I think that many of our problems with the cost of medicine date back to the 80’s and 90’s when state by state we passed laws requiring emergency rooms to admit all that came in without telling the ER’s how they would pay for this. We truly have universal coverage because of these laws, and it is the most expensive type possible. Prior to forcing hospitals to use creative accounting, ($40 aspirin), they just added a margin to their cost and charged like any other ethical retailer. Now the system is to charge as much as possible depending on the patient and their coverage. This philosophy has now spread to the entire medical industry and spurred the development of many well paying professions in the “managing benefits” industry and buying medical accounts receivables. Keeping track of the many insurance plans and how they differ in their payments also keeps many employed. The growth of employment in medicine has been boosted way beyond reasonable with all these people making a living without ever seeing a patient.
In an effort to keep their jobs, these non-practitioners have orchestrated a huge fear campaign. They cite huge additional costs for ‘single payer’ when they don’t even define what it is covering, and ignoring the money currently being spent that would no longer be spent. Until it is designed we can’t possibly know what the cost will be. They also trash the “Canadian System” for long wait times. Well, Canada has a different system for each province and some are better than others. The long wait times usually refer to elective procedures. The folks I’ve talked to in both Ontario and Quebec wouldn’t change their system for anything. The phoniest objection I’ve heard is fear about a government bureaucrat making decisions for you. I think a non-profit government bureaucrat would make more favorable decisions about my care than the current ‘for profit’ insurance company bureaucrat would.
I think it’s obvious to all that reform is needed. We need to communicate with each other to get it right. Both the fights for Social Security and Medicare were contentious, but civility lead to the compromises we have now: government provides the base protection, and the individual provides the extras: By setting a payment schedule, similar to Medicare, and then paying the providers 100% of the schedule amount if the provider bills for that amount, and then reducing the payment to the provider by the same percentage that the provider charges over the scheduled amount. This would allow the providers to charge what they want while allowing the patient to keep their doctor, if they can afford him/her. It also leaves open business for our health insurance companies with “gap” or “advantage” insurance similar to Medicare.
With the health insurance industry and the pharmaceuticals leading the country in political donations we are unlikely to see any changes.