American exceptionalism in medical care

Click to enlarge.

I’ve often run versions of this chart on my web log.  It shows that we Americans pay more for medical care than do people of other rich countries, and yet our health is worse, and many of our citizens lack good medical year.  Yet a lot of us are afraid to change.

As a writer for The Economist said:

Republican reluctance to embrace health care, despite the president’s best efforts, is understandable.

On the one hand, America’s health-care system is woefully dysfunctional: the country spends about twice as much on health care as other rich countries but has the highest infant-mortality rate and the lowest life expectancy.  Some 30m people, including 6m non-citizens, remain uninsured.

And yet, though costs remain a major concern—out-of-pocket spending on insurance continues to rise—Americans say they are generally satisfied with their own health care. Eight in ten rate the quality of their care as “good” or “excellent”.  Few are in favour of dramatic reform.

Source: Health spending and life expectancy – The Big Picture

I think many Americans are in the same situation I am.  I have medical insurance that I can afford, providing by a company that I don’t think is going to cheat me.  I don’t know what I’d do if I had to pay my medical bills out of pocket—partly because the insurance company can negotiate lower rates than I would have to pay as an individual.

So it is natural to fear any change, and to be skeptical of anybody who promises to take away what I’ve got and replace it with something else that supposedly is just as good.

So these fears lock me into a system in which I’m at the mercy for for-profit insurance companies whose profitability is based on maximizing what they take in as premiums and minimizing what they pay back as benefits.

In the best of cases, the insurer’s need for profit is added to the medical bill.

T.R. Reid, in The Healing of Americawritten 10 years ago, said one of the reasons why American pay more for medical care and get less than people of other rich countries is the for-profit insurance system.  At the time he wrote, only Switzerland had for-profit insurance companies.

The other reason is that the other countries negotiate drug prices on a national basis, which the U.S. government is forbidden by law to do, and that medical professionals in the U.S. get more than in other countries.  I don’t have any reason to think any of these things has changed in 10 years.

The justification for the high fees of American physicians is that they have to pay off their medical school debt.  Medical education in other advanced countries is free or affordable.  If Americans ever wanted to cap physicians’ fees, we should combine that with some kind of medical debt forgiveness.

Reid said that there are three alternatives to the U.S. system: (1) the Canadian Medicare model, in which health insurance is nationalized, (2) the British National Health model, in which medical care is nationalized and (3) the system in Germany and Japan, in which non-profit organizations, accountable to patients, provide health insurance.

I don’t think it is feasible to create a patient-run cooperative insurance system for scratch, and I don’t think we Americans have the administrative capability of duplicating Britain’s National Health, even if we wanted to.

So that leaves Medicare for All as the path forward.  And it’s not Medicare for All unless we get rid of private insurance and regulate drug prices.

LINKS

Why a “Public Option” Isn’t Enough by Benjamin Studebaker and Nathan J. Robinson for Current Affairs. The two writers conflate Britain’s National Health with Medicare for All, which is based on the Canadian system, but otherwise an excellent article.

“Medicare for All” vs “Public Option”: the 2020 Field Is Split, Our Survey Shows by Abby Goodnough and Trip Gabriel for The New York Times.  Where the Democratic Presidential candidates stand.

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