and had to return the next night - when the nurse on duty correctly diagnosed my condition. I couldn't wait the two weeks to see my primary provider because I was in extreme pain. Medical schools need to work with financial institutions and other programs to help fund medical education. Whether telehealth will really help with the physician shortage remains to be seen. Yes, more people have insurance now - but unless there are physicians to provide care, what's the point?
19
All politicians love to say the US has the "best medical system in the world". Unfortunately, that claim is never backed by facts. As the article points out, the facts are there for people to see - if they are willing to look. As many other people have mentioned, the major culprit to the mess of the US medical system is "profit". I cannot think of another major industrial country that allows insurance companies to profit from healthcare; or where pharmaceutical companies are allowed to advertise and pitch their products directly to the public. Finally, this is a country where going to a hospital and asking for the price for any service is impossible - even the doctors do not know how much a particular service is going to cost! All because the collusion between hospitals and insurance companies! As to going to an emergency room, the first question you are asked is not "What is the problem?" but "How are you going to pay for it?". Let's scrap the whole system to go to a single payer solution supported by tax dollars and managed by non for profit healthcare professionals.
126
Thank you. Your comment summed up some of the major problems with our Healthcare System, in particular the need to profit off of the suffering of our fellow Americans. I would also add that unlike many other industrialized counties the United States does not view Healthcare as a Human Right and as a result we treat it like all money making ventures and try to maximize profit regardless of the cost to human life. The cost of premiums, co-pays and deductables is almost as much as rent or mortgage for some people. Now people go broke because their forced to subsidize the health insurance, pharmaceutical and hospital industries and they still can't afford to see a doctor. Obamacare is just a giant corporate welfare program. At least with Single Payer we could cut out the middle man.
12
Hey, the USA has been subsidizing global medicine for decades. What did Obama-Bush-Clinton do about that?
Nothing. Zip. Nada. Zero.
There's your problem -- weak leadership.
Nothing. Zip. Nada. Zero.
There's your problem -- weak leadership.
Why is there not one mention of the role of Big Pharma and the private insurers? Although excellent health care for all citizens can be accomplished with either private or government or a combination of both policies (read T.R. Reid), I believe our peculiar aberration of capitalism serves only to provide enormous profits without regard to service commensurate with costs. We are in the grip of powerful corporations that care not a whit medical needs.
As a primary care physician, I can tell you exactly what prevents me from taking care of more patients: the very cumbersome, time consuming and frustrating e-records we all have to use. There are numerous reports that e-records have greatly reduced physician productivity, increased their hours of homework, decreased interaction with patients and lead to burn out.
And there are no e-links between e-records of hospitals and clinics who use different software.
And our clinic is plagued with drug sellers bringing cheap takeout food most days and get the midlevels to prescribe "me too" drugs that are different from generic drugs only in name and higher prices. Cheap, free food works.
Then there's the endless messages from pharmacists that the generic drug I ordered is no longer covered. I'm told to order the alternative, which is often a brand name, new variant of the same class of medication I already ordered.
Why?
In sum, I do feel the very imperfect e-records and the profit motive come between me and my patients everyday.
As a primary care physician, I can tell you exactly what prevents me from taking care of more patients: the very cumbersome, time consuming and frustrating e-records we all have to use. There are numerous reports that e-records have greatly reduced physician productivity, increased their hours of homework, decreased interaction with patients and lead to burn out.
And there are no e-links between e-records of hospitals and clinics who use different software.
And our clinic is plagued with drug sellers bringing cheap takeout food most days and get the midlevels to prescribe "me too" drugs that are different from generic drugs only in name and higher prices. Cheap, free food works.
Then there's the endless messages from pharmacists that the generic drug I ordered is no longer covered. I'm told to order the alternative, which is often a brand name, new variant of the same class of medication I already ordered.
Why?
In sum, I do feel the very imperfect e-records and the profit motive come between me and my patients everyday.
63
No one is addressing the elephant in the room: profit. Large corporations should not be profiting off the health of Americans. No one is willing to do what needs to be done: let Medicare negotiate with drug manufacturers. Putting forth large deductible plans for middle class and poor individuals restricts healthcare because they can't afford to use it. The result? More profit for the insurance companies.
