American Healthcare

American healthcare has lately been in the news quite often. Why? Well, for one, people are feeling the pinch of rising costs of healthcare. For those with insurance, co-pay and deductibles are going up while the insurance rates are also going up. Many employers are no longer provideing free health insurance, expecting the employees to pony up anywhere from 10% to 50% of the premium. For those without insurance, life is full of stress because of the amazingly high costs of medicines and doctor visits, not to mention surgical procedures. Employers too are feeling the heat from insurance companies as they attempt to trim costs, especially towards retiree healthcare.

Many Americans are coming up with clever methods to reduce their costs. Many in the northern states are visiting Canada for a weekend of fun and a bagful of medication for their chronic conditions, from diabetes supplies to heart pills. Many others are going on medical-tourism, getting elective and not-so-elective surgeries done in Poland, India, China, Thailand and Mexico. All these developments beg the question - Is our system broken?

Critics of the American system of healthcare often point out that Americans spend far more money than any other developed nation without the commensurate benefit in the form of higher life expectancy and better quality of health. Is it a fair statistic? As tempting as these statistics might be, I don't think that they are fair. Life expectancy is a complex measure derived from a lifetime of choices and decisions. We Americans lead, by and large, sedentary lives and are exposed to far more mental stresses than most other people. While medicine definitely has a role to play, life expectancy is more about lifestyle choices than medicine.

The supporters of our system of healthcare are quick to point out that Americans lead in innovations in medicine, surgery, therapy and if you were to be involved in a major accident, your survival is best in the US. All of this might be true but it still does not answer the fundamental question - Is our mechanism for healthcare delivery broken?

The American system has evolved over many decades, with many features and nuances that are unique to this country. The American psyche is quite allergic to government-run and government-mandated systems even though we interact with them on a daily, even hourly basis. Our electricity, gas, water, cable-TV, sewage, garbage collection and roads are all either supplied directly by the federal, state or local government or through government-sanctioned monopolies. The healthcare system also has a veneer of private enterprise even though many of the hospitals are funded by state or local governments and most hospitals are run with federal monies. In addition, many millions get health insurance from Medicare or Medicaid, both federal government programs.

My personal frustration with the healthcare system is the un-needed complexity and disincentives built into the system. For example, each health insurance company (and there are hundreds of them) has their own codes and forms for the doctor to fill out for reimbursement. Because of this lack of uniformity, errors in billing are common and require quite a bit of extra work on part of the doctors, nurses and ancillary staff. In addition, each health insurance plan has its own list of covered services which is another minefield that the medical staff, not to mention the patient, has to negotiate. The upshot is that payments take a long time, require many iterations of attention from the insurance company, the provider and the patient and in general waste a lot of productive hours, which get paid out of the higher medical costs.

The disincentives are even worse. Most insurance plans allocate a fixed amount of money for each patient to pay the providers for regular care. As the providers have an incentive to do the least amount of tests and spend the least amount of time and thus save money, the real loser is the patient and his/her health! Insurance companies pay large sums for treating diseases such as cancer but prevention takes a backseat. Many insurance plans don't even cover vaccinations!

What can we do to improve the situation?

Well, there are a lot of things that we can do. We can definitely try to compel the health insurance companies to get together and unify their codes and forms. This would reduce inadvertant billing errors which eat up a lot of time, effort, money and energy.

But, a bigger issue is, what is the society's response to the healthcare situation in the big picture? General Motors has been in the news lately for its very high healthcare costs that are helping it shrink. Toyota overtook GM as the world's largest automaker. Are the American companies and the American society going to go that way?

So, dear reader, ponder on the questions while I try to formulate how a single-payer system can be to our benefit.

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