Democrats: Health care should be a right for all Americans. No one should suffer or even die from a treatable illness just because of a lack of means to pay.
Republicans: We cannot afford universal health care. It is too expensive and will bankrupt the government.
Normally, I would say right here why both sides are wrong, but in this case, both sides are right. No one should have to go without healthcare, especially anyone who is working as hard as they can to support themselves and their family. However, we cannot afford to insure everyone. It costs to much.
However, universal health care or not, with an increase in health care costs of 7% a year and inflation of 3% a year, it doesn't take an economic genius to realize that one day in the not to distant future no one will be able to afford health care.
Why does it cost so much?
There are a number of reasons why health care has become so expensive in this country, very few of which are actually being dealt with in any meaningful way by policy makers.
- Separation of consumer and payer
- Malpractice risks
- Overtesting/overprescribing
- End of life overspending
Separation of consumer and payer
This comes back to the discussion of the Free Market. The Free Market is an excellent tool for setting prices, and it is entirely missing in the health care market. Why? Because the consumer does not have any skin in the game. He has no reason to consider cost in his calculations. Hospital A is 15% more expensive than Hospital B without any better results? Who cares! The consumer is not paying for it.
Some will say that money should have nothing to do with health treatment. People should just get what they need. This makes some sense, but everything is a trade off. Everything has a value and a cost. Some tests and procedures are quite necessary, but others are less so. Only the consumer can decide what something is worth, but the consumer is out of the equation.
When someone decides if they want to take vitamins and what brand to buy, they will consider cost, and vitamins stay relatively affordable. However, insurance companies pay for prescription drugs, removing market pressure to keep prices reasonable, and prices go through the roof. People without insurance cannot afford their pills at all, and the higher costs are passed on to everyone through higher premiums.
Malpractice Risks
The concept of malpractice is that doctors will want to make sure that they do what they are supposed to because if they do not, they can be sued for all they are worth. Unfortunately, this system has gotten out of control in two ways. First, the payouts have gotten extreme enough that they throw off the calculus of the doctor's decisions. Second, the doctor can never be sure what the courts will use to decide if the doctor is liable.
Every doctor has malpractice insurance. That means that every malpractice case payout is actually spread among all doctors, thus passed on to the rest of us through the insurance companies' increased premiums.
Overtesting/Overprescribing
When the doctors are terrified of malpractice, they want to cover all their bases... and cover them again... and maybe a third time just to be sure. No doctor was ever sued for malpractice for sending a patient for an unnecessary MRI. However, if there is a 0.05% chance that the patient may have something, better send him for the test just in case, because if he has that extremely unlikely affliction, you know that he's coming after you for his $1 million dollar settlement. What happens when every doctor orders an extra $1500 test for every patient. That's a lot of extra $1500 tests, and scientists keep inventing newer and more expensive tests that doctors will feel obligated to send patients for.
End of Life Overspending
I'm going to say something that doctors hate to face. Everyone, eventually, dies. Doesn't matter what you do for them. If you think that you can fight death, you've got another thing coming, but doctors pour an obscene effort into prolonging the lives of the terminally ill just a few more days. As this USAToday article discusses, tens of thousands of dollars are spent on treatment for people at end of life. Not only does this drain the coffers dramatically, it also makes those last few months less pleasant. How would you like to spend your last 6 months? Being poked and prodded in a most undignified way to fight the inevitable to the last, or resting comfortably at home with medication and treatment to ease your transition to the end? For me, I'll take the quiet, peaceful one that doesn't cost society $24,000. Of course, it doesn't matter what I want. There is no option. The doctors will decide how heroic their efforts will be to grant you immortality, the options usually being heroic, really heroic, and tortuously heroic.
None of this is particularly new. These problems are well known, but the current political discourse does not allow any room to discuss actual solutions. Instead, we rearrange deck chairs of "Death Panels" and "donut holes" while the ship sinks under the weight of massive health care costs.
Don't worry. We'll act on it eventually. America, like college students, tends to work better under an immediate crisis deadline than well in advance.
a couple comments:
ReplyDelete1. don't forget that part of the reason drug costs are so high is because of the exhorbitant amount of money it takes to actually develop drugs and put them through clinical trials, not to mention that the majority of drugs don't make even make it to clinical trials, and many of the ones that do don't make it to the market. so the money they make from the drugs that succeed have to make up for the drugs that fail. and i don't see that situation changing anytime soon, not only is it unethical to not have rigorous testing, but if lower prices resulted in lower income for the scientists, you'd probably see a lot of people moving to other biotech fields, decreasing the amount of drugs that get developed. public sector research helps, but only to a certain point, its generally impossible to take a drug through trials without the help of the private sector.
2. as far as the idea that fear of malpractice suits leads to overtesting, this may be true, but i think this is also heavily influenced by what the doctor learns in medical school. i mean, if they know that a test will rule out another possible disease, or whatever, it makes sense for them to do it, because if even if its something extremely uncommon, there are still people being afflicted by that thing, and it wouldn't be fair to just never test and later treat for it just because its uncommon and the test costs a little more. on the other hand, you may or may not remember that i work on parasites. i heard a story not long ago about someone who worked on malaria, and they came down with malaria. so they went to the doctor, and the doctor refused to test for malaria until they did a million other tests first. finally, he tested for malaria, and what do you know, it was malaria. the problem in this case is that there isn't enough focus on tropical medicine and parasitology in american medical school, and that they spend relatively too much time on rare chronic ailments than on the things which affect millions of people in the tropics. and malaria is usually the exception, since its not uncommon to get while traveling, if someone contracts another parasitic disease it usually takes american doctors forever to diagnose it, sometimes after its too late to cure it.
ok, sorry it was long, i'm done :)