Old Joke
Patient: Doctor, it hurts when I do this. What do I do?
Doctor: Don’t do that.
New Version
Patient: Doctor, it hurts when I get my medical bill. What do I do?
Doctor: Don’t do– Oh, no, wait, there’s no cure for that.
America doesn’t have the world’s worst healthcare, but it may have the world’s most inefficient. Did you know that the U.S. government pays more money annually for healthcare per capita than any other country on earth ($10,586)? And yet, on top of that, the amount each American spends out-of-pocket has gone up over 900% since the 1960s. Why? Inefficiency. Our healthcare “system” is a cobbled-together glob of:
- Medical insurance, a “temporary” stop-gap measure left over from the 50s
- Employer-based coverage, an undependable “solution” originally designed to be a job perk, not a necessity
- Constantly rising administrative costs–over 25% of all medical charges are administrative
- Out-of-control drugs prices–Americans pay more for prescription drugs than anyone else, only a small percentage of which is due to research and development
- Ever-changing government programs–Medicare, Medicaid, VA, and more–patches on a garment full of holes
There are divided opinions about government’s role (if any) in healthcare. And yet the government is already–largely and expensively–involved. Add to this the fact that:
Expectations have changed. 100 years ago, healthcare possibilities were limited. Even rich people died of conditions for which we now have cures and treatments. Yet these are made horrendously expensive by an inefficient system. So, should only those who can afford to pay “any price” be treated? “No,” most people agree. Then what do we do? It’s not simply a matter of nationalized vs. privatized. For starters, we need to focus not on who will pay…
But on how to make the system more efficient!
Mitch Teemley 
I completely agree. In India, we have free medical care. However, doctors are seldom found at the desk. Hence, people to go private hospitals. the inefficient system renders the money insufficient.
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I agree. It is a problem that has been tough to solve.
On the other hand, given the quality of the care, many of the very wealthy from all over the world come here for serious ailments. Our creativity and efficiency have just produced the fasted researched vaccines in history. They have been administered at no charge. Thank God my wife and I are fully vaccinated.
We must apply the lessons learned versus COVID 19 to other, unconquered diseases and the efficiency of all of our healthcare. May God bless those efforts as he did the vaccine research.
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In Canada, doctors only work 2 or 3 days a week because the government can’t pay them more. When I was there, our hospital closed down for about six months because the government didn’t have money for anything but the emergency room. Drs discovered my husband needed a new heart valve in February. They didn’t get to him until September. By then he was walking baby steps and could not have survived another two weeks. Oh, and we paid 50% income tax for our freebies. Yes, efficiency is key. But, as long as greed exists, it will not be improved. That’s my opinion and I hope I am wrong.
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Yep, we’re human, so perfection isn’t attainable. Whether privatized or nationalized (the U.S. is a pastiche of both), some systems are more efficient than others.
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And speaking of greed, so much that doctors earn has to go to malpractice insurance. There are definitely cases where patients have the right to sue, but as with anything else involving humans, there are excesses in the courts, too.
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Most doctors also accrue much debt in order to pay for medical school and some must invest even more into establishing a practice. Some specialties (like G.P.s) do not earn the high salaries that expedite the pay-off of those debts.
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I couldn’t agree more. There has to be a better way.
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Katheryn is right, that as long as greed exists, the system will not improve but will deteriorate. Reminds me of the woman in the gospels who spent all her money on doctors. And that was 2000 years ago. The top-heavy system of rewards (25% for administrators) is outrageous, but unsurprising. The same thing happens even more egregiously in education, another basic human need.
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Excellent point. There are many studies comparing Canada and other countries to our “adminstrative” costs. Roughly, the patched together systems you note above cost 2-5% for administrative costs, while insurance companies average between 20 and 30%. Government can be inefficient, but removing the profit motive from insurances and middle-people (managed care, etc)…will produce less costs. Also, covering the costs of a medical degree will put physicians in far better circumstances to provide lower cost care and do more family practice rather than the high-end specialties. In the for-profit medical schools, students leave with debts upwards of $300,000….
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One of the saddest stories about the absolute train wreck of our health care system was when a seminary classmate of mine was forced to divorce his wife so that she could qualify for Medicaid. She had a chronic, debilitating condition that had forced her into long-term nursing home care. As a result, they hit their “lifetime maximum cap” on their private health insurance.
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A big problem is that everyone thinks health “insurance” should pay for everything. What we really should have is health insurance that protects against events that are financially crippling. For example, I avoid dental and eyecare insurance simply because the chances of anything catastrophic in those areas is very, very low. I prefer to pay as I go. The good news is that I get discounts at my dentist because I pay cash. If they were billing the insurance company, they would bill full price. Health insurance, if I could buy it as a younger person, would best cover only the big, scarey costs, not the doctor visits. Far too many consumers seem to think covering every sniffle is a great idea. No wonder it is expensive.