The US should train primary care physicians and pay the tuition of individuals willing to work in needed areas for 10 years. Primary physicians are the poorest paid doctors and spend half their time (or more) on paperwork. Change the system! Do what's right!
The US should train primary care physicians and pay the tuition of individuals willing to work in needed areas for 10 years. Primary physicians are the poorest paid doctors and spend half their time (or more) on paperwork. Change the system! Do what's right!
113
Got some numbers to back that up?
More profitable than newspapers? TV stations? "Non-profits" like the Clinton Foundation, and its many well-paid lawyer/workers?
More profitable than newspapers? TV stations? "Non-profits" like the Clinton Foundation, and its many well-paid lawyer/workers?
Improving access to care should mean putting the patient needs first, we have just increased access to insurance not care. In the process we have transferred and increased costs to patients and employers. Any employer will tell you that their costs for insurance have skyrocketed and they have to pass some cost on to employees. this leaves little if any money for decent salaries and raises.
We will only see real change when we acknowledge that all Americans deserve medical care as a basic human right.
We will only see real change when we acknowledge that all Americans deserve medical care as a basic human right.
13
Yes, you can wait longer in Canada. On the other hand I have two friends who had serious medical problems who were promptly admitted and treated. It seems that here is a system of triage -- at least in British Columbia -- under which patients are evaluated by urgency of need. Both friends had cancer, one brain cancer the other a lump on the leg.
The brain cancer patient was admitted immediately and seen by the best cancer specialists and surgeons, but treatment was, unfortunately, unsuccessful. Despite the failure the young patient's parents have high praise for the prompt attention, highly skilled doctors and high quality methods used.
The second patient waited about three months to see a specialist before being operated on, and was not happy with the wait. However, his operation and rehab was successful.
The cost to both were almost free. The brain cancer treatment that covered a span of a couple of years before the failure would have bankrupted the patient's parents; the patient who lived would have suffered heavy a financial burden for a long time.
The brain cancer patient was admitted immediately and seen by the best cancer specialists and surgeons, but treatment was, unfortunately, unsuccessful. Despite the failure the young patient's parents have high praise for the prompt attention, highly skilled doctors and high quality methods used.
The second patient waited about three months to see a specialist before being operated on, and was not happy with the wait. However, his operation and rehab was successful.
The cost to both were almost free. The brain cancer treatment that covered a span of a couple of years before the failure would have bankrupted the patient's parents; the patient who lived would have suffered heavy a financial burden for a long time.
36
Its is not enough to look at ACCESS. That view distorts the purpose of a visit, whether nights or on weekdays. The purpose was to find a CURE. The cure-success and the (in)ability to properly diagnose, equipped to analyze and impartially medicate is much worse here than in any of the comparison countries. Here, "patients" lie about pain intensity at a 99% rate, and misdirect ER staff, and their conditions have - at normal - been untreated or chronic for ages, and much graver than elsewhere as a result of the shortages. France has no limits on Doctor-Visits, and that might be costly, but folks are healthier at the end.
4
Where I come from, easy access to one's primary physician is almost impossible. A call to my doctor is always answered by voice mail telling me to call 911. We do have a number of urgent care clinics which serve us when we need help for non-emergency cases. But we can't count on any of our own doctors for quick help.
9
Same or next day visits to a physician are easy in the more populated parts Canada via a network of walk-in clinics and hospitals. Canadian results are no doubt skewed by providing universal healthcare to a small population spread over a very large country.
I've been in both the US "system and the canadian system and you can give me Canada's any day.
I've been in both the US "system and the canadian system and you can give me Canada's any day.
85
Geography does make a big difference in both systems. If you need acute care in far northern Canada or in the rural USA you may be out of luck. And care is likely to be better in major centers than in backwaters. BUT, at least Canada attempts tp address these issue in a humane, rational fashion. In this country if your medical needs are deemed to be a "cost center," good luck. In total, as a non-proceduralist physician, I would rather have to drop with an MI on Yonge Street than almost anywhere in this country - the care would be excellent and I (or my estate) would not be in danger of financial ruin.
4
I visit Canada often, and most of our friends are older people who are using the Canadian system. I've yet to meet a Canadian who is unhappy with their health system. They wonder why the US has such trouble providing health care.
