The best health care system in the world
If you set out to design the most complicated, inefficient, ineffective, frustrating, back-*ssed health care system possible, you could not do better than the current US system.
It is effectively designed by, for, and to serve insurance companies, Big Pharma, and middlemen, to funnel a river of taxpayer dollars to insurance and drug cos. while ensuring that the smallest possible amount gets spent on actual care and the ins. cos. et al. charge all they can get away with (which is a lot, since most people prefer health to sickness and death) and otherwise do all they can to deny and delay benefits while imposing admin requirements that either afford additional fee-extraction opportunities or impose massive, externalized man-hour costs on patients, their families, and employers and on doctors and other actual providers of care (not to mention worry, stress, and poorer health).
Our system ensures that there is little or no rhyme or reason as to who gets insurance and what kind; if you live in one state, you may be able to afford insurance; if you live in another state, you may not, or may have to sell or give away your home in order to qualify for Medicaid; and the variations in the kinds of costs of insurance depending on where you live and who you are or aren’t employed by are equally random from the point of view of everyone except the insurers who get to define them.
The goal of those who get to define them is, of course, to extract as much value from the system as possible without actually getting convicted of a crime; and even if a company gets convicted, of course, the executives responsible usually walk away unscathed and on to their next job.
Meanwhile, millions of patients, employers, and providers spend countless hours per year re-evaluating the ever-changing landscape of available plans to decide which ones they’ll purchase or participate in and then applying for them, filing claims and appealing, if they don’t simply give up on it all. (Moreover, in order to apply for Obamacare, you must give up a fair amount of private info; and in order to receive care at all, you must give up a fair amount of private info to gawd knows how many providers and intermediaries – my own info has been on the dark web for years, not because I clicked on something I shouldn't but because those who required the info failed to keep it safe – here again, more uncompensated time, effort, and costs imposted on patients.)
Even after you’ve done your research and selected a plan that you think will cover your needs for the year, committing to it for the next year, the insurer can unilaterally change what it will cover at the drop of a hat. Drugs they said were covered are no longer covered (and in the US, without insurance, you can expect sky-high prices for them); doctors they said were in-network drop out as soon as they can afford to do so; and I’m not sure what other coverages they’re entitled to change at will, while you have no power to switch plans until the year is up.
This system in which concern for profits preempts all others is also destroying the quality of what care we do manage to receive. Doctors, having seen their patients’ claims denied by insurers under an ever-expanding list of pretexts, learn to record in their notes an ever-expanding list of whatever criteria ins. cos. devise. I appreciate the value of records and checklists and don’t mean to suggest they should be discarded altogether, but between these pressures and the challenges of making a living while bearing all the admin costs imposed by our system, it’s to the point that doctors often rush through appointments, barely glancing at their patients, their eyes glued instead to their computers as they check long lists of boxes and cut-and-paste the required language into forms – then exiting as quickly as possible, leaving patients with questions for which they must make additional appointments in order to obtain answers – creating additional burdens and/or costs.
A continual escalation in box-checking and magic-language-repeating requirements imposed by insurers ensures continuing denials and delays in benefit payments and does little to deter fraud, since fraudsters learn at least as quickly as anyone else what boxes to check and what magic language to use.
The system is so onerous that some of the best or most talented doctors or potential doctors either decide to choose other careers, retire early, or charge extra “concierge” fees for their services in order to be able to provide decent, non-rushed care.
There are a great many other aspects of the US health care system that are serious f*cked, and I won’t go into them all; but I think it’s important to at least note in passing that leaving pharmaceutical development and testing in the hands of Big Pharma, together with the endemic revolving-door and other kinds of regulatory capture that we currently allow of the FDA and the CDC as well as other governmental regulatory agencies, have on many occasions resulted in serious harm to patients. One result, of course, is that new drugs or treatments are not always properly tested before they’re allowed into the market, effectively making patients Big Pharma’s unwitting guinea pigs; another is that new drugs or treatments that are unlikely to be profitable aren’t developed at all.
And meanwhile, of course, we have the most expensive system and worst life expectencies of any developed nation in the world.
It doesn't have to be this way.
Canada's health care system, e.g., like those of many other developed nations, is universal, free, and was recently designated by the World Health Organization as the best in the world. We could just copy it, but for our lack of political will.
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... for killing the public option.
