Saturday, December 12, 2015

Why single-payer healthcare funding may not work in America

Of course Obamacare is failing.

Not quite as badly as No-Obamacare was failing, so I'm still glad it exists. It's a necessary stopgap until we find a system that actually works.

But you know what? Single-payer healthcare will fail just as badly.

In 2015, U.S. spending is projected to hit $10,000.
Yes, I know that single-payer healthcare systems succeed in other developed nations. I also know that competitive insurance-based healthcare systems succeed elsewhere. But neither system will succeed in the United States, because the U.S. is the only nation on earth that refuses to keep healthcare spending from spiraling out of control. If the cost remains the same, it doesn't matter who's paying. In the long run, we all are.

Many Americans believe that a free market would drive spending down, but the American healthcare mishmash (both before and after Obamacare) is definitely not a free market. Just try finding out what a procedure is going to cost so you can choose the least expensive provider. Even the providers have no idea until they've already signed you up and run your insurance numbers. If you're computer literate and have lots of time and patience, it's possible to get approximate prices for prescription drugs, but what can consumers do about profiteers like the infamous Martin Shrekli?

And anyway, when you're being rushed to Emergency is no time to comparative shop.

Many in the general public scream "Rationing!" whenever any limitation to healthcare is suggested, no matter how sensible it may be (refusing to fund drugs with no proven benefits, for example, or allowing futile, often painful, but expensive procedures for people in the last stages of dying). It's frustrating when we grow up and realize that we can't all have everything we want, but it's rational to make sure that, when something (like money for healthcare) is in short supply, it's apportioned wisely for the common good. Americans are not rational about rationing.

Congress, as the right arm of lobbyists, has no interest in keeping healthcare affordable. They would not pass either George W. Bush's Medicare prescription drug plan or Barack Obama's Affordable Care Act until all threat of price caps was removed. Medicare is not even allowed to negotiate drug prices.

Well, folks,
  • if consumers are unable to do comparative shopping;
  • if we all believe we have a divine right to any healthcare that's available, no matter how expensive or ineffective it may be;
  • if we will not allow our healthcare payers to set price ceilings or negotiate lower prices;
  • and if our lawmakers continue to favor the lobbies who fund them rather than the people who elect them;
of course our healthcare system will fail.

It will fail millions of people who cannot afford the treatment they need. It will fail millions who pay high prices for treatment they don't need. It is failing all of us, since we pay twice as much for healthcare as we would pay in other developed countries.

Until we find an effective way to limit healthcare spending, American healthcare will continue to fail--whether it is funded by private individuals, by competing insurance companies, or by a single payer.


RobS said...

Lots of good comments, thank you for the write-up.

Healthcare industry seems like it could make giant strides in modernization and efficiencies. Just last week we received a statement of what benefits were paid by our plan for an early April invoice -- only around $120 worth. We had settled with the local provider months ago. Why send us a statement now? It's hard to imagine what value a statement 7 months later will do.

Meanwhile, our new 2016 plan requires some changes of doctors. I phoned them and asked for a list. After getting personal info, including my email, they told me they had a hard copy and volunteered to mail it over in 7-10 days. I asked if they could email it over since I had just provided that information.

They said, they couldn't -- had to send it by hard copy. I asked if they had an intern that might be able to create a PDF file scanning this document and then email it over. The lady on the phone paused, trying to decipher my suggesting, but then ultimately said it had to be hard copy mailed out.

There seems to be little culture of efficiency or immediacy in much of what they do.

Lileonie said...

I had read this post when you first shared it, and already found it remarkable; I still do.

If only your politicians had access to it! At least those who can read.

The friends of the USA are watching the drama unfold with a growing sense of disbelief, and I have sadly given up trying to influence my extremely right-wing brothers and my nephew.

I'll be in touch, one way or the other, but in the meantime: "Brava"!