Several years ago, I had excellent insurance which provided a list of vendors who were all approved with each vendors cost listed for a mammogram. I called up each one that was nearby and spoke to the billing dept. I knew to ask questions - are there any other fees for the mammogram, is it digital and if not, when is the equipment from, how much does it cost to have it read, get the report, etc. The price varies from $75 to $175. While some had no idea when their equipment was manufactured, an important point in a rapidly changing field of radiology, the cheapest one, all in, was one at $159. Every other one had added fees. And, the end of the story is I was billed $185 including a hospital usage fee I hadn't asked about and they didn't tell me either. Plus once you have a mammogram at a place unless you return, you have to carry the images to the next place since they look for year over year changes.
Now I could do this with a mammogram because I had time to do it. When I was hospitalized for emergency cancer surgery - surgeon's fee alone $185k - you can't.
From the article: "Where is this new, much better insurance going to come from, if not from the “big, fat insurers”? Exactly how are people going to negotiate with insurers, and over what? Prices? Benefits?"
This is it, exactly. It's disturbing that Trump "tweets" something he's given no thought to, and his surrogates and enablers give it a modicum of thought and then go on TV to agree with him.
I have NO desire to negotiate my own health care costs, and I bet there will be a lot of people like me.
First of all, the notion that this or any Congress in the foreseeable future will work over the next two years to come up with a replacement, much less better plan is just laughable. If Congress actually did its job then we wouldn’t be shutting down the government because they can’t pass a spending bill at the 11th hour.
Second of all, as long as health care and insurance are considered as money-making problems for private companies, and not as sound public health policy, there will never be an effective or efficient solution. If Trump REALLY cared about the people and not the “big, fat insurance companies” he would propose regulating them and not us. Would not be at all surprised if a Republican plan involved giving Trump and his family a lucrative stake in it.
Good review and report. What is usually not explicitly covered in discussions of health care plans are 3 key aspects of the financial reality of health care. The first is that there is no such thing as a free market in health care - nor could there ever be one. The second is that the care currently being delivered (at any point in time) costs what it costs and the only way to reduce what it costs is to do one or both of the following: a) limit care and or b) limit profits - in the case of private insurers and providers. The third is: healthcare is so expensive you can't just dump money in a personal account and move on.
No free market in health care: this one is easy. Health care is complicated. When you purchase a car even those of us with the most rudimentary understanding of automotive engineering can go to the dealer and figure out what features we need vs. want and what we're willing to pay for those features. Safety ratings are readily available with objective reviews by all sorts of not for profit objective entities and we can then make a decision - Mercedes or Yugo - we can actually decide on this. This is a free market that can actually compete on price, features, and quality that mere mortals can understand. But health care is so much more complicated. The vast majority of doctors and hospitals are pretty good, there is precious little data to distinguish one from the other in a meaningful way (Sorry healthgrades, CMS star ratings, etc - these measures are so rudimentary as to be almost useless). Also, the worst care is care that is fragmented and not integrated. That means you simply have to have a navigator that coordinates and plans your care - this is typically a primary care doc for most of us. Once you have a complex diagnosis, the coordinator might be a specialist, and so forth - but the point is: you are going to follow the primary doctor's or the specialists' recommendations about what test to have, where to have it, etc, etc. You are NOT going to go out shopping for price. THIS IS NOT AND NEVER WILL BE - AND NOR SHOULD IT BE - A FREE MARKET.
Care Costs What it Costs: DaVinci Robots, Mako Robots, chemo therapy, hospital beds, doctors visits, etc etc are expensive. The only way to control these costs is to a) limit care: this means saying - hey wait, let's not allow gall bladder surgery to be done by Da Vinci robots - we were doing just fine with laparoscopy. Or other more controversial limits like, a 90 year old with advanced cancer probably should not be a dialysis candidate (I know - sounds like death panel stuff). Or, b) limit profits. I actually heard a Republican congressman on Potus saying that we can't go on letting insurance companies make such high profits - it was Rich McCormick. - and there was no follow up question on whether he was advocating price controls, socialized medicine, single payer, or what? Incredible lapse of interviewing skills.
