I’m constantly finding myself in debates over which healthcare delivery model is “the best”. Many people argue in favor of government-based healthcare, while many others stand by private / for-profit delivery models. The truth is, they all suck. Money controls the care. Bottom line, no arguing, it’s just the hard truth. You can’t sustain any form of practice without a source of income, there’s just no way around that. So where the real argument lies, is where the money comes from.
Everybody has a budget and has to live within that budget to stay in business. This is no different between any of the delivery models. When the money runs low in a socialized system, income is increased by raising taxes while the private sector raises prices. Either way, the poor bastard working paycheck to paycheck winds up being the only one really affected.
So which one is better?
It’s no secret that I’m not a huge fan of government-ran healthcare, but that doesn’t mean I think the private-sector is without fault. My issue with government being in control of healthcare is their lack of ability to balance a budget. It just seems like healthcare would be yet another thing on the chopping block when it comes time to reduce the deficit. Instead of the sob stories telling us that “we will have to lay off police officers, firefighters and teachers if we don’t raise these taxes”, we will have the pleasure of having nurses and doctors added to that list. Plus, there is just too much red-tape and BS that goes into getting anything done.
Now I meant it when I said the private-sector isn’t perfect. As a matter of fact, they are far from it. Profit margins and favors to share-holders certainly do their share to affect patient care. Now let me set the record straight. I’m OK with someone making a profit off healthcare. That’s what drives growth and creates jobs. What’s troubling is some of the measures that are often taken to increase those profits.
Throughout my experience in healthcare, I would have to say that non-profit is my favorite delivery model. Like I said, there is still a budget but not so much of a profit margin to compete with. You tend to see things actually being done to benefit the patients that we serve. It’s just a different mentality. I currently work for 2 non-profit entities and I can say that we do a lot of things to benefit our patients that aren’t covered by medicare or probably any insurance agency. It’s just done because it’s the right thing to do.
Of course, there are always exceptions. For example, my last employer was a for-profit ambulance service. While we were in business to turn a profit, we did a ton of things to improve patient comfort, safety, crew comfort, etc. None of which was required. I know that there are a lot of government-based services that do the same as well, it’s just not the norm.
That’s just my opinion, ableit a biased one.
The real problems
The issues around our healthcare problems in the U.S. aren’t a matter of delivery methods. It’s a matter of reimbursement, abuse and lawsuits and all 3 are directly related to each other. It’s like that movie “Human Centipede” with lawsuits being on the front of the of the chain, abuse right behind and reimbursement on the tail end.
Side note – If you haven’t seen Human Centipede, consider yourself lucky. Whatever you do, DON’T watch that movie, it will scar you for life. If you have seen it – god forbid – then you should get the humor in the reference.
Lawsuits by themselves aren’t necessarily raising the cost of healthcare, but what they do is encourage defensive medicine. Doctors start ordering tests that they know aren’t necessary only to be “safe” just in case it’s actually something serious. So the 19-year-old with a headache and no other symptoms gets a CT scan and the frequent flyer who comes with the same complaint of chest pain every week gets a full cardiac workup. Those are just a couple examples of what the ER’s see on a regular basis.
A system that encourages defensive medicine also encourages abuse. The frequent-flyer previously mentioned will continue to come in on a regular basis, because he knows that nobody is going to just do a medical screening exam and send him away. Whether it’s food or attention he’s after, he knows he’s going to get it and so he continues to come back. Once again, that’s just one example.
So now comes the problem of reimbursement. Every time our frequent-flyer uses emergency services generates a bill. A bill that’s not going to get paid. Even if he is covered by Medicaid / Medicare, they are only going to cover a fraction of the cost. So what happens to the uncovered portion of the bill? Well, prices for these services just continue to increase in order to make up for the lost revenue. See: COST SHIFTING
Throwing money at the problem or changing our delivery model does nothing without addressing the core issues that got us here in the first place. As it currently stands, the people who pay for their insurance are essentially paying for those that don’t. Switching to a single-payer system or socialized system doesn’t change that. That problem with never go away.
What we need is better access to primary care providers and incentives for seeking appropriate levels of care. There isn’t much incentive for a primary-care physician to see Medicaid or Medicare patients because the reimbursement is terrible. Something has to be done about that. But not in the way that you might think. A trip to the family doctor or urgent care is going to be far less than a full-blown work-up at the ER. If more people were seeing their doctors instead of using emergency services to address their problems, then our insurance providers – both private and public – would have more money to spend on things like reimbursement.
Now this sounds fine and dandy, but getting people to seek appropriate levels of care isn’t going to happen by asking them nicely. There has to be serious incentives. For me, such incentives already exist. For me or my family to visit the ER, we pay a $100 co-pay unless we are admitted. In that case, the co-pay is waived. So every time me or a member of my family gets sick, we have to decide what will be the best way to seek medical attention. Obviously I’m not going to pay $100 for a sore throat, I’m going to pay $25 to see a PCP. Why can’t we use a similar system for Medicaid?
Like I said, asking nicely isn’t going to do the trick and neither will sending a bill. I think most would agree that people that habitually abuse emergency services aren’t going to willingly fork over the cash for a co-pay. And nobody is going to turn them away for lack of ability to pay, and that’s perfectly OK. But what we can do is deduct that co-pay from other benefits, like welfare. I would even go as far as saying that a $30 ER co-pay would substantially reduce the abuse.
If you set out a box of free donuts, people will naturally over-consume. If you charge even 50 cents people will most likely only take one, if even any. When people are visiting ER’s because they don’t have enough money for Tylenol, then we know we have a huge problem. Nobody is held accountable, so why would they act any different?
People abuse the system because it’s not only allowed, it’s encouraged. Until we actually get serious about addressing the high cost of healthcare, nothing is going to change. It doesn’t matter how much money we throw at it or who’s running the show.