It's been a while, folks. It's summer. Need I say more?
Let me get right to it. Why the sky high health care costs? Why the climbing insurance costs? What the French, toast?
Obviously, books upon books can be written on this subject (and have been). There are an enormous number of reasons for the insanely high costs (that continually climb) of health care in this country. Clearly, a profit-based health care system is leaving many out in the cold.
But what I want to focus on here is our medical delivery system. The fascinating history of medicine in this country has fenced us into a system that encourages complex, expensive procedures for every ailment, injury, or malady. The more of these procedures that can be completed on a patient, the better (i.e., the more that can be charged to insurance companies, leading to higher premiums, leading to higher co-pays, more cost-sharing... but I'm getting ahead of myself).
Patients that only need a prescription for antibiotics or have a minor complaint or simply need a check up are in no way making the money these docs need. Well, can we really blame the docs for wanting the more complex cases? Look at the crushing debt they've acquired! But really, we can begin to understand how the disillusionment with our physicians (and thus the insanely high incidence of malpractice suits) originated. Family practice and primary care can be interpreted as a patient mill, the goal being to get people in and out as quickly possible, to see the highest number of patients in order to maximize income. I'm really generalizing here, but these generalizations are broadly supported by fact and can be easily confirmed with quick internet or academic searches. A great place to look is Paul Starr's book, "The Social Transformation of American Medicine."
The origins of Medicare are partly to blame for this complexity phenomenon. Medicare was designed to compensate more complex procedures in a manner seen as more fair. Lobbying by medical stakeholders (the AMA, insurance companies) allowed for more medical and surgical specialties. These specialties, of course, come at a premium. The costs to patients rose, insurance companies became more prominent, and further lobbying allowed them to make more profits from premiums. Insurance companies, for their part, mostly follow the same methodology as Medicare for procedure compensation.
Again, considering that enormous debt, any medical student would certainly want to enter a specialty that paid more. And that's exactly what has happened. Our system is top heavy, like an inverted triangle. Our country enjoys an (over)abundance of specialists who make up the largest part of the triangle; cardiologists, perinatologists, oncologists, and on and on. The more specialists we have, the more specialized procedures are given (necessary or not), and so health costs climb. As befits the triangular imagery, our primary care physicians are far fewer in number, occupying the downward pointing tip of the triangle.
Now let's be realistic; in a country of over 300 million, most people's health needs are not met by specialists. Don't get me wrong, when I keel over during a cardiac event, you can rest assured that I want the best cardiac physicians in the world to save me, and here in the U.S., I have that. But, interestingly, we know that heart disease is the number one killer in the nation, so a growing number of people do need the skills of specialists.
But the question must be asked; if we had more primary care physicians to help us monitor the little things (blood pressure, cholesterol, diet, etc), would we need so many specialists? A quick illustration: England's care provision is the reverse of ours. It looks like a point side up triangle, with a vast majority of physicians in the primary care fields, and fewer in secondary and specialty fields. Their National Health System is cheaper than ours and provides better outcomes for patients (not the least of which are a longer life expectancy and a lower infant mortality rate). Of course, healthcare is far too complex an issue to break down into this one category as the smoking gun for all our cost problems, but the issue is relevant and bears further study, and certainly some reflection for the public.
Of course, the discussion of health care and its various issues encompasses every facet of our lives. It is as basic as personal responsibility and as complex as Obamacare. It is as intimate as the patient/provider relationship and as far-reaching as global economics. It is as fundamental as public education and as esoteric as the most complex scientific studies. Each facet lies adjacent to the next, and an adjustment to one invariably changes the shape of each of the others.
