What A Sustainable Health Care System In The U.S. Might Look Like

Allow me to preface this post by stating that I am a physician with over 40 years in active practice. Take it for what it's worth.

By almost any measure, the U.S. health care system [for most Americans] lies somewhere between horrendous and untenable. Something radical needs to be done. The question is, "What?"

I believe the answer is fundamental, that is, we need to transition to a real health care system from the present one better termed a "sick care system" [where there is little interest in maintaining patient vitality as it produces little to no corporate profits].

If we can agree that the present system is tragically flawed as well as being nearly completely skewed in the interests of the major health corporations [insurance companies, BIG Pharma, tech, and the like], and their responsibility [by law] is to act in the interests of their shareholders, then it is not difficult to see that the prognostications of the 1950's have come true as we were warned that if business and medicine ever mixed, the result would be utter disaster.

Patient outcomes aside, and merely from a fiscal perspective, the present system is NOT sustainable. This should be obvious to all. I am not exactly certain what the current statistics are, but we all know that Americans pay substantially more for their health care [with poorer outcomes] than almost every advanced economy [and their systems are universal].

The above point demonstrates just how sick this system is. Incredibly expensive costs with poor outcomes. It is the worst of all worlds, a coalition of government and mega-corporations with near monopoly control over their markets. Can't imagine how that could go wrong!

Now there are areas where the U.S. health care system is top-notch. These are almost all related to super high technology specialties which generate enormous corporate profits. Routine and preventative care is not so wonderful as providers are paid little for their time in examining and educating patients. The money is in prescribing, testing, and doing procedures, all which maximize corporate profits. Surprise, surprise.

So what would a real health care system look like? First and foremost, it would be one in which the individual is in charge of their own health care. There would be no insurance. Providers would be paid a market rate determined by what people can actually afford. Since there would not be an unlimited amount of money being invested in health care technology [as nobody will be able to afford it], the explosion in costs will be seriously tempered. Like it was decades ago, patients will partner with their provider and determine what is best for their individual situation [not what's best for corporate profits].

When people realize that there are consequences for acting like a complete fool [over-eating, not exercising, excessive alcohol and drug abuse, and all the rest], perhaps they will reconsider bodily self-destruction as a life philosophy. If not, they are on their own. This society cannot continue to fund everybody's health dys-fucntions. The gig is up.

The bottom-line is that people need to grow-up and take responsibility for themselves. I do realize that there are conditions that affect people through no fault of their own, but that's life. We cannot continue to steal from the future in order to find every possible cure when the sane way to approach this is to do everything within reason to stay healthy in the first place.

Obviously, what needs to happen in health care demands rigorous debate at all levels of society, but something needs to change...soon. It's time to cut the corporations out of the deal and give the system back to the patients and their providers so they can make the decisions that will create the best outcomes. Continuing along the same path will only enrich the few at the cost of the many. And whereby there are many people who have been the beneficiaries of some amazing technology, it's just not affordable and therefore not sustainable.

You know, it would be great to give everybody a $100K car and a million dollar house, too, but we can't afford that either. Who exactly was it that decided that we could continue to invest tens of billions in health care technology resulting in costs that are bankrupting the country?

This is massive stupidity and greed on a biblical scale walking hand-in-hand down the short road to Hell. Talk about global warming!

 

Well half our hospitals are already not-for-profit and that doesn't seem to have helped anyway. Likewise people paying based on what they can afford doesn't sound like a workable system since I shouldn't have to file a financial statement and have a credit check just to get antibiotics. Lastly, nothing you proposed seems to fundamentally change a system that you deem fundamentally broken. Perhaps we can begin by making more things OTC or allowing pharmacists to dispense common medications without the need for a prescription. Perhaps we should mandate that uninsured patients and insured patients get the same charge.

 

I pay $50/mo for unlimited access to a clinic. They aren't going to perform heart surgery or treat cancer or give me a CT scan, but its a good way to keep minor problems like rashes and infections from getting worse and get professional diagnosis, advice and scrips written. I go in about once a year for some minor thing or another. I reckon I've been paying them at least $1000/hr for this service, based on the (very small) length and frequency of my visits over the years. Im pretty sure I'm covering for other people who go in way more often for way more problems. And I think that's great, because I can opt out the instant I feel like I'm not getting the care that I'm paying for. I don't have a problem with socialized medicine, I have a problem with mandatory participation. There's gotta be a way this kind of voluntary system can work on a larger scale.

