Washington Post’s Sunday edition had an opinion piece on our health care system. Nicely done as far as it goes.
The Post’s myths, with medicynical comments:
1. “America Has the best Health Care in the World”–
” We rank near the bottom of countries in the Organization for Economic Cooperation and Development , just ahead of Cuba and way behind Japan, France, Italy, Sweden and Canada, countries whose governments (gasp!) pay for the lion’s share of health care.”
Medicynic: This appears to be an accepted truth, except perhaps for the very wealthy, for whom cost and access are not issues.
2. “Someone else is paying for your health insurance”
“Rising health-care costs are partly to blame for stagnant wages. Over the past five years, health insurance premiums have risen 5.5 times faster on average than inflation, 2.3 times faster than business income and four times faster than worker’s earnings.”
Medicynic: This also seems to be understood. What’s missing is the fact that we all are paying one way or another for those who are uninsured and need care.
Also, as we move away from employer based coverage to a more rationale arrangement the question whether the money used to pay for insurance is employee salary or employer profit will need to be settled–watch this issue carefully.
3. “We could save a lot if we could cut the administrative waste of private insurance”
“For one thing, some administrative costs are not only necessary but beneficial. Following heart-attack or cancer patients to see which interventions work best is an administrative cost, but it’s also invaluable if you want to improve care. Tracking the rate of heart attacks from drugs such as Avandia is key to ensuring safe pharmaceuticals.”
“Let’s just say that we could wave a magic wand and cut private insurers’ overhead by half, to what the Canadian government spends on administering its health-care system — 15 percent. How much would we save?”
Medicynic: The authors include monitoring for toxicity and evaluating a drug’s or procedure’s effectiveness as administrative costs and as noted above seem to posit that private insurers routinely do such work. Others count this a drug or procedure development expenses and while administrative are not what insurers do or what they count as an insurer’s administrative cost.
However, even with these non-typical costs included as administrative expenses, they believe that as much as 125 billion dollars can be saved–not chump change. Medicynic thinks the numbers are conservative as most other countries spend far less than the 15% suggested overhead. Medicare for example spends less than 10% on such expenses.
4. Health Care reform is going to cost a bundle
“Even moderate reform of the delivery system would improve care and save money. The Lewin Group’s analysis shows that a bill proposed by Sen. Ron Wyden , an Oregon Democrat, calling for a more comprehensive overhaul of the health-care system than either McCain ‘s plan or Obama ‘s could actually insure everyone and save $1.4 trillion over 10 years. More reform is cheaper.”
Medicynic: Health care reform will be costly but probably no more than our current system that excludes 50 million people. Omitted in the article’s analysis is the major problem of conflicts of interest in the system, and the need to control the costs of developing new technology. See this for more on cost saving strategies for health reform.
5. Americans are not ready for a major overhaul of the health-care system
“A recent study published in the New England Journal of Medicine found that only 7 percent of Americans rate our health-care system excellent. Nearly 40 percent consider it poor. A whopping 70 percent believe it needs major changes, if not a complete overhaul.”
Medicynic: Medical expenses are one of the major causes of bankruptcy in our country. The system is toxic and and people are dying from their lack of reliable affordable access to care. It’s time to heal ourselves.
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Right now, “he who has the gold makes the rules” – the lobbyists, the health insurance companies who are starting banks and venture capital outfits instead of reimbursing providers, Big Pharma trying to convince us newer is better in direct-to-consumer advertising, etc. Tear it all down and start again, it’s far too broken to fix.