Health care in our country is exhibit number one that free markets are not the solution to every problem. Free market generally leads to how much can you charge for an object or service and get away with it. Doesn't work in healthcare, but we now have so many piggies on the teats it will be hard to undo it. Sadly, the very money we overpay for medicine (think Epipens) is then used against us in lobbying.
56
Wrong. We do not have anything even remotely resembling a free market system in health care - not before ACA and not after. Prices are hidden to the consumer. Transactions are basically between the provider and the insurance company. Consumers are not able to make decisions with accurate price information. Until we have more transparency and more market forces at work, we will continue to have the most expensive and wasteful system in the world.
3
Sorry, abm, but your observation is incorrect. We have the greatest intrusion of market economics into health care of any first-world nation. Part of the reason for the obscene mess that we have is that the unregulated market economic model is so inappropriate for health care delivery. More would not be better.
For so many marketeers, their passion is almost religious in nature, not unlike that of the alchemists. If we have not succeeded in changing lead to gold, we must try harder to believe. Some of them believed that it would work if nobody within a certain radius would think of elephants. If it did not work, someone must have had a pachydermal reverie. Could that be you?
For so many marketeers, their passion is almost religious in nature, not unlike that of the alchemists. If we have not succeeded in changing lead to gold, we must try harder to believe. Some of them believed that it would work if nobody within a certain radius would think of elephants. If it did not work, someone must have had a pachydermal reverie. Could that be you?
Back to Econ 101: A free market solution occurs when buyers and sellers have sufficient information to make informed decisions. This is not the case with US health care. I dare you to try to find out for certain how much a procedure is going to cost in a hospital. There are no market forces at work to control health care costs.
4
As an intellectual problem, building a good system for disease care in this country is easy.
1. Follow other nations and regulate costs and provide payments thru a single national source.
2. Support training of physicians, nurses and other clinicians in accord with needs (geographically and by specific discipline and specialty).
3. Pay for the system thru national funding - expanding the current deduction system for Medicare to enable coverage for all.
4. Replacing malpractice litigation against individual practitioners by a claim mechanism against the government.
Simple, isn't it?
The "real" problem is that people aren't interested in rational problem solving.
If we bothered to study "human nature", we might be able to deal readily with "difficult" societal problems within our nation and around the world.
Until then, tough luck...
Stephen Rinsler, MD
1. Follow other nations and regulate costs and provide payments thru a single national source.
2. Support training of physicians, nurses and other clinicians in accord with needs (geographically and by specific discipline and specialty).
3. Pay for the system thru national funding - expanding the current deduction system for Medicare to enable coverage for all.
4. Replacing malpractice litigation against individual practitioners by a claim mechanism against the government.
Simple, isn't it?
The "real" problem is that people aren't interested in rational problem solving.
If we bothered to study "human nature", we might be able to deal readily with "difficult" societal problems within our nation and around the world.
Until then, tough luck...
Stephen Rinsler, MD
209
Agree completely.
4
Steve, if it were so easy -- don't you think it would already be done? Well, it is not.
Example: Vermont, home of Socialist Sanders, just defeated alleged "single-payer," as financially bankrupting.
If the MDs are volunteering to go bankrupt first -- be my guest. Will be right behind them.
Example: Vermont, home of Socialist Sanders, just defeated alleged "single-payer," as financially bankrupting.
If the MDs are volunteering to go bankrupt first -- be my guest. Will be right behind them.
2
I knew you were a doctor before I got to the end of your comments. How? When you wrote that we should "Replac[e] malpractice litigation against individual practitioners by a claim mechanism against the government," you made yourself very, very clear. I've been seen by more than a few quacks in my life, and I instantly run for the hills and tell all my friends and neighbors to never use that specific doctor. Without the prospect of malpractice facing doctors, just WHO would stand up for patients who are maltreated, sometimes permanently?
2
We need one system for all except active duty military. We need medical care, not insurance. We will always ration because we cannot afford to do all we know how to do for everyone, but we should stop rationing economically and do it based on best practices. Yes, we need fundamental change.
21
Sounds great, but it would mean in reality denying care to affluent white professionals -- in favor of diverting care to the poor, minorities, "awful rednecks in red states" and illegal aliens.
It would mean telling affluent white people that they had to stand in line, or be denied stuff like arthroscopic knee surgery. Or wait for months or years!