Third: Health care IS EXPENSIVE: When a previously healthy person gets chest pain, then has a stress test, then needs open heart surgery with a valve replacement, and a CXR shows an incidental pulmonary nodule that then requires a CT scan, bronchoscopy, biopsy, surgery for lung cancer followed by chemo therapy - the bill after a couple of months is going to be in the range of $500K - Are we to believe that dumping money into a personal HSA and letting the patient shop for the best deals is going to address this patient's needs. Please.
Bottom line - either single payer (Medicare for All) or ACA with regulations (yes, REGULATIONS) addressing pricing (i.e. pricing, incomes of providers, profits of insurers, etc) ALONG WITH: some tough soul searching on the part of America regarding "standardizing" (or maybe read: "rationing") care. I mean, we CAN have it ALL - but you gotta pay for it (read: higher taxes for government insurance, higher premiums for private pay) - or if you want to pay less - lower taxes, lower premiums - you CANNOT have it ALL.
I can't bear to proof read this before posting, so maybe some typos, heh?
Thanks for this analysis! I’m going through this where I need a test/procedure and the quote I got seems high but my issue is potentially urgent and I’m not gonna shop around and wait another 2 months to get in somewhere. Thankfully I’m able to just pay it.
Politicians so sheltered from reality that they have no clue what real people have to do to acquire healthcare. The whole point of the ACA was because group plans weren't available to most people and they had to pay a fortune for individual insurance. They have such a hard on against anything that Obama was involved with they're willing to throw the baby out with the bathwater and screw their own constituents. The stupidity is amazing. The pittance they're talking about giving to the people is not going to make up for what they could get through the ACA. But who cares, as long as the billionairs get their tax cuts.
The shopping for healthcare proposal and paradigm is both impractical, ineffective and patently offensive at every level.
Does anyone believe that any government subsidy, individual health savings account, or tax credit, proposed by politicians, would be big enough to cover insurance premiums at today’s costs? How are “average” folks supposed to pay co-pays, which add up if one is chronically ill, or older and have recurring check-ups. Overnight stays in a hospital, even for simple procedures, are cost prohibitive.
Just the idea that we are consumers of health care – simply akin to shoppers looking for a good deal on goods, on a new car, on a vacation is insulting and ludicrous. When it comes to health we cannot be akin to a consumer who can shop for the best deal on Amazon, read the reviews, and be ensured of a return policy.
Bad medicine allows for no return. We did not go to medical school and therefore do not have the requisite medical knowledge in order to make an informed choice regarding doctors and procedures.
“The administrators made sure beneficiaries knew where to get cheaper, but still high-quality knee replacements. A widely cited study found people did indeed gravitate toward those cheaper providers”. And did they indeed get better quality from cheaper providers, mostly likely the only ones that they could afford under their health plan?
The ACA addressed the affordability issue allowing millions to have the comfort of a defined health insurance plan, albeit at a cost. Choice? All plans that I know of, whether subsidized or not, now have networks, and it is only within the given network of hospitals, clinics, doctors, and testing centers that you can pick. Even Medicare says that you can go to any provider that “takes Medicare”. If the payment for a given visit or procedure is not sufficient, the provider may not accept your insurance, or may choose to become a part of a given network.
The burden, and worry are put on the populace, rather than the health care conglomerates who have carved out areas whose hospitals and doctors and pharmacies they will absorb, allowing collusion and price fixing. All these politically designed plans are designed to increase health care corporate profits, at the expense of the patients (“consumers”) and employers’ bottom line as it lowers their share of the cost. Creating incentives and regulating a system in order to make care more available and more affordable is not on the agenda of any politicians whose donor class includes the health care monopolies.
I’m sure that Rick Scott – he of the largest fine for health insurance fraud – is looking out for his constituents, especially the seniors in Florida. And Dr. Oz who has been censured by his colleagues and stripped of his rights at his (former) hospital is hardly interested in making America Healthy – more like MACRA: make American corporations richer again, and rip off actual consumers of the products that he promotes.
Moral hazard theory? What an affront! Of course, I would let my house burn down, because insurance covered the loss; have a car accident so I could have the covered damage fixed; make myself sick so I could have a nice hospital stay because it was covered.
Our health care system is immoral, unethical and corrupt, becoming more so each passing year. It is the collision of profit and savings that renders these huge payouts possible that causes real moral hazards to the people, making America sicker. The only moral solution, one that would put health and not wealth first, is a national health care system or “Medicare for all” (that is if the government doesn’t privatize it).
