The state of US health care

[snousle]

One of the most insidious propaganda campaigns going on right now - and a disturbingly effective one, too - is promoting the idea that single-payer systems in other countries have "failed" while the US is has the "best healthcare in the world". This is a plain, transparent lie, and because it's so easy to beat it into the ground, I am going to do so right now.

Measured by technical prowness, the US is almost certainly the best bet for those people that happen to have six-figure slush funds to put into their own health care through the private system. For that 99% of the country we have been hearing so much about lately, the ones that don't have that kind of spare change, the situation is a little different. There are so many sources to cite it's hard to list them all, but if you're a little on the nerdy/analytic side, a great place to start is the site gapminder.org, where you can configure your own charts, like this one, which tells pretty much the same story as any other source: the US has slightly worse health outcomes than most industrialized nations, but at about twice the price. Even as a percentage of GDP, the US spends about twice as much overall as comparable countries.

When it comes to subjective measures of patient satisfaction, the US also lags - see here and here, and for those of you who are worried about liberal media bias, here's something from Fox News saying the same thing.

What really shocked me was that the US already spends more in tax dollars alone than other countries:



That's from this article. Think about this for a bit. We already have a socialized medical system - one that is more socialized than other countries in the sense that it already consumes a slightly huger chunk of tax revenues than it does in, say, Canada or the UK. But to actually use it, we have to pay again. Either payment system alone should be enough to pay for decent medical care, but we have to pay twice.

That, I'm afraid, is "failure" on a grand scale. It is possibly the greatest waste of money in all history, and it is an outrage. And, as the article suggests, the right-wing take on this truly is denialism; there are no outcome- or satisfaction-based statistics I know of that contradict this picture, only heart-wrenching tales of grandma not getting her MRI when she wants it.

Let's be clear: running an effective health care system means saying "no" to a lot of people, and that is going to result in a whole lot of drama and dissatisfaction. The amount of money one could justify spending on health is literally unbounded, particularly as technology advances. If we can grow new hearts for a million dollars a pop, what elderly person wouldn't want one? Who wouldn't feel they have a right to one if it saves their life? It makes me clench my teeth whenever health care is framed as an entitlement; this path leads to ruin. Instead, it must be approached as a cost-benefit analysis, with the benefits measured in quality-adjusted life years (QALY).

There are a couple of ways to approach this. One is to say "no" in the easy cases, by shuffling them off to the side and hoping they die cheaply. Another is to say "no" in the hard cases, in dramatic situations that call for emotional demands for treatment, but where the treatments are unjustified because they don't provide the same QALY improvement as you'd get treating someone else. (In neither case do I oppose letting people pay out of pocket for procedures that the state doesn't cover.)

Unfortunately the US is caught in the reactionary, emotionally-driven mode, where preventative care is neglected and measurements of effectiveness are tossed out the window. The medical industry has capitalized on this and is quite good at the use of fear, self-dealing, and fantasy accounting to extract as much money as possible from patients. (I call it blackmail, and is a very good argument against letting private interests control medicine in the first place.) It is not clear if the political structure of the US even makes it possible to run a rational, evidence-based health care program. Obamacare might or might not be a step in the right direction.

BUT THE LIES HAVE TO STOP before there is any hope of progress.

This post is based on comments in a previous post.

Comments

agree!

[txkink.livejournal.com]

I agree with you on all of this and that graph is an eye-opener. The health care industry is so mucked up right now and many of the lies/half-truths continues to perpetuate.
Here’s a few of my observations working as a boots-on-the-ground doc in a public hospital:

- Health care has truly become a profit driven industry – not a “need” that is then met with a service, but a “create the need” mind set. Even in my public hospital there are administrators who talk of “we can bill for this so let’s provide the service”. One of the private hospitals built a small free-standing day surgery hospital near one of the major highways recently – was that because there was such a great need for day surgery centers in the city? No, it’s because surgical procedures are the easiest to bill for and day surgery means less overhead since no one stays in house. If there were patients needing day surgery and the dozens of surgery centers in town were not able to meet it then yes, build another, but the thought seems to be less of need and more of “can we bill”? Whenever we speak of needs at one of our hospital, the first question is always, Can you bill for it? and if so, how much?

- Which brings me to the second point; there are too many administrators and not enough health care providers. The bureaucracy is astounding and contributes nothing to patient care. Another factor is that most of these administrators are either newly minted college graduates who have never cared for a patient (and never will) or are nurses who haven’t touched a patient in 20 years. They write regs that sound good on paper but are never practical and carry such penalties for lack of compliance that it becomes more about following the letter of the regs and not about actual better care. For instance, one of the more recent “patient safety goals” put out annually is fall prevention. Sounds good on paper, but what it means is that so many hospitals fear the bad outcome of a patient who falls that they will not admit them to their units meaning that the patient must wait for hours in the ER while another hospital is found to take them.

- Final thought – the focus on the industry aspect of health care means you get people with no actual vocation to take care of people (some docs and nurses but especially technicians). I’ve seen this first hand – here we have TV commercials for these quickie schools that can get you trained to work “in the exciting health care industry.” While not the majority, I have been struck by the number of these graduates who have little sense of actually caring for patients and look on it as “just a job”. I think this leads to reduced overall care and the patients are able to tell as well.

I don’t know the answers but I know that the business side of all this has truly burdened the provision of care and where there’s money involved politicians are not far behind. The fear mongering is reprehensible as is the idea of using health care as a means to profit at the expense of good patient care.

Re: agree!

[snousle.livejournal.com]

Thanks for the observations!

Re: agree!

[h0gwash.livejournal.com]

I am currently finishing up a pharmacy technician certificate at a public school (which has recently lost its public funding thus doubling student costs) and I would have to say you are correct. While it is still a fascinating material to learn, I began the course with an understanding of the inefficiencies of our third party billing system but I simply saw it as a lot of gravy that maybe I could get a bit of. I continue to hope that the medical industry bubble won't burst until I've paid off my house in 6 years. (or at least until I get a job fetching drugs)