 

I don't really see "what a sustainable health system" would look like from you post. I would be interested in alternatives and fixes from someone like yourself who's worked in that system for decades, but your post seems shy on that.

 

I was attempting to start a conversation, not write a book. I have already stated that the key feature in such a system is to eliminate the corporations and the government and give the system back to patients and providers. That's pretty significant, don't you think?

Just imagine if our vehicle insurance system was similar to our health care system, that is, people [either through their employer or through the government] will be billed monthly for car insurance. It would not matter whether you maintained your car or had 23 accidents, you keep on paying the same rate as everybody else. Then all the car repair shops would be owned by just a few mega-corporations. How would that work? How expensive would it be to have a car in this case? This is how health care operates...corporatism at its finest.

Create a system similar to car insurance [or better, no insurance at all]. People need to be as responsible for their health as they are for their car. Hopefully more so. The free ride is over.

 

Health care services have been the ultimate "something for nothing" reward for the most irresponsible among us. Live as reckless as you wish, no problem, the rest of society will bail you out by making excuses for your behaviors and paying your bills. Go on, drink like a fish, do all kinds of toxic drugs, eat like a herd starving hyenas...no problem at all.

This madness needs to end. You want to live like an irresponsible four year old, then pay your own way. Society can no longer afford to subsidize your dys-functional behaviors.

 

If I could pay the doctor with a couple of chickens, then sure. But as it is, the price of healthcare is beyond the reach of most people who aren't multi-millionaires. Of course I'm including some serious injuries and illnesses over a lifetime. A cancer diagnosis, over the course of a year or so would cost what, a couple of hundred thousand dollars? The average person can't afford that. So doing without insurance and government under such circumstances doesn't seem like a viable alternative.

 

Well, if everybody was forced to buy a Ferrari, then they most wouldn't be able to afford to maintain it either. Don't you see what has happened? The government and corporations sold the American people a system that is not affordable to the average person [and is horrible, to boot!]. And they did this because they are taking advantage of the fact that most people live in abject fear of [every damn thing] and because they are making vast fortunes.

People need to sell the Ferrari's and buy Civic's. Not only will they have a much more affordable car, but much more reliable, as well, because they can do a great deal of the routine maintenance themselves [if they choose]. The same applies to health care. The answer lies in doing everything possible to maintain your health. You actually have to CARE ABOUT YOURSELF.

Top-down control of the economy, where the few decide what everybody else is going to get, doesn't work for anybody except the few at the top [and the folks who have benefited by the technology made possible by bankrupting the country]. It is completely unsustainable, something the people at the top could care less about because once they have taken all they can with this scam, they will pack up their bag of tricks and move on to the next one. These are sociopaths who could care less about anything except getting as rich as possible.

 

There's a lot of wisdom in what you say, but you can't mandate 'good behavior' in a country like ours is, where more and more people take advantage of a long list of gov't welfare programs and 'subsidies'.

And remember, even if a person never works at all, and if he sucks a living off of taxpayers all his life, that guy still gets to VOTE in every election with no restrictions.

Bottom line, I see no solution. The welfare system in this country corrupted everything, and then corporate greed and professional tax evaders made everything even worse.

 

Here's the solution.
1.Throw as many of the corrupt people out of positions of power as possible [pretty much all of them].
2. If people want to act like irresponsible four year olds, so be it. Let them [and everybody else] pay for their own health care.
3. Revoke all corporate charters.
4. Cut government spending by 80%.

This would be a good start.

 

OK I've traded in my Ferrari for a Civic. What sort of health care does that get me if I come down with a cancer diagnosis, or if I'm severely injured in an accident?

 

What you can afford.

 

But you forget the key point I made in my previous post -- those who live off of welfare handouts and subsidies are able to VOTE. And, considering how many people in this country receive some kind of UNEARNED welfare and subsidies, how could you ever make any changes that would not take us directly down a path to 'socialized-medicine' or some kind of "Medicare-for-all"?