Reforms needed? Absolutely. But not the kind that politicians propose.
Health care is a right, not a privilege, as it is in our country. The cost to us – in life expectancy, infant mortality, chronic illness and now preventable diseases (caused by our most vocal, but ignorant health care “expert” – RFK Jr. is real.
ACA is a start: it must first be restored, then expanded, not “reformed” as proposed now. We can only hope that there will be more than a few politicians who will find their moral compass. Or maybe look to their children or grandchildren and wonder why measles is proliferating in their schools.
Applause for this!! Thank you. I am a Canadian, Retired Physician. I never considered going to the USA, in spite of plentiful “recruitment mail” (given that I’m a University of Toronto Medicine grad). No. A massive morass if broken systems, and none of them with the focus that Medicine *should have*, which is: that the best efforts and the quickest attention are focussed on the “sickest people”, regardless of income.
—A *good* and successful Medical system, that includes the moral imperative above, is by the truths of the biological-beings that we are, it is a Capitalism Failure. You see, some of us might never have a car-accident (or one that damages more than the car itself, with a fixed replacement-value), or we might never have a fire or theft at home; but none of us get out of this interval called “life” in persistent good-health, do we??
—The total *crime*, IT IS THE PROFIT MOTIVE, the need to provide “returns” for shareholders: that DOUBLES the per-capita health-care costs in the USA, for definitely lower “average outcomes” (—1/ see, life-expectancy data; 2/ see, the astounding incidence of “Medical Bankruptcy”, which is just NOT a thing in some 25 comparably “high income” countries). One thing used to maximize profits (and attract more shareholders) is a whole layer of employees, who are Paid to Deny the maximal number of claims… Healthcare that is “not provided at all”, it is very low-cost for the Company!, also it helps to “pick off” from the list of insured-people, some of the sickest ones —dead people stop being a sunk-cost for the Company, right?
—I wasn’t just a provider (just kidding, “just”, I did Primary Care, plus part-time ER for ~14 years, and delivered 1000+ babies, with no bills to the already-stressed parents), but I also witnessed our system “working”, in one of our fine Ontario Cancer Centres. My husband had Stage3 Melanoma in 2019, requiring several tests including a Head MRI, before expert surgery, followed in 2020 by a year (17 doses) of Immunotherapy. And, he’s cured, just discharged by his Oncologist (a published Melanoma specialist). What were our “deductibles” or our “co-pays”? Yes, well some places we paid a few dollars ($Can) for parking!! —You poor people. 33 of the finest 34 countries in the world have figured this out. Fix your system.
What you described for your husband’s health recovery sounds great.
Although, this monk recalls that there were problems with public health care in other countries, compared to healthcare for those workers who can afford good insurance coverage.
In a query, this monk found the following info generated by ai. Would be very interested to get your perspective.🙏
Specialist Appointments: Wait times are a significant issue for specialist care in Canada, with studies showing a much higher percentage of Canadians waiting a month or more for a specialist compared to the US. Some American states even track these wait times, with average wait times from GP referral to specialist treatment being shorter than in Canada.
Elective Surgery: Canada has the longest wait times for non-emergency surgeries among several developed nations. In the US, the waiting time for this type of procedure can be much shorter, especially if one has private insurance.
Urgent Care: Wait times for life-threatening emergencies are typically similar in both countries. For example, wait times for a broken arm are generally short in both Canada and the US, although a patient may have to wait longer for non-life-threatening conditions.
Emergency Room: Some studies indicate that Canadians wait longer in emergency rooms compared to Americans.
Contributing factors
Systemic Differences: Canada's publicly funded system prioritizes universal access, which can lead to longer wait lists for elective care. The US system, which relies more on private insurance, can lead to shorter wait times for those who can afford it, but can create access barriers for those without insurance.
Indeed, I mentioned the wait-lists! And, I think our system needs more money into it, to improve these things! The point is, not that we have “great access” to everything, (though people with Emergencies, trauma, heart-emergencies, strokes, cancer… they do not “wait”, and our outcomes are just as good).
