The problem with health care and drug prices in America isn’t that we spend too much money. The real problem is that we believe we are spending “other people’s money.”
Yes, I was raised in Sweden, but no, I’m not a Socialist. The irony is that “free” health care there is more clearly understood to be directly financed by local(!) taxes that can go up if people in that region consume more health care. Here, nobody knows what anything health care related costs, or who pays how much, so how can we care about the cost of health care?
Here, most health insurance is financed by employers, and I don’t believe the average American worker is lying awake at night worrying that his family’s medical bills will eat into the corporate profits of his employer. Even if American workers bear some of the costs of their health insurance — the relationship between how much health care they consume and how much their portion of the insurance premium will go up is less than obvious. And this depends on who else is insured in the same risk pool as each particular worker’s employer-sponsored insurance.
The Swedes have — in spite of their minimal churchgoing — a set of ethics that relates their personal choices to the impact they have on society as a whole. They recycle batteries instead of throwing them away. They worry about air pollution – so much that it is illegal to idle your car for more than 60 seconds. My former countrymen also care deeply about how waste in the health care system can affect the availability of health care for vulnerable people.
Another thing they are more sensitive about than we are over here is corporate greed. The examples on this side of the Atlantic are so many and occur so frequently that we soon forget each case. What we do retain is the regrettable sense that health care is a dirty business where someone is always taking advantage of someone: providers cheat Medicare, insurers cheat patients, drug companies cheat them all.
What we need in this country is a moral wake up call, whether that comes as a crisis or a disruptive innovation. It is obvious that government regulation and oversight has done relatively little to reduce the “Wild West” behavior and mentality of the big players in our “industry.”
The first thing we need to do is scrap the concept of health insurance because insurance is when something expensive but unusual and infrequent is paid from a pool of money that a lot more people pay into than withdraw from. In America today, everybody draws from that pool of money, even for things that are completely predictable, like having a baby or even an annual physical (except if you have Medicare, and then you get a Wellness Visit, but that’s another story). That means every single transaction of health care in this country becomes a profit center for one or more types of middleman, who most of the time adds little value but draws handsome revenue from what they do.
If we are trying to cover everybody for everything, let’s call it what it is: socialized medicine. But are we ready for a society where we all stop and consider the common good before we ask for that MRI, “just to know what’s going on” or where drug prices are negotiated between a “single payer” like CMS or each State Health Department and the drug companies?
I believe the citizens of my adopted homeland prefer to have more freedom of choice than a Socialist system usually offers, and I believe that by having both the ability to choose and the responsibility to pay for services, we can make the health care value equation come out more even.
And, I’m sorry, but if we reign in the excesses of insurers and drug companies, American patients may act more responsibly, but as long as the gauging, fraud and abuse continue to be rampant in the industry — there will be no loyalty between patients and “the system.”
Then, our only hope will be a post-apocalyptic direct primary care model, which is just as American as the corporate model. Come to think of it, maybe even more so.
“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.
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