Saturday, August 10, 2013

Epic Failure: The American Healthcare System

Why do Americans pay so much for healthcare and get so little in return? Our current system is one of - if not the most - expensive system in the world. PBS NewsHour reports that we pay $8,233 per year per person: "That figure is more than two-and-a-half times more than most developed nations in the world, including relatively rich European countries like France, Sweden and the United Kingdom."


An ongoing year long investigation by The New York Times reporter Elisabeth Rosenthal reveals that it "costs $13,660 for an American to have a hip replacement in Belgium," while "in the U.S., it's closer to $100,000." 

That modest $13,660 sum even covers airfare and rehabilitation, while the price range for the American version can top out at a stiff $130,000. What's even more astonishing is that both surgeries utilize American manufactured hip joints. Same product. But absurdly divergent prices.  

But Americans are some of the healthiest specimens on earth, right? Wrong. It's time we ditch this falsehood. Considering costs, our healthcare system performs poorly with embarrassingly dismal outcomes.

Here's where we stand:

Life-expectancy: #51

On the CIA World Factbook page you will find that citizens of the EU, Jordan, South Korea, Puerto Rico, Australia, Bermuda and Hong Kong enjoy a longer life on average than Americans. Number one on the list is Monaco with Monacans enjoying more than an extra decade of life.

Infant mortality:  #30

The Centers for Disease Control and Prevention finds that for infant mortality we have fallen "behind most European countries, Canada, Australia, New Zealand, Hong Kong, Singapore, Japan, and Israel (5)." In 1960 we were #12. CBS News also reported in 2013 that we have the highest first-day infant mortality rates in the industrialized world.

Premature death: #16

Out of 16 high income nations, the US comes in dead last. The Common Wealth Fund writes: "The United States placed last among 16 high-income, industrialized nations when it comes to deaths that could potentially have been prevented by timely access to effective health care, according to a Commonwealth Fund–supported study that appeared online in the journal Health Policy."

Reuters reports that France, Japan and Australia rank best in preventing premature death. Again, the USA is last - out of 19 leading industrialized nations.

Such vastly inferior healthcare outcomes compared to other wealthy countries that spend much less can mean only one thing: that our healthcare system disappoints (sucks) when ranked internationally. The New England Journal of Medicine reports that the 2000 World Health Report ranks the performance of America's healthcare system 37th in the world.

Yeah that's right: #37. To say we are in need of reform is an understatement. A major overhaul is calling. Our system is inadequate, inferior, and more importantly, inaccessible to huge numbers of folks. Still, Americans who do have healthcare pay too much. The majority of medical bankruptcies are declared by the insured and more than half of bankruptcies are medically related, reports CNN:

"Unless you're a Warren Buffett or Bill Gates, you're one illness away from financial ruin in this country," says lead author Steffie Woolhandler, M.D., of the Harvard Medical School, in Cambridge, Mass. "If an illness is long enough and expensive enough, private insurance offers very little protection against medical bankruptcy, and that's the major finding in our study."

The Washington Post's "21 graphs that show America’s health-care prices are ludicrous" makes it heart-attack-inducingly clear that costs are ridiculously exorbitant for us all. But why? 

NPR Terry Gross's recent interview with NYT's reporter Elisabeth Rosenthal explains why our medical bills are prohibitively high and what solutions can be gleaned from our European counterparts. It's definitely worth listening to:

Americans pay more for health care than people in many other developed countries, and Elisabeth Rosenthal is trying to find out why. The New York Times correspondent is spending a year investigating the high cost of health care. The in her series, "Paying Till It Hurts," examined what the high cost of colonoscopies reveals about our health care system; the explained why the American way of birth is the costliest in the world; and the third, published this week in The Times, told the story of one man who found it cheaper to fly to Belgium and have his hip replaced there, than to have the surgery performed in the U.S.

As she details the case of the American medical tourist in Belgium, getting his hip replaced for a mere $13,660 compared to $100,000 in the States, Rosenthal exposes the factors driving up costs for Americans. The core issue is a lack of regulation, which creates a free-for-all for those providing the products and services. And because everyone wants to skim the fat off the top, the whole process is itemized - or what's called "unbundled" in technical terms. Unbundling is rarely done in Europe and elsewhere where prices are much lower.

Unbundling means that for a typical surgical procedure, like a hip replacement, you are charged an exorbitant fee for every aspect or thing involved in the process, down to the baby aspirin. Because the government doesn't use its massive bargaining power in setting prices and bargaining with medical providers and suppliers (like it does when setting electricity rates), companies can charge what they see fit; and of course, what is fit to them is profit. Rosenthal reports that in the rest of the developed world the government intervenes to set rates. In Europe prices are bundled and highly regulated. Without this sort of regulation, the capitalists running the show monetize the whole system and profit off our bodies.

My mom has been an RN (Registered Nurse) for nearly thirty years and has worked for non-profit as well as for-profit hospitals. She says they are all the same. The end goal is maximizing revenue. I asked her about this à la carte markup of medical costs. What goes into the excessively high cost of that hip replacement surgery? In no specific order she rambled off:

Operating room fee, recovery room fee, other floor fees, anesthesiologist/drugs, surgeon, hip joint and tool kit, medication (routine and/or prescribed), pain meds, physical therapy, respiratory therapy, lab work - CBC, PT, PTT, CMP, IV fluid, IV starts, heating pad, tedhose, oxygen, pre-op nurse, recovery nurse, any other supplies. 

If she had specifics about the surgery, she claims the list would carry on. For each of these items we are charged outrageously inflated prices, by the time the bill is tallied we face the following nightmare: 

Source: Washington Post

Bottom line, we are getting shafted. Big time. Don't worry, the only thing at stake is our lives. What we have here is a case of mercantile principles overriding basic human principles, rights and values. Really, it's unconscionable. Medical care is a human right, not a privilege. This axiom is the philosophy underpinning healthcare systems elsewhere that are managed better than ours, are cheaper and more effective. As one of the wealthiest nations on earth we are capable of much more. A humane, affordable system is not unthinkable; it exists and is exemplified throughout the world.

After listening to the NPR segment, I would definitely check out Rosenthal's first three pieces in the New York Times series to gain a broader understanding of the issue. Ironically, the problem is not as complicated as it is enormous. 


Thursday, August 1, 2013

A Must Watch: Demystifying Unions (National Public Radio)

Bill Fletcher (Image via billfletcherjr.com)
Why are Americans so willing to give up their rights in the workplace? Where are we in the long (and storied) fight for worker rights? How do we best address the power differential inherent in the relationship between worker and employer? Listen to the discussion with activist and scholar Bill Fletcher: "Demystifying Unions with Bill Fletcher Jr."