What we don’t have is “discriminated access”: It is not an individual’s fault, that when they need their hip-fracture repaired, that they are owner of a solo-small business (in fact, it’s a great attribute!), rather than a unionized auto-worker with “good insurance” —both groups should get equal access to the “hemi-hip replacement” which is the treatment for many such fractures (I’ve assisted on such, being the one who’d come in at short-notice on a Tuesday evening.)
People die every year, in the U.S., for lack of surgeries they need, like heart-bypass surgery, because they haven’t any “insurance”, and cannot afford the extraordinary prices (c.f. Your lower “average” life expectancy). It’s a Societal Shame. USA says its people are “free”, but clearly not all their lives are valued by their Country.
Suddenly they have more than the framework of a concept of a plan? Only took fifteen years. It'll be ready in two weeks. Right after infrastructure week.
Cohn gives a good description and analysis of much of the foolishness and fallacies of the supposed "debate" we're having about healthcare.
I've been around healthcare for most of my career and one thing I've seen is that physicians are knowledgeable about "medicine" - providing care to patients - but they don't know that much about "healthcare" - all of the policy and infrastructure that goes into enable them to provide that care.
So I don't give the physicians in Congress (like Cassidy, Barasso) any more credence on the subject than any other member of Congress. And I especially discount (ignore, really) anything a Republican says. When they're not making exaggerated claims about fraud and abuse, they're recycling bad ideas that have failed in the past (as Cohn explains), offering shallow ideas that would create more problems than they'd solve, or spouting nonsensical buzzwords and cliches that have no meaningful substance.
One Fallacy of believing that consumer shopping will lead to lower overall health care spending is that while specialty providers may be able to reduce costs on specific procedures (like knee replacement), generalized and urgent care costs will increase due to duplication of talent and equipment. The specialist orthopedic surgeon doing knee replacements will not be available for emergency room duties.
I'd love for Democrats and moderate Republicans to seize on Trump's "greedy insurance companies" trope; use that to push forward a tied and true way to control insurance costs: mutual companies (and maybe non-profit HMO's) are the only ones allowed to provide health coverage. Paired with a no preexisting conditions prohibition removes the profit pressure. If the investment returns on premiums go back to the members instead of shareholders there is less pressure to raise rates.
The Republican Party's "healthcare plan" is the same one they've had since they opposed Hillarycare: Get sick quickly and die young. When healthcare is seen as a privilege, it the providence of God's blessing. And God blesses who God blesses, so if you haven't been blessed with wealth and healthcare then you must be a heathen that's hellward bound. Also, no matter how advance medical technology gets, doctors should still be paid in chickens like they were a century and a half ago before the discovery of penicillin and when carpentry tools were still being used to perform surgeries.
This is why Bernie Sanders, AOC, and Mamdani have gained a foothold in American political discourse. When the guardians of Capitalism are screwing up hard, Socialism starts to look rational. If your the citizen of the country, if you pay taxes into the system, and corporations receive corporate welfare from the government with tax payer money; then shouldn't the actual tax payers receive stuff universal healthcare and universal basic income from the government they pay for.
I see another flaw that you didn't mention...at least where I am, there is very little price transparency...most won't even tell you what the cost is, so how do you compare?
Even with the same procedure, paid for by your medical insurance, they can't tell you what it will cost out of pocket, let alone what the total cost is...
I had a colonoscopy once that cost me $2500 out of pocket as a cash payer at the time...( which they always raise the costs for cash payers, then give you a discount, but it often still is way above what the insurance would pay....in this case $1500 was normal.
Then out of the blue, they tried to tell me that I owed them $9,000 for this procedure, took me months ( and only by contacting someone in the corporate office ) to get them to fix that.
Yes! Every medical bill is a surprise bill, in my experience. Even for minor things. I make regular visits to a retina specialist. Same imaging, same consultation with each visit, but the bill is different every time.
Thank you. As a senior, this is all very upsetting. Here I manage to get to this point in my life and now looking at my final years as being a freaking hell hole shell game. I already lost most of everything during the Great Recession and was unable to make it up as I aged out of the workplace. So this is all...JUST FLIPPIN' GREAT. Still, thank you, Jonathan, for making this miasma somewhat understandable to my greying brain matter.
