March 29, 2017 by John Crapper
Before I begin this post and In full disclosure I must tell you that I’m fairly opinionated regarding health care in this country because formerly I was a health insurance underwriter tasked with approving and denying people health coverage. That in the trenches experience gave me an up close and personal insight into our private health care delivery system in the United States. This past experience has led me to advocate for a single-payor system of health care modeled roughly after Medicare.
But since the Affordable Care Act or Obamacare has been and continues to be a hot current events issue I’d like to share some thoughts.
The Affordable Care Act or Obamacare is under attack. In my opinion, it’s been a flawed law from the beginning and the Democrats have been flawed both in their approach and in their defense of the law.
Of course the ACA has insured millions more Americans and improved coverage for those insured. It’s a good thing that there is no lifetime limit to coverage. It’s a good thing that children can stay on their parents plan until age twenty-six. It’s a good thing that people can no longer be denied coverage due to pre-existing conditions.
But the big flaw in the ACA was that it catered to the private medical delivery system and the big mistake committed by Obama and the Democrats was their unwillingness to initially push for a single payer system and then later to at least push for a public option to complete with the private insurers.
Here is a simple explanation as to why trying to maintain the private medical care system is flawed and cannot be corrected or fixed.
First, we need to remind ourselves of the players in the current system. The major players are:
- Health care professionals
- Hospitals and clinics
- Drug companies
Now back to the explanation.
Most health care professionals are trying to make a good living while at the same time providing good healthcare. They are under pressure from hospitals and clinics to see a certain number of patients in a given timeframe. They are under pressure to administer health care in such a way to avoid malpractice suits. Also, they are under pressure to predetermine that the tests, procedures and treatments they recommend will be covered by the patient’s insurance. Finally, many physicians have a financial interest in the clinics/hospitals in which they work resulting in a desire to ensure they are profitable. All these factors influence their health delivery performance.
Hospitals and clinics are trying to make a profit. They want their appointment calendars and beds to be filled. They want their equipment and facilities to be utilized in an efficient manner. They want to charge as much as possible to maximize their profits.
Pharmacies are trying to make a profit. They want to sell drugs to as many customers as possible. They want to maximize their profits.
Drug companies what to make a profit. They want as many doctors as possible prescribing their drugs. They want to sell as many drugs as possible at the highest price to maximize their profits.
Lawyers want to make a profit. They want to win as many malpractice lawsuits as possible and settle those lawsuits at the highest price possible . They want to maximize their profits both for their firms and themselves.
Patients do not want the cheapest care. They generally do not shop around for the best price. They don’t want a cut rate bypass surgery or a two for one cataract operation. They want the best care they can get. Finding the lowest price of care is not their primary concern.
With the exception of some health care providers I contend that a medical delivery system that has profit as its motive for all in the system except the patient does not have the patient’s best interests paramount in their mind. They have their profits.
The doctor has motivation to over test, over treat and over prescribe to avoid malpractice suits. He has motivation to inquire and consult with his patients quickly to maximize the number seen in a given timeframe.
The pharmacy has motivation to stock and/or push only the most profitable brands of a given medicine.
Hospitals have motivation to fill beds at the highest price. They have motivation to cater to the most profitable patients which translates into serving the most lucratively and completely insured.
Drug companies have incentive to push their most expensive lines and fight to keep prices high for as long as possible. They have reason to provide incentives and kickbacks to health care providers to induce them to prescribe their drugs.
Where is doing what’s best for the patient fall in the hierarchy of motives within this system?
Now that Trump Care has failed the Democrats need to go on the offensive and adopt the Bernie Sanders approach by calling for the adoption of a single payer health care system for the replacement model. This should be their constant mantra.
They should concede that the current system is flawed because it was a failed attempt to keep the for profit medical delivery system in place. It was also a desire on the part of President Obama and the Democrats to take a bipartisan approach to health care which in retrospect we now know was a total failure.
With the colossal failure of the Republicans health care repeal and replace effort things have changed; the atmosphere is different. Democrats should seize the moment and begin a relentless drive to push for what is truly needed to correct the healthcare delivery system in the United States.