It would mean denying care to seniors, because they are old and hence less valuable to society than young people.
That would ENRAGE many very large, influential segments of American society! We get away with denying care to poor and working class because they are POWERLESS and VOICELESS (and when they find a champion like Trump...the lefty media excoriates him!).
It would mean telling affluent white people that they had to stand in line, or be denied stuff like arthroscopic knee surgery. Or wait for months or years!
It would mean denying care to seniors, because they are old and hence less valuable to society than young people.
That would ENRAGE many very large, influential segments of American society! We get away with denying care to poor and working class because they are POWERLESS and VOICELESS (and when they find a champion like Trump...the lefty media excoriates him!).
2
@CC - Medical tourism is already a big industry. If the US had single-payer, the offshore hospitals would undoubtedly take off. You could fly to Bermuda or Switzerland and have your knee replaced by top doctors for less than it costs in the US.
2
There is an important additional problem with this notion of manpower. That is that only physicians can and should provide primary care. There is another capable store of workers who are being held back by organized medicine in our country and that is the highly skilled and well trained group of nurse practitioners and physician assistants. There is no evidence based reason why these so called physician extenders cannot serve and primary care providers.
13
What matters is not how many people are "covered" by insurance programs or enrolled in government programs, but that everyone have timely access to needed health care.
Focus on end points, not on intermediate measures that are bad proxies for what we want to achieve.
Focus on end points, not on intermediate measures that are bad proxies for what we want to achieve.
8
The point and the OECD data stand, of course, but you didn't mention that much of primary care is delivered by non-physician clinicans. We have significantly broader scope of practice for advanced practice RNs, NPs, PAs, etc. There is plenty of research on these non-physician clinicians and the quality of their care. I'm not saying that we shouldn't have more primary care physicians, but you can't realistically ignore the great care that these other clinicians are providing.
10
We trail other civilized countries because we allowed health insurance companies and healthcare providers to profit off of the government and patients. Germany is controlled by non-profit insurance entities. Britain and others have a government controlled system. Most nations control the price of prescription drugs and treatments. The U.S.? We allow insurance companies and pharmaceutical companies to bankrupt our citizens and take billions upon billions out of our government coffers every year. Our government steps aside while hospitals and other healthcare providers mug individuals and families for sake of the almighty dollar.
If we want to have real healthcare reform, we'd better take a long, hard look at what entities are paying off our politicians. Congress and the healthcare industry are far too chummy, and the relationship endangers American fiscal and physcial lives.
Through lack of access to affordable care, our politicians and the healthcare industry are our true "death panels."
If we want to have real healthcare reform, we'd better take a long, hard look at what entities are paying off our politicians. Congress and the healthcare industry are far too chummy, and the relationship endangers American fiscal and physcial lives.
Through lack of access to affordable care, our politicians and the healthcare industry are our true "death panels."
286
I have begun to wonder lately, since other countries regulate drug costs, if we in the United Staes are subsiding their lower costs. Drug companies are multinational and drugs are sold everywhere.
We in the United Staes complain about obscene profits of drug companies. If they are price controlled in most industrialized nations, either we are providing those profits or drug companies can still profit handsomely with controlled prices. It would be interesting to know how much of the profits we actually provide.
We in the United Staes complain about obscene profits of drug companies. If they are price controlled in most industrialized nations, either we are providing those profits or drug companies can still profit handsomely with controlled prices. It would be interesting to know how much of the profits we actually provide.
7
We rank 11th in results and outcomes of the leading industrial nations- fifth in breast cancer results. France is best in that area. Britain ranks first over all. We pay the highest per capita, double Britain and get the worst results.
Our drug cost are the highest in the world also.
From the Commonwealth Survey as noted in the article.
Your opinion is unfounded- please provide a link to prove your assertions.
Our drug cost are the highest in the world also.
From the Commonwealth Survey as noted in the article.
Your opinion is unfounded- please provide a link to prove your assertions.
7
Thatbis true. one reason behind is that the US fears of loosing innovation in drugs. However, as everything in life, there is a balance and sometimes you just have to try.
