The Whys of Healthcare Frustration

Last week I wrote of my frustration with a health care system that no longer focuses on patient satisfaction. A reader suggested I explain why costs are so high and what led to the degradation of services. Though healthcare is more expensive in the U.S. than in any other industrialized country, it is not best for all, according to a 2019 Johns Hopkins report. Of the $ 3.5 trillion spent by Americans per year, one-third is wasted according to Harvard Professor of Global Health, David Cutler.  NBC News reported that a man hospitalized with COVID-10 for 62 days received a $1.1 million medical bill. Receiving that large a bill would give me gray hair if I didn’t already have it.

There are several reasons doctors don’t provide patients with the compassionate care that was once considered standard. David Cutler, professor in the Department of Global Health and Population at Harvard puts it down to three factors; corporate greed, price gouging, and higher utilization of costly medical technology. Not having universal health care with guaranteed access for everyone is a contributing factor. 

The most notable problem is that U.S health care operates within a “for-profit insurance system.”  Private individuals and companies pay for their care and for that of their employees in contrast to who pays in most developed countries that consider health care to be a right, not a privilege. The motive to make money ripples through our medical economy. Insurance companies, for example, pay a great deal to review claims with the aim of not paying consumers for the care they believe themselves to be entitled to.

Other issues revolve around structure. From billing to service delivery, the system is fragmented and complex. Administrative processes and overhead make up 34.2 percent of costs, twice that of Canada with its decentralized, publicly funded program. The only exception is in the U.S. with Medicare for older Americans.  Operating with less bureaucracy than private healthcare systems, administrative costs are much lower. Little time is given to denying people care.

In a privatized system, patients are charged based on the services they receive. It’s in the economic interest of hospitals and physicians to call for extra tests or scans—the more the better. In my previous article, I complained about the service primary care physicians provide. Hospitals and clinics are buying up private physicians and pushing their profit motive down to the primary-care doctors. Internists are pressured to see a certain number of patients every day. Those who meet their quotas, often find them increased the following year. During visits to the doctor’s office, rather than handling minor problems with a physical exam or collecting history that might provide answers, patients are routinely referred to specialists who cost more. This is why over several years, my one-hour annual check-up was reduced to a half-hour and finally a fifteen- minute visit. I was asked to make a separate appointment for every issue I wanted to raise, no matter how insignificant. 

Perhaps the most difficult part to understand is what results from a lack of government regulation. Hospitals systems and pharmaceutical companies have an easier time keeping costs high when negotiating with private insurance companies. With a single- payer system run by  the federal government, they would be pressured to meet demand at a lower cost. Private insurance companies often pay as much as two and a half times more for services at the same facility as does Medicare. 

The federal government doesn’t regulate how much companies charge for services, whether insurance, drugs or care. And, as more and more hospital systems and insurance companies merge, costs have risen significantly. There is little incentive to keep fees low since patients don’t have much of a choice.

If you are sick and wealthy, the U.S. is still a good place to be. You can get the care you need though you may have to dig for it yourself.  But, our country does not have a system that caters to all. It leaves thousands of vulnerable people to fend for themselves when ill. That is not compassion. It is not ethically nor morally the right way for a society to behave. No wonder so many people walk around angry much of the time. 

References:

Hohman, M. (200\20)Why is health care so expensive in the United States? Today. retrieved from https://www.today.com/tmrw/why-healthcare-so-expensive-united-states-t192119

Himmelstein, D .,Woolhandler,S. & Campbell, T. ( 2018) Health Care Administrative Costs in the United States and Canada, 2017. Annals of Internal Medicine. retrieved from  https://www.acpjournals.org/doi/10.7326/M19-2818

Cutler, D. (2020) the world’s Costliest Heath Care Harvard Magazine. retrieved from https://www.harvardmagazine.com/2020/05/feature-forum-costliest-health-care

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