The current system of health care, in which private insurance companies decide who gets health care and when — and then take a large cut of the costs for themselves — is needlessly inefficient and expensive. It is a large part of the reason America spends more per capita than any other country on Earth.
In 2015, the latest year in which statistics are available, Americans spent an average of $9, 024 dollars on health care for every woman, man and child. That’s nearly three times the average amount spent by the average of other countries with comparable standards of living.
And yet the people who live in these other countries have longer life expectancies! At 79.3 years, the average life span in our country is less than those of Chile, Cyprus and Costa Rica.
America is great about providing the most advanced medical care for seriously ill people and for those who have almost unlimited resources to pay for it. But the costs are outrageous, and too many Americans are stuck with paying too much for too little care, or even no care at all.
Why is health care so expensive in the United States?
- We have a complicated pay-for-service system that nobody seems to fully understand. To cope with it, every medical practice employs staff to set prices, handle payables and receivables, and contact insurance companies for pre-approvals and appeals. The same efforts are repeated in every doctor’s office and by every specialist a patient may contact through the course of his or her care.
- Each claim is then submitted to an insurance company, which employs buildings full of people who process each claim again and sends statements and bills to the patient, who by now is completely mystified about what’s going on.
- Too many Americans still don’t have health coverage. This means they don’t see a doctor for checkups or they put off seeking care when they or their loved ones are sick. Often, the first physician to see a patient works in a hospital emergency room, where a long-brewing medical condition has turned into a full-blown crisis. This situation is tragic, not to mention expensive. And when a patient can’t pay the sky-high bills, the hospital is forced to pay the cost by raising prices for everybody else.
- Health care is based on an outmoded assembly line model that fails to put the patient first. Currently, physicians are pushed toward seeing as many patients as possible in a single day. The typical patient gets to talk to his or doctor for about 10 or 15 minutes and diagnoses and treatment plans are made on the fly. This leads to unnecessary mistakes and false starts in treatment plans that can set a patient back to square one — or worse. The process is repeated by specialists who frequently fail to consult with the primary care provider. Several specialists may be involved in caring for the patient with little or knowledge of what the others are doing — again leading to uncoordinated care and possible costly mistakes.
- The pharmaceutical industry is out of control. Abuses are rampant as manufacturers betray the public for the sake of profits. Unbelievably, federal law prohibits state and federal health agencies from negotiating the price of drugs. On top of that, companies get away with outrageous abuses of the patent laws, which let vital drugs stay in private hands and out of the competitive generic drug market.
- We don’t have an organized approach toward addressing chronic diseases like diabetes, heart disease and arthritis. Many of these conditions can be helped by engaging patients and the public at large on how to prevent, moderate and manage these diseases through diet, exercise and other nonmedical means.
What can we do about it?
- Adopt a single-payer system once we develop a plan to pay for it. This would drastically reduce the bureaucratic demands of the current system and lower overall costs, as we’ve seen in almost every other developed country in the world. The simplest way to do this would be to extend Medi-Cal, Medicaid and/or Medicare to everyone. Paying for it is a major problem, of course, but in the end it would save most taxpayers money by eliminating premiums and making the medical system more efficient and less costly.
- Put the patient at the center of health care through a system that promotes “team” care. In this model, the primary doctor takes on the role of a “concierge” who coordinates all of the medical specialists, nurses, dietitians, chiropractors and others involved in each patient’s care. This approach has been shown to improve medical outcomes at substantially lower cost. It may seem counter-intuitive, but studies show that spending more time with a patient — and listening to the patient — decreases the overall cost of care.
- Take a close look at how the pharmaceutical industry is structured and regulated — and take action. California’s Legislature may not be able to act directly on this field, which is under federal control, but we can investigate solutions that our representatives in Congress can move forward.
- Promote a healthier California through educational programs in the schools and media advocating good dietary choices, exercise and productive and efficient use of health care options, including mental health, dental, vision and other forms of care.