1
One of the bigger issues that makes most of these problems hard to solve is that we have so many uninformed voters in this country. Party loyalty has people listening to folks usually more educated and far wealthier then them in media, whose self interest (their tax bill), is usually at odds with the self interest of the listening audience. So, the elites (usually in conservative media) sucker the poor and middle class into throwing away their only leverage (their bundle of votes). How else do you explain middle class people voting against unions, social welfare, regulation of financial markets, regulation of police, etc? Racism, xenophobia, false patriotism, etc are all part of the ruse. Notice how few people are upset at athletes still playing who beat their wife, but are in an uproar over someone kneeling for the national anthem? Suckers aka the 85% who are either dumb, deaf, blind or a combination of the 3.
63
Against unions? You mean, to be for GM-size bankruptcies?
Hey, what would could wrong? Other than becoming like Venezuela, that is.
/eyes rolling/
Hey, what would could wrong? Other than becoming like Venezuela, that is.
/eyes rolling/
The ACA was never a legitimate plan,it was an Obama legacy project that the administration had to lie about to get passed.Waiting for a Drs. appointment is inconvenient but not life threatening,waiting months for a vital test or major surgery is,ask your friends in the socialist utopias how that works out for them.If you have the sniffles or a headache maybe the US isn't so great,but if you have cancer or heart disease you wouldn't want to be anywhere else.
4
You should look up all the resistance and weakening of the original plan before you blame the President. Obamacare would be far stronger and more expansive if all 32 Republican Governors actually expanded coverage. But since the plan is too help nothing work that has the President's fingerprints on it, nothing seems to work right. It's not a coincidence that the health outcomes in the southern parts of our country are so much worse (Republican country).
89
Excuses, Excuses.
No amount of finger pointing can alter the truth: when in power the Democrats passed a badly designed reform that has failed to work as promised.
No amount of finger pointing can alter the truth: when in power the Democrats passed a badly designed reform that has failed to work as promised.
3
I'm not sure if you work in healthcare, but the only time the US ranks ahead of others for treatment f any kind of illness is if you go to Mayo or the Cleveland Clinic or MD Anderson or one of our other world leader facilities. However, bread and butter healthcare is no better in the US than it is in any other "socialist" system and it delivers that mediocrity at an astronomical cost to those who can afford it. Those who can't afford it cost even more because they wait until problems are out of control and then rely on the non-profit system for "free" care which isn't "free at all - you, I and others pay for it through taxes (Medicaid, Medicare) and elevated health insurance premiums. What is most dismaying is that the focus on interventional care, vs. wellness, ensures that the demand for cancer and heart disease services remains elevated in the US and reinforces the perceived - but not necessary - demand for expensive diseases. Consider that over 60% of hospital diseases are because of lifestyle choices - diet, exercise, sleep, high-risk behaviors such as smoking - and you can imagine what it would be like here if we focused our innovative capabilities on keeping people healthy instead of keeping the system churning because the population base is so sick.
7
The problem is that too many people don't see healthcare as a basic human right, one that the government should be providing to everyone.
Almost every other developed country realizes this.
Almost every other developed country realizes this.
179
That would be because healthcare is a service, not a right. How can you put a financial limit on a right (all single payer systems severely limit spending on care)? Or do you suggest that the entire healthcare industry be nationalized? It is really easy to declare something a right, but then reality sets in and the adults have to take over.
1
That's wrong. Those countries have provider strikes. They've had cutbacks. They have serious financial problems.
To think otherwise is to be unread or simple-minded.
To think otherwise is to be unread or simple-minded.
1
Access to care does not equal quality care. Obamacare expanded the Medicaid numbers but if few physicians accept Medicaid, the poor are still forced to go to the ER. Medicaid pays poorly, far less than Medicare or private insurance. Working on volume rather than quality becomes key to staying afloat in those few practices.
Furthermore, those with actual private insurance have less access due to extremely high deductibles and forced employee contributions. When you still must pay when you already have done so, avoiding the doctor becomes a financial decision--not a medical one despite being middle class.
And finally, we have too few General Internists because they are paid poorly in comparison. Obamacare has reduced reimbursements and burdened internists with greater regulations, restrictions and penalties for noncompliance with expensive electronic medical records. Obamacare might have expanded Medicaid, but made it far more difficult for primary care doctors to cover their overhead. Make primary care financially attractive and watch the numbers of medical students entering this field rise exponentially.