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Access to quality health care should be a right in the USA—like education is. But how do we cover the cost?
Some folks are unhealthy through no fault of their own. But others ruin their health through bad habits. Should everyone else pony up for this?
Like any difficult problem, the answers are complicated. There aren’t many one size fits all simple health care solutions.
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I left a career {education} two years earlier than I had expected because of my health issues. I paid $500 a month just for me for 3 years after. And was denied neck surgery until I go to THEIR required rehab (who cares that I did rehab for two years under a plan that THEY didn’t approve). It’s such a complicated crisis. I am self-pay. My family thinks I’m crazy. I got fed up and tired of my premiums leaving me with nothing in my pocket and the stress making my health worse. I get discounts for self-pay. And because of my health issues I know that I need to set back money for each of my required self-maintainer visits. I took control of my health. I started meditating, eating better to control my diabetes, I’m strict to a fault. And I put 💯 into THE great physician. Call me crazy. But I’ve saved $12,000 in two years. And the $3,000 I spend each year self pay to have required visits is a drop in my bucket compared to the depressing premiums. I make $2,000 more than I should to qualify for any Medicaid. I got pushed in a corner. And I had to take control. If something catastrophic happens I’ll just make my payments. My health is only as good as my provider and thank GOD I have a wonderful believing doctor. She joins me in my efforts and listens to me. She supports me. And she understands. Both of my sons joined the Air Force knowing that the benefits, and of course their hearts for serving, would hopefully keep them and their families insured. And I pray they always have the doctors to give excellent care. Thank you for this post. This is a subject my family and I discuss frequently.
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As unique as your healthcare path has been, Karla, it has one feature we all need: Personal pro-active involvement. Health on, my friend!
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Thank you, Mitch. With Christ anything is possible!
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I’ll be looking forward to your ideas for efficiency, Mitch. Our system leaves much to be desired!
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It does indeed, Nancy.
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If only there were some simple solutions. One person speaks glowingly of Canada’s health care system and next tells horror stories. But we have our own horror stories. Before the Affordable Care Act, I know of children with birth defects who were refused insurance coverage, because their insurance claimed they had per-existing conditions. We definitely need a better system.
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We have to be able to take care of everyone, that is what society is all about. To reform health care means reforming taxes and requiring all to pay their fair share. It all starts at the top…
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So everybody should pay for everyone? Even the ones who choose not to work, or put effort forth to manage their health?
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Yes. That’s the way a great health system works. Even the lazy idle rich are entitled to it.
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Well, that’s a relief. The hard-working and rich should be able to pay cash.
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i wager 10592
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I think at this moment, if I had to change one thing it would be removing all incentives to provide specific treatments to as many people as possible. No advertising medicine, paying doctors & pharmacies to push a particular medication, etc. That way physicians are motivated to correctly diagnose patients and patients are not confused or insisting on an incorrect treatment because they watched an ad or saw something on google.
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Single-payer. Public health as a priority. Health care as a basic right. Get all profit-makers out of the system. Done.
Everything else is just about who gets the care and who doesn’t and which exploiters get the money.
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No one mentioned health care sharing. For the last nine years, I have been a part of a health care sharing ministry. We walked away from the dictates of medical insurance due to the high-cost premiums, larger deductibles, and rising co-pay costs. It was increasing multiple times per year but our incomes were not. (My husband and I were both self-employed.)
Nine years later my monthly costs are still 60% less than what we were paying for insurance when we left. That gap does not reflect the jumps in insurance premiums over the past nine years, I know insurance has increased astronomically. In the health care sharing ministry, I have experienced multiple occasions where my monthly share has been reduced due to fewer needs that month. That NEVER happens with for-profit insurance business.
This has been a huge financial and spiritual blessing. I have no regrets. Every month I pay a share to help someone else who has a financial burden due to a medical need. When I have a medical need I receive checks to meet the need plus prayers, cards, and hand-written notes. What a blessing!
It is simple and the shares are a fraction of the cost of any insurance plan we previously had. Plus, I have more trust in my physicians and medical providers knowing they are not biased nor bound by mandates from a for-profit business. My doctor and I choose the best course of treatment for me.
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That’s wonderful, Manette. I’ve heard some mixed reports on health care sharing in the past. Glad your experience has been so consistently positive. Can you provide a name or link to it here?
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There are several the one me and several family members use is Samaritan Ministries.
https://samaritanministries.org/
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My extended family use samaritan’s as well – I think it’s an excellent way to provide and look forward to using it myself. I’ve also used government insurance, and that has been terrible. When we lived in a small town there was an AMAZING private practice that also worked on monthly payment plans. Costed less than some gym memberships and we had a great relationship with our doctors.
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Thanks, Manette!
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