Several years ago, I had excellent insurance which provided a list of vendors who were all approved with each vendors cost listed for a mammogram. I called up each one that was nearby and spoke to the billing dept. I knew to ask questions - are there any other fees for the mammogram, is it digital and if not, when is the equipment from, how much does it cost to have it read, get the report, etc. The price varies from $75 to $175. While some had no idea when their equipment was manufactured, an important point in a rapidly changing field of radiology, the cheapest one, all in, was one at $159. Every other one had added fees. And, the end of the story is I was billed $185 including a hospital usage fee I hadn't asked about and they didn't tell me either. Plus once you have a mammogram at a place unless you return, you have to carry the images to the next place since they look for year over year changes.
Now I could do this with a mammogram because I had time to do it. When I was hospitalized for emergency cancer surgery - surgeon's fee alone $185k - you can't.
How about national health insurance?
From the article: "Where is this new, much better insurance going to come from, if not from the “big, fat insurers”? Exactly how are people going to negotiate with insurers, and over what? Prices? Benefits?"
This is it, exactly. It's disturbing that Trump "tweets" something he's given no thought to, and his surrogates and enablers give it a modicum of thought and then go on TV to agree with him.
I have NO desire to negotiate my own health care costs, and I bet there will be a lot of people like me.
First of all, the notion that this or any Congress in the foreseeable future will work over the next two years to come up with a replacement, much less better plan is just laughable. If Congress actually did its job then we wouldn’t be shutting down the government because they can’t pass a spending bill at the 11th hour.
Second of all, as long as health care and insurance are considered as money-making problems for private companies, and not as sound public health policy, there will never be an effective or efficient solution. If Trump REALLY cared about the people and not the “big, fat insurance companies” he would propose regulating them and not us. Would not be at all surprised if a Republican plan involved giving Trump and his family a lucrative stake in it.
But the Republicans have notebooks full of ideas to improve health care!!! Didn't you hear Mike Johnson say that? lololol hahahahahah
Good review and report. What is usually not explicitly covered in discussions of health care plans are 3 key aspects of the financial reality of health care. The first is that there is no such thing as a free market in health care - nor could there ever be one. The second is that the care currently being delivered (at any point in time) costs what it costs and the only way to reduce what it costs is to do one or both of the following: a) limit care and or b) limit profits - in the case of private insurers and providers. The third is: healthcare is so expensive you can't just dump money in a personal account and move on.
No free market in health care: this one is easy. Health care is complicated. When you purchase a car even those of us with the most rudimentary understanding of automotive engineering can go to the dealer and figure out what features we need vs. want and what we're willing to pay for those features. Safety ratings are readily available with objective reviews by all sorts of not for profit objective entities and we can then make a decision - Mercedes or Yugo - we can actually decide on this. This is a free market that can actually compete on price, features, and quality that mere mortals can understand. But health care is so much more complicated. The vast majority of doctors and hospitals are pretty good, there is precious little data to distinguish one from the other in a meaningful way (Sorry healthgrades, CMS star ratings, etc - these measures are so rudimentary as to be almost useless). Also, the worst care is care that is fragmented and not integrated. That means you simply have to have a navigator that coordinates and plans your care - this is typically a primary care doc for most of us. Once you have a complex diagnosis, the coordinator might be a specialist, and so forth - but the point is: you are going to follow the primary doctor's or the specialists' recommendations about what test to have, where to have it, etc, etc. You are NOT going to go out shopping for price. THIS IS NOT AND NEVER WILL BE - AND NOR SHOULD IT BE - A FREE MARKET.
Care Costs What it Costs: DaVinci Robots, Mako Robots, chemo therapy, hospital beds, doctors visits, etc etc are expensive. The only way to control these costs is to a) limit care: this means saying - hey wait, let's not allow gall bladder surgery to be done by Da Vinci robots - we were doing just fine with laparoscopy. Or other more controversial limits like, a 90 year old with advanced cancer probably should not be a dialysis candidate (I know - sounds like death panel stuff). Or, b) limit profits. I actually heard a Republican congressman on Potus saying that we can't go on letting insurance companies make such high profits - it was Rich McCormick. - and there was no follow up question on whether he was advocating price controls, socialized medicine, single payer, or what? Incredible lapse of interviewing skills.