Furthermore, those with actual private insurance have less access due to extremely high deductibles and forced employee contributions. When you still must pay when you already have done so, avoiding the doctor becomes a financial decision--not a medical one despite being middle class.
And finally, we have too few General Internists because they are paid poorly in comparison. Obamacare has reduced reimbursements and burdened internists with greater regulations, restrictions and penalties for noncompliance with expensive electronic medical records. Obamacare might have expanded Medicaid, but made it far more difficult for primary care doctors to cover their overhead. Make primary care financially attractive and watch the numbers of medical students entering this field rise exponentially.
17
How does the Kaiser system do it, while paying everyone, including doctors, a fixed salary? Primary care will never be as "financially attractive" as the specialties, as long as the system remains the way it is.
1
You do not want to get some rare form of cancer or other disease requiring a good specialist if you have Kaiser. That is the Achilles heel of that system.
Having worked in healthcare management for 35 years, it's hard to know where to start on the problems in the system that this article doesn't even begin to address. Fragmented insurance, profit motives, misalignment of incentives among major players (hospitals, physicians, suppliers, payors)...the entire system is held together with bubble gum and baling wire. If it were any other industry, or at any other scale of operation, it would be considered a rampant failure. Unfortunately, it is too big to fail, consumers have been convinced that they will receive substandard care with improvements to the model and the vested interests - whose powers rival the NRA - overpower Congress. The Affordable Care Act was a start, but the nation needs to apply more of the innovation for which it is known to make the system work well, and it needs to be a top-down rebuild, not just a few fixes. Universal insurance does not mean "socialist medicine". Private insurance can be involved in a more rational model than today's system. The one thing that America cannot afford is to go back to the pre-ACA model that encouraged denying insurance, and focused on the heroics of "sick care" instead of health maintenance, until people hit Medicare with its bottomless purse. Little wonder the Trust Fund will be depleted when the US spends a multiple on a per capita basis on its elderly compared with countries where heroics such as open-heart surgery on patients over 90 years old are discouraged.
150
I think you have covered the issues - and dilemma that we are in. There isn't the heart and determination necessary to totally revamp the way medicine is paid for in the US. We can't get concerted bipartisan work done - not on anything!; all becomes about blame - - a refusal to approach health care rationally. Add fronting for the insurance industry, with some legitimate concern that serious disruption would end up in losing jobs, and there is incredible pushback. [A dreadful truth that Trump has uttered among the garbage, is a reminder that LOBBYISTS write most legislation, to benefit their industries]
I don't think, however, that the opponents in Congress who tried to repeal the ACA- what was it, 50 times? - can simply return to ignoring the millions who accessed care for the first time in years under this. Unless they vote against their interests.
I don't think, however, that the opponents in Congress who tried to repeal the ACA- what was it, 50 times? - can simply return to ignoring the millions who accessed care for the first time in years under this. Unless they vote against their interests.
10
The shame of US health care is that we have excellent providers and facilities for health care, but no effective health care system. Our health care is an uncoordinated jumble of services gamed by private insurers, those unneeded middlemen between provider and patient.
The ACA introduced two invaluable innovations: a set of model coverages, on which health care insurers can compete toe-to-toe, and a market in which the insurers can offer comparable coverages for patient choice. ACA also restricted several obnoxious practices by insurers, but failed to address the worst, the provider networks that restrict patient choice of providers.
There is a straight-forward solution: let Medicare offer coverage to all at cost-based, age-adjusted premiums, in open competition with private insurers. As the private health insurers wither away due to low profit margins, we’ll be left with a single-payer health care system.
There is no need to repeal ACA and start over. Instead we should use the ACA market mechanisms to run off the parasitic private insurers and create a real health care system.
The ACA introduced two invaluable innovations: a set of model coverages, on which health care insurers can compete toe-to-toe, and a market in which the insurers can offer comparable coverages for patient choice. ACA also restricted several obnoxious practices by insurers, but failed to address the worst, the provider networks that restrict patient choice of providers.
There is a straight-forward solution: let Medicare offer coverage to all at cost-based, age-adjusted premiums, in open competition with private insurers. As the private health insurers wither away due to low profit margins, we’ll be left with a single-payer health care system.
