US HEALTH CARE – DOWN THE RABBIT HOLE AUTHOR Michael Flynn , MD
DOCTORS ' LOUNGE
All of the other first world / industrial countries have health care systems whose function is to provide health care to all the citizens of each country . The purpose is simple in that the goal is to provide universal health care managed by the government . The method varies from government provided health insurance to a totally government-run health care system as in the United Kingdom . Funding also varies involving an assortment of taxation methods ranging from general taxation to multiple source funding , such as combinations of taxation ( central and local ), employer , employee and out-of-pocket sources . Some countries allow private health insurance , regulate fees , supervise and regulate drug costs . Health insurance is mandatory / compulsory in most and some countries do not allow for-profit health insurance .
The Scandinavian countries , the European Union , the United Kingdom , Canada , Australia , New Zealand , Japan , South Korea , Taiwan and some South American countries all have different forms of universal health care , functioning market economies and have not been bankrupted by providing this benefit to their citizens .
In the US , we have a health care industry , which functions in a magical arena , the competitive medical market place . While all those other first world countries consider health care an essential public service , in the US health care is a commodity to be exploited by an assortment of profit-seeking entities .
Most other first world countries have health care systems managed by the central government . In the US , we have a patchwork or more correctly a crazy quilt of different entities , some focused on providing health care and others focused on extracting profit from the health care industry . Medicare is government health insurance for older citizens and some with disabilities . Medicaid provides government health insurance as a federal / state collaboration for the poor and individuals with certain disabilities . Medicaid covers different things in different states . The US Public Health Service is trained to respond to national health crises and emergencies . The Army , Navy and Air Force all have health care systems within the Department of Defense providing health care to active-duty military and their families , retired military and dependents and politicians . Senators McCain and McConnell and Presidents Reagan and Trump were all treated at military facilities without cost . The VA health system , while not without challenges , generally does a good job caring for veterans .
And then we have the uniquely American approach to health care , over 1,000 for-profit health insurance companies whose primary goal is profit , not providing health care . Actually using the revenue from premiums charged to customers anticipating health insurance is considered a “ Medical Loss Ratio ”. 1 The Medicare administrative costs are in the 2-3 % range , for-profit health insurance companies are allowed to keep 20 % as administrative cost as per the ACA and often find ways to keep higher amounts in certain plans . 2 Each health insurance company may have 10-30 different plans with a range of premiums and coverage . The end result is an insanely complex and confusing health care environment inflicted on the American public .
How did we get into this mess ? From the mid-1970s to the mid- 2010s , the number of administrators / managers has increased by an astonishing amount : over 3,000 %. There are now 10 managers / administrators for each physician . 3 These people do not work in ICUs or ERs , they do not do COVID-19 tests or vaccinate . They may help , but they also interfere and are paid salaries that are often multiple times higher than the nurses , respiratory therapists and physicians who provide medical care .
The pharmaceutical industry functions without restraint , a very different situation compared to most other first world countries . Medicare is prevented by law from negotiating with the pharmaceutical companies , an astonishingly stupid economic policy . 4 The for-profit health insurance companies extract hundreds of billions of dollars annually out of our health care as profit , outrageous administrative costs , advertising , political contributions and investor dividends . 5 Over 60 % of bankruptcies filed in the US are the result of citizens unable to pay medical bills , a situation that simply does not exist in most other first world countries . 6
As disturbing as the current situation is , it is already getting worse . Private equity firms are purchasing nursing homes , hospitals , health systems , physician practices , outpatient surgery centers , laboratories , imaging facilities and whatever else they can get their hands on . 7
The Wolves of Wall Street are about to devour US health care . The process involves buying the non-professional component of a practice , “ improving efficiency ” with the expectation of a return on investment of 15-30 % annually and selling for a profit in three to five years . 8 This is not meant to be a long , happy marriage . The investor invasion into health care creates the fundamental conflict of interest . “ You can ’ t serve two masters . You can ’ t serve patients and investors ”. 7 About 70 % of US nursing homes are investor owned . 9 The resulting “ improved efficiency ” involves reduced staffing , increased use of medications and decreased quality of care .
( continued on page 36 )
NOVEMBER 2021 35