Third: Health care IS EXPENSIVE: When a previously healthy person gets chest pain, then has a stress test, then needs open heart surgery with a valve replacement, and a CXR shows an incidental pulmonary nodule that then requires a CT scan, bronchoscopy, biopsy, surgery for lung cancer followed by chemo therapy - the bill after a couple of months is going to be in the range of $500K - Are we to believe that dumping money into a personal HSA and letting the patient shop for the best deals is going to address this patient's needs. Please.
Bottom line - either single payer (Medicare for All) or ACA with regulations (yes, REGULATIONS) addressing pricing (i.e. pricing, incomes of providers, profits of insurers, etc) ALONG WITH: some tough soul searching on the part of America regarding "standardizing" (or maybe read: "rationing") care. I mean, we CAN have it ALL - but you gotta pay for it (read: higher taxes for government insurance, higher premiums for private pay) - or if you want to pay less - lower taxes, lower premiums - you CANNOT have it ALL.
I can't bear to proof read this before posting, so maybe some typos, heh?
Excellent report Jobathan.
Thank you for such a well constructed and informative post.
Thanks for this analysis! I’m going through this where I need a test/procedure and the quote I got seems high but my issue is potentially urgent and I’m not gonna shop around and wait another 2 months to get in somewhere. Thankfully I’m able to just pay it.
Politicians so sheltered from reality that they have no clue what real people have to do to acquire healthcare. The whole point of the ACA was because group plans weren't available to most people and they had to pay a fortune for individual insurance. They have such a hard on against anything that Obama was involved with they're willing to throw the baby out with the bathwater and screw their own constituents. The stupidity is amazing. The pittance they're talking about giving to the people is not going to make up for what they could get through the ACA. But who cares, as long as the billionairs get their tax cuts.
The shopping for healthcare proposal and paradigm is both impractical, ineffective and patently offensive at every level.
Does anyone believe that any government subsidy, individual health savings account, or tax credit, proposed by politicians, would be big enough to cover insurance premiums at today’s costs? How are “average” folks supposed to pay co-pays, which add up if one is chronically ill, or older and have recurring check-ups. Overnight stays in a hospital, even for simple procedures, are cost prohibitive.
Just the idea that we are consumers of health care – simply akin to shoppers looking for a good deal on goods, on a new car, on a vacation is insulting and ludicrous. When it comes to health we cannot be akin to a consumer who can shop for the best deal on Amazon, read the reviews, and be ensured of a return policy.
Bad medicine allows for no return. We did not go to medical school and therefore do not have the requisite medical knowledge in order to make an informed choice regarding doctors and procedures.
“The administrators made sure beneficiaries knew where to get cheaper, but still high-quality knee replacements. A widely cited study found people did indeed gravitate toward those cheaper providers”. And did they indeed get better quality from cheaper providers, mostly likely the only ones that they could afford under their health plan?
The ACA addressed the affordability issue allowing millions to have the comfort of a defined health insurance plan, albeit at a cost. Choice? All plans that I know of, whether subsidized or not, now have networks, and it is only within the given network of hospitals, clinics, doctors, and testing centers that you can pick. Even Medicare says that you can go to any provider that “takes Medicare”. If the payment for a given visit or procedure is not sufficient, the provider may not accept your insurance, or may choose to become a part of a given network.
The burden, and worry are put on the populace, rather than the health care conglomerates who have carved out areas whose hospitals and doctors and pharmacies they will absorb, allowing collusion and price fixing. All these politically designed plans are designed to increase health care corporate profits, at the expense of the patients (“consumers”) and employers’ bottom line as it lowers their share of the cost. Creating incentives and regulating a system in order to make care more available and more affordable is not on the agenda of any politicians whose donor class includes the health care monopolies.
I’m sure that Rick Scott – he of the largest fine for health insurance fraud – is looking out for his constituents, especially the seniors in Florida. And Dr. Oz who has been censured by his colleagues and stripped of his rights at his (former) hospital is hardly interested in making America Healthy – more like MACRA: make American corporations richer again, and rip off actual consumers of the products that he promotes.
Moral hazard theory? What an affront! Of course, I would let my house burn down, because insurance covered the loss; have a car accident so I could have the covered damage fixed; make myself sick so I could have a nice hospital stay because it was covered.
