In the US, 55% of healthcare is paid for by state and federal government (Economist Magazine). Medicare and Medicaid is the lion’s share of that. Every analysis I have read indicates that no matter how underfunded Social Security may be, these programs dwarf it by comparison and threaten US finances for the next several generations. How can anybody argue in that light that the governements should take on more responsibility?

The people who get employer benefits are also on a socialized system. I am lucky enough to be in one and therefore I know first-hand that I have no motivation whatsoever to contain costs. There is no penalty for me when avoiding preventative care, no incentive to shop around for doctors, or even bother avoiding the emergency room. The guy in the cube next to me is my age, my height and 100 lbs heavier than me! He pays the same premiums as I do. In this light, is 3rd party payment (government or employer) a good idea in keeping prices down?

In the US, we fight until the end against death and are willing to pay (rather have somebody else pay) for every conceivable treatment even if it prolongs life as little as a week. 80% of a person’s lifetime healthcares costs are at the end of their lives (Can’t remeber where I heard that, but it makes sense) NPR had a story on England’s healthcare. The government has a list of allowed treatments that it pays for and that is it. Hospice takes over and tries to ensure a good end of life. The Brits interviewed seemed OK with that. Good for them, but I am not sure Americans would be.

As a matter of fact, I bet Americans would sue the government if they had a one-payer system and told Americans that to cut costs, you wouldn’t be able to try every treatment out there. That brings me to the next point of out of control lawsuits. Malpractice insurance is tens, even hundreds of thousands of dollars a year. I dated a doctor who worked in a Public hospital in Chicago and she spent more time in court testifying for fellow doctors against abulance chaser lawyers than she did treating patients. Our judicial system needs repair if any progress is to be made here.

I can go on about the way the AMA certifies schools based on nice facilities and not training doctors and how the medical industry has not embraced IT like the rest of society, but what amazes me most is that people are so sure that the medical industry should not make money. When I need a doctor, I personally hope he/she is being well paid. When the researchers are finding the cure for cancer or some other disease that I might yet get, I hope they are well paid. When an evil rich guy invests in a big pharma company and they create drugs that save me later, I hope he gets a good return on his investment. I might even be willing to pay something for that.

As an administrative physician for a large group of physicians, my gut tells me a single payor system ‘might’ help, but then again it also might not. The devil is in the details.

But notice I only say ‘help’ and not ’solve’, for I do think single payor systems are a kind of ’smoke screen’ of both the left and right. My gut tells me neither approving not rejecting a single payor system will really deliver America to the promised land of lower healthcare costs.

As I see it, there are really four main reasons healthcare costs are escalating in this country and they are pretty easy to understand (I just hope I am up to the task of explaining them

1. The various players in the system no longer trust each other (in prisoner’s dilemma language– the players are beginning to ‘defect’) and they are increasing barriers within the entire system with the intent of improving things, but in totality making things far more expensive than they otherwise would be (at least from a cost standpoint). In this fashion, what we are witnessing is analogous to the credit crunch. Imagine a marriage with all kinds of regulations, would it really ever work? Yet the marriage must operate according to husband and wife ‘playing by the rules’ or it would fall apart for lack of trust.

It is a circular problem without answer, except that it works when the participants trust one another.

2. There are many well intentioned regulations which dramatically increase barriers to competition (this is really again the same thing as problem #1). The biggest of all of these ’sacred cows’ were really past over 100 years ago and have to do with what a physician or healthcare practitioner is-should be and what skills they need before they can even practice medicine (think bariers to entry).

As medicine become more and more proceedure oriented, this issue is becomming bigger and bigger. Since all of these laws are passed at the state level, they are often ignored in national discussions. This is the biggest ‘low hanging fruit’ of all.

3. Most people do not understand the fractal nature of illness and healthcare spending (most people don’t even understand fractals!). This leads many people to MANY wrong impressions regarding who is ill, what is ‘bad medicine’, and where our healthcare money is spent.

Further, since people don’t understand fractals, they don’t understand how to reconcile issues of scalability and ‘power laws’ with issues like trust.

3. America continues to avoid a values discussion on when it is ‘OK’ for our healthcare system to ration care and who should be empowered to ration. Indeed the very notion of rationing or tiage (so fundamental to medicine once apon a time), are completely anathema to most Americans.

Yet whomever empower as a society to ration healthcare (just as we empower judges to administer justice), still we must decide this issue. For rationing SOMETIMES requires override the wishes of individual patients and families (like judges must sometimes override plantifs or defendants), in order to protect ‘our collective finances’.

AND, if you have the power to ration, you must also have the power to be wrong (just as judges are allowed this privledge), or rationing will never work.

You may not have ever thought of how physicians in America were once the guardians of your healthcare resources (and they still are in countries like England and France) but in America today, with its diminishing trust, SOME of the physicians who once guarded your resources are loosing faith in their patients, and prescribing care as if it were a blank check (this is on top of an besides the point of any financial motive they may have)– physicians fear character assaults or errors in their judgement leading to malpractice.

…While this point can be overstated, there is a strong kernel of truth to it.

If any of you want further elaboratino on 1, 2, or 3 (or all), let me know, I can easily provide further details.

Without caps in litigation or other forms of protectionism, a private economy would sort out the bad from the good in no time as doctor’s insurance premiums would assign risk adjustments for drugs and procedures.

So, who did the ‘individualistic’ Americans think should help out? The employer. Of course. We expect our employers to supply health care, pensions, and what, unemployment insurance?

What a crock. The business who likes you so much they fired you, or who is doing so well they laid you off, is supposed to ‘help’.

What this shows is how our refusal to rely on our govt has resulted in this inane system of relying on private employers, who are not accountable to their workers. The business world is not a democracy, for heaven’s sake.

Americans are worker-serfs. How many millions are stuck in jobs because they have health insurance? How many businesses don’t get started because the founder can’t risk no health insurance?

Rant On: Americans are best in the industrialized west at one thing: kissing rich and corporate butt. You may end up on the street in your fifties with no pension or health insurance, but comfort yourselves with this: you’ve got a mouthful of rich ass. Leave in your will for your kids before you jump off that bridge. Rant Off.

US has the second worst infant mortality rate of the developed world:
http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/index.html

A general view of the healthcare issue and the US’s issues:
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=640980

Personal stories do not the big picture make. And if one is looking for horror stories on health care, one can find quite a few right here in this country.

Market solutions only lead to avoidable deaths and rising costs. American health-care delivery has been inefficient and immoral for too long.

It’s astonishing to me we have chosen profits over people. We are the only industrialized nation on earth to have such twisted priorities. The human suffering must end!

I think single payer is time. Let’s just take insurance out of the mix completely.

weinerdog43