The worst
The US health care “system” is chaotic but there’s one thing we can say: it’s the worst of its kind.
The U.S. health care system has been subject to heated debate over the past decade, but one thing that has remained consistent is the level of performance, which has been ranked as the worst among industrialized nations for the fifth time, according to the 2014 Commonwealth Fund survey 2014. The U.K. ranked best with Switzerland following a close second.
Isn’t that impressive? Go us.
The Commonwealth Fund report compares the U.S. with 10 other nations: France, Australia, Germany, Canada, Sweden, New Zealand, Norway, the Netherlands, Switzerland and the U.K. were all judged to be superior based on various factors. These include quality of care, access to doctors and equity throughout the country.
Although the U.S. has the most expensive health care system in the world, the nation ranks lowest in terms of “efficiency, equity and outcomes,” according to the report. One of the most piercing revelations is that the high rate of expenditure for insurance is not commensurate to the satisfaction of patients or quality of service. High out-of-pocket costs and gaps in coverage “undermine efforts in the U.S. to improve care coordination,” the report summarized.
Gee, who could have foreseen that.
Yes, we wouldn’t want to be like that European hell, would we?
@iknklast – Absolutely! Certainly not like that European socialist hell, with their commie pinko socialised healthcare. “Better dead than red” – wasn’t that the mantra? Well, mission fucking accomplished! U! S! A!
Socialized medecine?
It sounds like you want to hand out health care to anyone and everyone for FREE! Where’s the profit in that?
Shudder.
It’s astonishing, isn’t it, that when everybody pays a small percentage of their income into a government fund, which the government then distributes directly to the health providers, it costs less and is more efficient than supporting a whole other competitive industry of insurance companies between the patients and the doctors.
tiggerthewing, I’ve done enough cost-benefit analyses to discover that most things are less expensive when delivered in that manner. I had to do a cost-benefit one time of a restoration project I was heading, because we needed that to get the state to cancel the contract we had with the private contractor, even though the private contractor had delivered not one iota of work and had received payment for at least part of the service they had not done.
When I finished the analysis, the boss was shocked at how very much we would save, even though using my labor (state employee) meant putting me up in accommodations overnight every month, plus per diem. The amount we would save by using government labor over the private contractors (even though they were local and required no travel expenses) amounted to well over $10,000 in 1998 dollars. The contract was cancelled, and the work actually got done.
Most people don’t realize that services tend to be cheaper when provided by government, and that they are often just as high quality, and sometimes higher. My required success rate when I worked for Social Security was 95% accuracy; the office rate was 99%; my personal rate was 99.99%, and the only error in my field was a typo made by someone else that I failed to catch. When I worked in private industry, the success rate was much lower, and sometimes almost nil, and at one job, the bosses spent so much time congratulating themselves for the good month’s productivity of their clerical staff that they took all the management out to the race track, though the management staff had a success rate of less than 1%. Our success rate in the hired help? 135% of quota. We stayed behind and worked while they celebrated (go figure why our success rate was so high and theirs so low).
One doctor told me that having a single payer would save his office tons of money, because he had to have a staff of insurance specialists to keep track of all the many different plans. If they had one payer, the work could be done by the person who handled all the other accounts without having to be able to keep track of the myriad of insurance plans. When I mentioned government single payer, he shuddered and said, “No way”.
Doctors are terribly afraid of price controls, and will tell you they are barely making a living as it is. I had trouble understanding that until I was reading a book by one doctor where he said if he stopped doing propaganda tours for pharmaceutical companies and stopped prescribing based on what the pharmaceutical companies wanted, he would have to figure out how to live on only $130 an hour! He seemed positively puzzled that anyone would be able to live on so little. He said he would hate to drop below $180 an hour, because it would be impossible to continue to make ends meet. Wow. This ($180/hour) is what doctors consider average pay. You wonder if they realize most of their patients aren’t making that much in a day, and in fact may take several days to make that much if they are on minimum wage.
