H. L. Menken said:
For every complex problem there is an answer that is clear, simple, and wrong.
First, the reality is that we have serious problems in healthcare in the US. Our costs are way too high and are spiraling upwards. As consumers, many of us don't see it directly because our insurance is, for the most part, paid for by our corporations. But our companies have been seeing double digit increases in premiums. The current system is simply unsustainable.
While we have some excellent care, the average is not as good as it should be. Our infant mortality rate is well below that of many other western nations. And we have too many instances of bad treatment, where people are improperly diagnosed, improperly treated, get infections while in the hospital, etc.
Our system of many different private insurance companies is terribly inefficient. Each company has their own forms, their own way for the providers to get reimbursed, etc. The paper-shuffling and bit-shuffling costs a huge amount of money. Each insurance company has a large staff of people who answer the phones, process claims, etc. Your doctor's office has a bunch of admin people who try to sort through the paperwork, and your doctor often has to spend time on the phone arguing with the insurance company to get a treatment covered. Furthermore, the amount of profit that the private insurance companies make would be enough to provide free healthcare to everyone in the US.
On several occasions I've had problems with insurance companies not wanting to pay a claim. The provider hadn't been paid once in six months. I called up the insurance company (Unum, IIRC) and they said that they had never received the claim (liars). I sent them the form. A month goes by, the provider doesn't get paid. I call up and they said that they had never received the claim (lied again). We did the dance again, with the same result -- the provider wasn't paid. So, I wrote up a letter to the company president, with CC's to the attorney general in my state of residence and the state's commissioner of insurance. I sent the letter FedEx and wouldn't you know it, the provider was paid in full within a week.
I have a friend who worked in one of the Blue Crosses about 10 years ago, processing claims. She said every week her supervisor would go through the office, pulling claims out of their inboxes and tossing the claims into the garbage.
Our insurance companies are part of the problem.
So is socialized healthcare the answer? Let's look at a couple examples. In Canada, it is illegal to run a private clinic. That is, a doctor can't decide to work for cash -- he has to get paid by the government. The result is significant rationing. If you need an MRI or a joint replacement or bypass surgery, be prepared to wait a long time. Hope your condition doesn't get worse while you wait! It works for the rich in Canada, because they simply go over the border to the US and pay cash.
A fellow that I have chatted with a couple times told me what happened to his family a few years back. I'll relate it as best as I can remember. He was born and raised in Canada. He went to medical school and did his residency in Calgary, IIRC. He has since moved to the US and works as an ER doc in Wisconsin. His family was skiing in Banff when his daughter took a bad fall on a Saturday. He examined her arm and believed that her elbow was broken. He called up the hospital where he had done his residency and spoke with one of his colleagues to see if he could bring his daughter in. His colleague told him that he could not bring his daughter to that hospital, he would have to take his daughter to the ER at the children's hospital. He was told to expect at least a 24-hour wait in the ER to be treated and that he could not fall asleep -- if he didn't answer when called they would go to the back of the line. And even when they did see a doctor, that it is likely that her daughter would not even see an orthopedic surgeon until the following Tuesday.
He gave his daughter some pain meds and flew her back to Wisconsin on Sunday morning. He took her to his hospital. The orthopedic surgeon operated on her arm that afternoon and his daughter made a full recovery. The surgeon told him that if they had waited until Tuesday that his daughter would not have regained full use of her arm.
The UK is a bit better in some respects. Unlike Canada, private clinics are legal. So if you have money, you can buy good care in the UK. If you don't have money, then you will have to wait. At the moment, there is a shortage of NHS dentists. There have been press reports about some Brits doing their own tooth extractions with a pair of pliers. The next time you meet someone from the UK, take a look at their teeth -- nasty.
So while our system is clearly broken, it isn't clear to me that socialized healthcare is the solution. If there is one thing that I trust about our government, it is that the government will screw up anything as complicated as a two-car funeral. It is my understanding that France's system is something of a hybrid and in better shape than the UK's system. But it would require a significant cut to provider salaries, and the AMA has a lot of clout.
Whatever solution we choose will need to address a number of problems including:
- providing coverage to everyone
- reducing healthcare costs (prescription costs, doctor's salaries, administrative expenses, claims processing expenses, etc.)
- healthcare quality
Any "solution" that does not do something to reduce underlying healthcare costs is bound to fail.