There is no need to repeal ACA and start over. Instead we should use the ACA market mechanisms to run off the parasitic private insurers and create a real health care system.
144
An ancient Aesop fable has two men spotting an oyster on the beach an d fighting who saw it first. A third man comes along, they ask him to referee, which he does by giving each a shell and eating the oyster. The insurance companies and the medical industrial complex get the oyster. The hard workers in the health care system and the public get one half shell each.
6
You're describing the public option. Obama should have asked for single payer and bargained back to the public option. I suspect he was told "no way" in no uncertain terms.
Are the Pritzers invested in health care?
Are the Pritzers invested in health care?
2
America's medical system is closer to third world countries than wealthy nations.
It is like us clinging to slavery, child labor, segregation, etc.
We have a need to hold on to atrocities.
However, just like with the issues mentioned above sooner or later we will be like most wealthy nations and have some form of universal health care, just like we have with Medicare for seniors...
It is like us clinging to slavery, child labor, segregation, etc.
We have a need to hold on to atrocities.
However, just like with the issues mentioned above sooner or later we will be like most wealthy nations and have some form of universal health care, just like we have with Medicare for seniors...
14
Medicare is NOT universal healthcare for seniors. Medicare pays only 80%. The other 20% is the patient's responsibility which includes expensive hospital care in the thousands. Citizens must cover these expenses out of pocket or purchase an expensive private supplemental plan which increases with age. My 90 year old mother pays $4000/yr for her supplemental plan.
Furthermore, this country is having trouble funding Medicare as well as Social Security which are on the verge of collapse. Universal Healthcare is a financial pipe dream at best. Those countries that do have it, provide doctors visits with limited access to timely hospital care and/or procedures. (It is the very reason Canadians cross our border daily).
Furthermore, this country is having trouble funding Medicare as well as Social Security which are on the verge of collapse. Universal Healthcare is a financial pipe dream at best. Those countries that do have it, provide doctors visits with limited access to timely hospital care and/or procedures. (It is the very reason Canadians cross our border daily).
2
Social Security is not on "the verge of collapse". That's nonsense. The system is fully funded for at least two decades, and even after that, can function for the foreseeable future giving out about 75% of benefits. So let's not say "because we may have to cut benefits in 2042, let's cut benefits today". Enough of this claptrap. Minor tweaks, like Reagan did in the 80s, can make the system sustainable for the rest of this century.
9
Agreed Mitch, the "gloom and doom" group will always use it as an excuse to kill it, ie medicare and SS...
All other peer countries have figured it out but us...
All other peer countries have figured it out but us...
4
Perhaps a bit off topic but what I do not understand as a foreigner living in the U.S. is this: Why can insurance companies be for profit operations? That seems like an inherent conflict of interest. Germany for example has a market-based healthcare system but has very strict Government regulations -- among them insurance companies must be non-profit operations. This actually helps a lot to keep the cost of care and insurance under control. But alas, so many people in the U.S. freak out when you use the words non-profit and government regulation in one sentence.
352
It varies from state to state. Some states do require non profit status to operate as a health insurer.
Not off-topic at all; it explains the whole problem. I wonder, though, what is the incentive of a German company to operate without the ability to turn a profit? The answer might lie in studying the difference between banks and credit unions. Although both are regulated, the latter enjoy much more consumer satisfaction in the absence of silly games to fleece their members, e.g. Wells Fargo.
33
A lot of us can't understand this either. Although, in the US, having followed a couple of hospitals which went from "public" - eg. officially primarily local government supported, to "non-profit," the level of remuneration of the officers and administrators is little different than in private health plans.
2
The fundamental reason the US trails in access to care is that our society views healthcare (like education) as a privilege, not a right. Perhaps owing to our strong "independent streak" the society as a whole wittingly or unwittingly believes everyone is responsible for themselves, including their healthcare. Unless and until we accept healthcare as a right, there will always be many people with limited access.
35
The problem is at the level of the health care system, insurance companies and the balkanized system of insurance regulation at the state level. The ACA was never meant to address those problems. Way too many people who are disappointed with their insurance company and health care are blaming the ACA for something it was never designed to address but that won't stop people from conflating the issues. Your anger is real but it is misdirected.
23
Single payor is the only way to fix this.