Iknklast @ 5
“Doctors are terribly afraid of price controls”
Not all socialized health systems apply price controls or force health workers to become state employees. So far I’ve received about $20,000+ worth of medical treatment for free because I’m enrolled as a public patient, ie I’m bulk-billed by the hospital and specialist doctors. However when I visited an ENT specialist who does not ‘bulk bill’ I only recovered half the fee from the system.
I will say this in defence of (American) doctors’ seeming greed: Medical school bills can easily put graduating medical students into a quarter-million dollars of student loan debt, for just the basic degree,let alone any specialties, any previous school debt, or otherwise; all things considered, a high-powered doctor in a long-term specialty can wind up owing over half a million dollars, often to private lenders with high interest rates. On top of that, their first few years is spent in residency, with salaries at about the median wage and 80-100 hour weeks—which often means that, while they are making repayments on loans, their repayments aren’t even enough to cover the interest, and so the principal increases *even more*. Then, once doctors go into private practice, they have to pay for *everything* in an office, from rent to salaries to equipment, on top of their private living expenses and their student loan debt. And don’t forget malpractice insurance, which can come to over a hundred thousand dollars a year (and sometimes two to three times that much) all by itself.
So when a doctor living in a major city (even by Midwestern standards) says that they can’t make ends meet on $130 an hour, it isn’t necessarily because they’re an out-of-touch rich asshole—it’s possible, even likely, that this is honestly their break-even point if they don’t want to live like a starving student until they retire (which they also need to find the money to do).
Of course, this ruinous debt is part and parcel of the problem with the US healthcare system…but, like making undergraduate institutions tuition-free or legalising controlled substances, it’s very difficult to reform the system without causing a great deal of pain and unfairness to those who’ve already gone through (or are in the midst of) attempting to make a go of the current broken system.
Seth, while that may be true (and is, at least to some degree), it is also hard to escape noticing that doctors tend to live in better areas of town than, say, someone with a Ph.D. in Biology can afford (though we often have huge amounts of debt, as well, and many spend years working for nearly nothing in a post grad). They drive nicer cars. They dress in nicer clothes. So, perhaps they do manage to get more than starvation wages for take home?
It is really easy to figure that one out: Government service needs to pay for what it costs to provide the service and… that’s it. For outsourcing to private companies, it is more like this: total costs = what it costs to provide the service + advertising and lobbying expenses + having to make a profit on the deal. The two ways outsourcing can be (and admittedly often is) cheaper than doing it in-house is by (1) being able to pay lower salaries and benefits and (2) saving money by not doing the job properly.
But the main reason that people believe that outsourcing and privatisation can deliver better is, in my eyes, the tendency to consider any mistake made or fraud committed by government as evidence of systemic inferiority and any mistake made or fraud committed by a private company as an isolated instance. Kind of like this, only for political economy instead of sexism.
Iknklast, note that I didn’t say that the 180 per hour you quoted was definitely a starvation wage, but that 130 an hour could reasonably be, given fairly common circumstances. And the fact that doctors don’t work at the minimum possible financial level is at least as much an indictment of the perverse incentives of academia as it is the greed of the average doctor. (Recently an accredited institution advertised a *volunteer* adjunct position. Such pressures are why I for one have abandoned any hopes of becoming an academic.)
The system is broken. Pitting postdocs against medical doctors is a bit like pitting disorganise labour against unions; it is true that unionised workers usually fare better than non-unionised ones, but that doesn’t mean unionised workers are out-of-touch vandals.
(I also point out that even tenured professors aren’t liable for malpractice, nor are they responsible for paying the salaries of their adjuncts and graduate students out of their own pockets, much less lab equipment and office supplies. So the analogy isn’t perfect on that end, either.)
80-100 hour work weeks for the residents sound like a perfect recipe for mistakes that will kill or cripple people.
#12
They do kill and cripple. The ‘ordeal’ style of training has been exposed as counterproductive for decades. Some improvements have been made, but the old model persists.