Expensively mediocre health care
Other studies have shown evidence of racial disparities in treatment, and this study doesn't totally refute those. There are still disparities in access to some kinds of specialized care, and the methodology doesn't really address barriers to seeking care in the first place. But once people sought care, they were treated generally the same.
The real kicker, though, is that that the care was rather uniformly mediocre.
The study ... found that though there are some disparities, the world's most affluent health system fails to provide all patients with optimal care at least 40 percent of the time.
"Differences exist, but they pale in comparison to the chasm between where we are today and where we should be," said chief author Dr. Steven Asch of Rand Health and the Veterans Affairs Health Care System in Los Angeles. "No matter who you are, it's almost a flip of the coin as to whether you get the care that experts want for you."
We spend more money per capita on health care than any other nation on earth. And what do we get? Mediocrity.
There are many things wrong with our health-care system beyond the skyrocketing costs. Most reimbursement systems end up giving bizarre incentives to health-care providers, driving up overall costs. And it simply makes no sense that the cost and quality of health-insurance coverage depends on one's employment status. Not only is that bad policy from a public health perspective, but increasingly it is a competitive disadvantage to American businesses and a barrier to hiring, constricting employment and economic growth.
It is time we seriously considered alternatives.
People talk about health-care rationing, but the alternative to rationing is exploding costs -- which eventually leads to rationing by ability to pay. Perhaps exploding costs would be acceptable if we were getting top-of-the-line care for all that money, but we're not.
Should nationalized health care be on the table? Sure. I don't think it's the best alternative, but it's arguably better than the system we have now.
Worried about a huge new bureaucracy? Right now we're subject to a private medical bureaucracy instead of a government one.
National health care limits choice and results in long waiting lists for non-emergency procedures? Well, all systems have their problems. I just don't see the logic in trying to boast about our system and bash every flavor of national health care out there. None of the systems are perfect; they all represent different attempts to address the cost/benefit ratio.
Say what you will about national health care on an individual level, but on a macro level it seems to keep the population pretty healthy at reasonable cost. And it's not at all clear that waiting lists are an inevitable result of a single-payer system.
But rather than looking at the extremes, I think the more useful discussion would be "is there a combination that provides maximum choice while reducing costs appreciably?" And if we can de-link health insurance coverage from our employment status, so much the better.
I actually agree in large part with the Heritage Foundation on this, especially their assessment of the problems with the current system. We may quibble a bit on the details, but their system is workable and, with a bit of residual government involvement, equitable.
My solution would look like this:
Instead of employers providing insurance, they simply boost your pay by the current premium amount, and you go out and buy coverage yourself. Tax credits help ensure that the money is spent on health care, and that the very poor can afford health care. Future increases are left to the market: the cost of health care becomes just one more factor that workers consider when weighing a salary offer.
Medical costs would automatically become linked to performance, insurance products would become more closely tailored to individual needs, you wouldn't lose your insurance coverage when you lose your job (or be forced to change doctors when you switch jobs), and employers would no longer be locked into ever-higher medical premiums -- eliminating a growing barrier to hiring. Small businesses -- the engine of economic growth -- could compete for the very best workers who might otherwise go to large companies simply for the cheaper, better health coverage.
There would still need to be some government involvement, to ensure adequate coverage for people with very expensive medical problems that a true market system, without the "group" aspect of coverage, would lock out. There might have to be a law requiring that everyone have health insurance, much like we do with car insurance. But overall you'd have better coverage and better care without a new bureaucracy deciding what each individual medical procedure is worth.
health care, politics, midtopia