Comment by Apocryphon
6 hours ago
The U.S. system is neither fish nor fowl, there is more spending per capita than other countries' public systems and endless amounts of red tape because instead of one government bureaucracy you're also dealing with the insurance networks, the providers, etc. I certainly don't think it'll be automatically cheaper, but one can't help but think that the current system encourages hop-ons that exploit the inconsistencies and convolutions. It's like one big nightmarish parody of public–private partnerships.
But our publicly run systems are full of inefficient bureaucracy and red tape, too. Why shouldn’t we assume our public healthcare system would be operated the same way as the public school systems in Chicago, New York, or Los Angeles?
Moreover, there is a massive amount of overcare that americans aren’t willing to confront. My wife’s grandmother had a stroke at 87 and was airlifted from rural oregon to a hospital in portland. She had only 3/4 of her lungs after having cancer in her 60s. The doctors wanted to do an intensive intervention, which didn’t happen only because she refused and died peacefully the next day. My parents are on medicare and they just wander into the ER every time their blood pressure goes too high. I took my 7 y/o son in for a black eye after he ran into a table. The doctor looked at him, concluded there was almost no chance of internal bleeding, but ordered an MRI (or CAT scan, I forget which) “just in case.” We got one and the results within 90 minutes because we just have million dollar machines lying around “just in case.” My daughter went to get her retainer at a small dental office in exurban Maryland, and the office had four people working at the checkin desk. I think this practice has only three dentists total.
America’s “customer is always right” culture means it will be politically impossible to roll back any of this.
Not how I view it as a 74 yo. Patients get what their doctors want as part of a culture of minimal preventive care (it does not pay) and massive medical care (procedures pay handsomely).
Try to get a unilateral diagnostic mammogram. Sorry in the system I am in there is no code for a unilateral diagnostic, only bilateral, even if only one side actually requires diagnosis.
Why? Because 2X the charge and income fir little extra care cost. And who would ever complain about such “excellent” care? Recent experience.
Frankly, dealing with healthcare claims as an American consumer is an excruciating experience and it is at the situation where “try anything else” is worth considering.
Also, as your description of overcare is happening under the current system, a profit-oriented one at that (which incentivizes the ordering of unnecessary tests and procedures) it sounds like you would actually benefit from a non-market-controlled, more modest (even austere), system!
Postwar America was built on the customer being right. The healthcare system is one of the glaring major examples of the customer not getting what it wants. Give the customer a better system.
> Also, as your description of overcare is happening under the current system, a profit-oriented one at that (which incentivizes the ordering of unnecessary tests and procedures)
Profit is part of it, but the legal system and culture are equally big parts. Malpractice claims are handled by jury trial in the U.S., and you can always get a doctor on the stand as an expert who will tell a jury that it was negligent not to order a million tests. The UK NHS avoids that by having the NHS set the standard of care. And malpractice claims have to go through an administrative system before resorting to court. And culture is big, too. Americans aren’t going to tolerate being sent to hospice before blowing through $1 million on heroic but futile end of life care.
> it sounds like you would actually benefit from a non-market-controlled, more modest (even austere), system!
I support such a system. My point is that there would be no political will to enforce modesty and austerity.