Health Care Doomed by Expectations

Uwe E. Reinhardt at Economix notes: 

For decades, Americans have lamented in vignettes published by various news organizations the families, stricken with serious illness, who find themselves unable to procure health insurance at premiums they can afford or are refused coverage altogether.

The Affordable Care Act was written to solve this problem by subjecting private health insurers to community rating and guaranteed issue.

But if Americans want the benefits of these two strictures, they must also be willing to countenance the mandate to be insured. It is not legislative hegemony. It is an actuarial necessity.

He also notes that virtually all other industrialized nations have found a way to offer coverage to everyone and all of them one way or another have the equivalent of a mandate to have insurance as part of their system.

As noted previously, the health industry is driven by expectations. Patients expect everything to be done no matter the cost,  the limited benefit of the intervention, whether they can pay or not or for that matter whether or not they have insurance.  It’s the American way.  They also largely expect that no matter the severity of the illness and difficulty of treatment that they will be the ones cured–that’s what it said on TV or the Internet. 

Doctors expect a handsome income to pay off their overhead, loans and to maintain their standard of living.

The medical technology industry including insurers expect double digit yearly returns on investment.

Hardly anyone in the non-system bothers with value, comparative efficiency, or the cost of all this.

The U.S. is an outlier.  Health care here costs more than anywhere in the world by far.   We have 50 million plus uninsured with limited to no access to care.  We lead the world in bankruptcy from health care and yes given how much we spend, our health care quality is marginal. 

Entering into the fray, some members of the Supreme Court, perhaps a majority, seem to feel that it is a shame that people “have” to have insurance.  That their free choice should allow them to have no insurance but leave unstated what happens if they should get sick.  How they would access care?  Who would pay?  In their cocoon of wealth and privilege the Supremes seem ignorant of the fundamental issues of health care and the economic disaster we have created.  Quite an amazing scene. 

Medicynical Note:  Let me clarify my view on quality.  When people eventually get care in the U.S. it’s quite good, as good as other places—albeit at twice the price.  Our problem is the delay often experienced from lack of insurance and money to pay our inflated price for care. 

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