Our health care system is immoral, unethical and corrupt, becoming more so each passing year. It is the collision of profit and savings that renders these huge payouts possible that causes real moral hazards to the people, making America sicker. The only moral solution, one that would put health and not wealth first, is a national health care system or “Medicare for all” (that is if the government doesn’t privatize it).
Reforms needed? Absolutely. But not the kind that politicians propose.
Health care is a right, not a privilege, as it is in our country. The cost to us – in life expectancy, infant mortality, chronic illness and now preventable diseases (caused by our most vocal, but ignorant health care “expert” – RFK Jr. is real.
ACA is a start: it must first be restored, then expanded, not “reformed” as proposed now. We can only hope that there will be more than a few politicians who will find their moral compass. Or maybe look to their children or grandchildren and wonder why measles is proliferating in their schools.
Applause for this!! Thank you. I am a Canadian, Retired Physician. I never considered going to the USA, in spite of plentiful “recruitment mail” (given that I’m a University of Toronto Medicine grad). No. A massive morass if broken systems, and none of them with the focus that Medicine *should have*, which is: that the best efforts and the quickest attention are focussed on the “sickest people”, regardless of income.
—A *good* and successful Medical system, that includes the moral imperative above, is by the truths of the biological-beings that we are, it is a Capitalism Failure. You see, some of us might never have a car-accident (or one that damages more than the car itself, with a fixed replacement-value), or we might never have a fire or theft at home; but none of us get out of this interval called “life” in persistent good-health, do we??
—The total *crime*, IT IS THE PROFIT MOTIVE, the need to provide “returns” for shareholders: that DOUBLES the per-capita health-care costs in the USA, for definitely lower “average outcomes” (—1/ see, life-expectancy data; 2/ see, the astounding incidence of “Medical Bankruptcy”, which is just NOT a thing in some 25 comparably “high income” countries). One thing used to maximize profits (and attract more shareholders) is a whole layer of employees, who are Paid to Deny the maximal number of claims… Healthcare that is “not provided at all”, it is very low-cost for the Company!, also it helps to “pick off” from the list of insured-people, some of the sickest ones —dead people stop being a sunk-cost for the Company, right?
—I wasn’t just a provider (just kidding, “just”, I did Primary Care, plus part-time ER for ~14 years, and delivered 1000+ babies, with no bills to the already-stressed parents), but I also witnessed our system “working”, in one of our fine Ontario Cancer Centres. My husband had Stage3 Melanoma in 2019, requiring several tests including a Head MRI, before expert surgery, followed in 2020 by a year (17 doses) of Immunotherapy. And, he’s cured, just discharged by his Oncologist (a published Melanoma specialist). What were our “deductibles” or our “co-pays”? Yes, well some places we paid a few dollars ($Can) for parking!! —You poor people. 33 of the finest 34 countries in the world have figured this out. Fix your system.
What you described for your husband’s health recovery sounds great.
Although, this monk recalls that there were problems with public health care in other countries, compared to healthcare for those workers who can afford good insurance coverage.
In a query, this monk found the following info generated by ai. Would be very interested to get your perspective.🙏
Specialist Appointments: Wait times are a significant issue for specialist care in Canada, with studies showing a much higher percentage of Canadians waiting a month or more for a specialist compared to the US. Some American states even track these wait times, with average wait times from GP referral to specialist treatment being shorter than in Canada.
Elective Surgery: Canada has the longest wait times for non-emergency surgeries among several developed nations. In the US, the waiting time for this type of procedure can be much shorter, especially if one has private insurance.
Urgent Care: Wait times for life-threatening emergencies are typically similar in both countries. For example, wait times for a broken arm are generally short in both Canada and the US, although a patient may have to wait longer for non-life-threatening conditions.
Emergency Room: Some studies indicate that Canadians wait longer in emergency rooms compared to Americans.
Contributing factors
Systemic Differences: Canada's publicly funded system prioritizes universal access, which can lead to longer wait lists for elective care. The US system, which relies more on private insurance, can lead to shorter wait times for those who can afford it, but can create access barriers for those without insurance.
Indeed, I mentioned the wait-lists! And, I think our system needs more money into it, to improve these things! The point is, not that we have “great access” to everything, (though people with Emergencies, trauma, heart-emergencies, strokes, cancer… they do not “wait”, and our outcomes are just as good).
