The answer is money. The question is why is our health care delivery system so expensive and inefficient.
We are Number One. We are Number One in the world in the amount we pay per person for health care. Where we are not Number One is in our health care outcomes. Sadly, we are way down the list, despite how much we spend. The Commonwealth Fund, a non-profit dedicated to improving health care in the United States, is over 100 years old. It regularly compares our health care system to those of the rest of the developed world. One of its most recent studies found the United States to be last among the ten richest nations in the world in health care outcomes and the only one without universal health care.
We not only do poorly compared to other wealthy countries. We do poorly on an objective basis. All you have to do is look at the number of people with no health insurance and no access to health care or the number of people skipping their meds because they cannot afford them or the number of people forced into bankruptcy because of a medical emergency. This is the United States of America, the richest country in the world. How can this be happening here? No American citizen should die because they cannot afford health care.
Not only is universal care the right thing to do, it is the most efficient and economical thing to do as well. You have heard the old adage, “Pay me now, or pay me later.” It was made famous by an auto repair advertisement. It refers to the fact that allowing a little mechanical problem to go unrepaired usually leads to a larger problem over time. That is definitely true of medical problems. If not addressed either preventively or when they are minor, they develop into larger problems that are more expensive to treat and more disruptive to the lives of the patients. Access to health care also leads to increased economic productivity. The sick person does not have to miss work. The parents of sick children do not have to miss work. Health problems that are not addressed often lead to disability, which reduces productivity and costs us a lot of money.
It is not for lack of spending that we do so poorly. So where does all that money go?
Have you heard of these companies? UnitedHealth, CVS/Aetna, Cigna, Elevance, Centene, Humana. They are the largest health insurance companies in the United States. Their top executives routinely make over $20,000,000 per year. How about these companies? Merck & Co., Pfizer, Johnson & Johnson, AbbVie, Bristol Myers Squibb, and Eli Lilly. These are the largest drug companies in the United States. Their top executives also routinely make over $20,000,000 per year. Every dollar these executives take out of the system as pay is a dollar that is not being used to provide health care to the American people. Lined up behind the top executives at these companies are other senior employees who are also taking billions out of our health care delivery system.
For every doctor who provides care directly to a patient, there is an employee of a health insurance company. Many of these employees do nothing but manage claims. Doctors must employ people to fill out the forms required by the insurance companies. The forms are not always the same. If the form is not filled out just right, it is rejected. Doctors did not go to medical school to fill out paperwork. The heavy paperwork load adds to their overhead and distracts them from providing patient care. Fights with the insurance companies to get approval for the care their patients need leads to burnout. Denials of care or refusals to provide prior approval leads to many patients not getting the care they need or at least not getting it when it is most needed.
The drug companies are no better. They charge patients in the United States more for their drugs than they charge anyone else in the world. They game the patent system to keep generic drugs at bay so prices stay high. They spend heavily to advertise their high-priced medications so as to boost sales when a cheaper medication might do the job just as well. Despite anti-kickback laws, they pay doctors to prescribe their medications. The fines they pay when they are caught are laughably small compared to the amount of money they make from the kickbacks.
If we were starting out and designing a health care system, it would not look like this. It would not give large roles to privately held companies that suck out billions of dollars each year in administrative expenses. It would pay a fair price to drug companies to develop new drugs and give them fair but limited patent protection for their work. Our new system would provide basic health care to all our citizens. There would have to be some compromises made but we would save money on health care and reap great benefits in terms of the health of our people and their increased productivity.
We are not starting from scratch, however. Any attempt to change our current system threatens the flow of billions of dollars to the big insurance companies and Big Pharma. These players are powerful and will not give up their privileged positions without a fight. Health care reform is an existential threat to them and will be fought with that in mind.
The first step for those who want a better future for America is electing politicians with spines who will not cower when the first volley of negative advertising hits the airwaves and social media. This will be a long, hard fight, but it is one worth having.
The post The Answer Is Money appeared first on Sandweg & Ager PC.