What we don’t have is “discriminated access”: It is not an individual’s fault, that when they need their hip-fracture repaired, that they are owner of a solo-small business (in fact, it’s a great attribute!), rather than a unionized auto-worker with “good insurance” —both groups should get equal access to the “hemi-hip replacement” which is the treatment for many such fractures (I’ve assisted on such, being the one who’d come in at short-notice on a Tuesday evening.)
People die every year, in the U.S., for lack of surgeries they need, like heart-bypass surgery, because they haven’t any “insurance”, and cannot afford the extraordinary prices (c.f. Your lower “average” life expectancy). It’s a Societal Shame. USA says its people are “free”, but clearly not all their lives are valued by their Country.
Great article. Thank you for helping me better understand this issue.
Suddenly they have more than the framework of a concept of a plan? Only took fifteen years. It'll be ready in two weeks. Right after infrastructure week.
Cohn gives a good description and analysis of much of the foolishness and fallacies of the supposed "debate" we're having about healthcare.
I've been around healthcare for most of my career and one thing I've seen is that physicians are knowledgeable about "medicine" - providing care to patients - but they don't know that much about "healthcare" - all of the policy and infrastructure that goes into enable them to provide that care.
So I don't give the physicians in Congress (like Cassidy, Barasso) any more credence on the subject than any other member of Congress. And I especially discount (ignore, really) anything a Republican says. When they're not making exaggerated claims about fraud and abuse, they're recycling bad ideas that have failed in the past (as Cohn explains), offering shallow ideas that would create more problems than they'd solve, or spouting nonsensical buzzwords and cliches that have no meaningful substance.
One Fallacy of believing that consumer shopping will lead to lower overall health care spending is that while specialty providers may be able to reduce costs on specific procedures (like knee replacement), generalized and urgent care costs will increase due to duplication of talent and equipment. The specialist orthopedic surgeon doing knee replacements will not be available for emergency room duties.
I'd love for Democrats and moderate Republicans to seize on Trump's "greedy insurance companies" trope; use that to push forward a tied and true way to control insurance costs: mutual companies (and maybe non-profit HMO's) are the only ones allowed to provide health coverage. Paired with a no preexisting conditions prohibition removes the profit pressure. If the investment returns on premiums go back to the members instead of shareholders there is less pressure to raise rates.
The Republican Party's "healthcare plan" is the same one they've had since they opposed Hillarycare: Get sick quickly and die young. When healthcare is seen as a privilege, it the providence of God's blessing. And God blesses who God blesses, so if you haven't been blessed with wealth and healthcare then you must be a heathen that's hellward bound. Also, no matter how advance medical technology gets, doctors should still be paid in chickens like they were a century and a half ago before the discovery of penicillin and when carpentry tools were still being used to perform surgeries.
This is why Bernie Sanders, AOC, and Mamdani have gained a foothold in American political discourse. When the guardians of Capitalism are screwing up hard, Socialism starts to look rational. If your the citizen of the country, if you pay taxes into the system, and corporations receive corporate welfare from the government with tax payer money; then shouldn't the actual tax payers receive stuff universal healthcare and universal basic income from the government they pay for.
I see another flaw that you didn't mention...at least where I am, there is very little price transparency...most won't even tell you what the cost is, so how do you compare?
Even with the same procedure, paid for by your medical insurance, they can't tell you what it will cost out of pocket, let alone what the total cost is...
I had a colonoscopy once that cost me $2500 out of pocket as a cash payer at the time...( which they always raise the costs for cash payers, then give you a discount, but it often still is way above what the insurance would pay....in this case $1500 was normal.
Then out of the blue, they tried to tell me that I owed them $9,000 for this procedure, took me months ( and only by contacting someone in the corporate office ) to get them to fix that.
Yes! Every medical bill is a surprise bill, in my experience. Even for minor things. I make regular visits to a retina specialist. Same imaging, same consultation with each visit, but the bill is different every time.
Thank you. As a senior, this is all very upsetting. Here I manage to get to this point in my life and now looking at my final years as being a freaking hell hole shell game. I already lost most of everything during the Great Recession and was unable to make it up as I aged out of the workplace. So this is all...JUST FLIPPIN' GREAT. Still, thank you, Jonathan, for making this miasma somewhat understandable to my greying brain matter.