I even thought up a 'single-payer' healthcare system that would go a long way toward fixing the mess we've got, but nobody listens. Briefly, you create a gigantic nationwide pool of enrollees in a single-payer system, and that system negotiates with the various medical and pharmaceutical sector corporate conglomerates for the best prices and the best terms and conditions. The enormity of the buying-power of this single-payer system would force competition on a scale not seen in this country before -- but there's one 'catch'... everyone who is enrolled in this system must pay to be in the system! No welfare, no handouts, no subsidies, no bullshit. What do you think?

 

That doesn't seem like a sustainable model if very few people can afford to come down with a cancer diagnosis, or handle the costs of being severely injured in an accident. Someone who's been in medicine for decades should have thought a bit more deeply on this topic.

 

I've given some thought to something similar; a public option model that's fully supported by premiums. Cost to the taxpayer? Zero.

 

Why does everybody here feel that they are Sigmund Freud?

What do people do now when they have a disease for which there is no cure nor treatment? And what if you were in an accident where there is, "nothing we can do?" You have to draw the line somewhere, right?

How about drawing the line on the other side of bankrupting your society? Look to the Soviet Union in their strategy of trying to keep up with the U.S. in the 70's/80's arms race to the point where it bankrupted their society.

I understand that people are afraid and nobody wants to die but these are states of emotional being that have been manipulated by people who have not come clean with the American people. You cannot continue to spend this kind of money to save everybody from the inevitable. Last I heard, 40% of the money spent in the U.S. health care system is on the last 40 days of life. What sense does that make?

The only sane strategy is to do what has been recommended for thousands of years, eat well, sleep well, exercise regularly, and pray/meditate daily. I'll add to that, work hard and be kind to others. What else can one do?

 

I don't think no plan is a viable plan. There is zero incentive to anyone to want to change from having something to having nothing.

 

It's not going to be a choice. When you have over USD100T in debt liabilities, sometimes reality makes the decision for you.

 

Perhaps you forget basic human nature. Given the opportunity and ability, nearly all people will choose to indulge their own interests, do what they want when they want, buy whatever they want, and live lives of unrestrained choices and prerogatives. They won't work hard; on the contrary, they want other people to do all the nasty, unpleasant things for them and cater to them and their needs and wants while they pursue their own amusements.

How do you enforce mandates that demand a person "eat well, sleep well, exercise regularly, and pray/meditate daily"? You don't! Especially not in a society like ours, where now over 50% of its citizens receive at least one or more types of UNEARNED government handout welfare, or "subsidies" (just another word for "welfare") -- AND -- those "recipients" getting all that stuff and "services" are allowed to continue to VOTE?

 

You don't have to enforce mandates, you make them take the consequences of their actions. If you tell people you are going to bail them out no matter how they behave, what do you think is going to happen?

Generally speaking, when things get this out of control [and there are no people left willing to tell the truth] a crisis will precipitate and force reality on the masses. It appears as if this is where we are heading.

 

What we have seen clearly, especially beginning with 9/11 (oddly enough) is that people don't take the consequences of their actions! Not the rich and not the poor.

The "Great Recession" itself was fueled primarily with people buying more "house" than they could even begin to afford, and that, coupled with reckless, idiotic stock market gamblers brought on "rescue" after "rescue" after "rescue" in the form one "Quantitative Easing" after another after another from the corrupt schemers in the Federal Reserve central bank. The meme, "Too big to fail" became well-known to a middle-class who watched interest rates slashed to zero on their savings accounts so that Wall Street wouldn't have to suffer "the consequences of their actions".

Eight years under Barack Obama taught us that for the Democrat Party's voter-base, there ARE no "consequences" for poor health habits, or anything else! And as I said before, so long as those who receive unearned welfare and subsidies from the government are allowed to continue voting in all elections, they never will face "consequences" again!

Reality: as it is shaping up now, the U. S. will adopt universal free health care for everybody, whether they are citizens or not. In the short term, get yourself signed up now with a good concierge medical practice. It'll be expensive, but at least you won't have to make appointments two months or more in advance to see a doctor, and you won't have to wait all damn day to actually see a doctor, even when you do have an appointment.

 

I wouldn't be surprised if you are right and we go down this path. The thing is [and although a universal health approach is certainly NOT the answer] it can work a hell of a lot better than what we have now IF the providers had control of how it was to be administered. As long as the corporations have control, it will be a system designed to generate profits for themselves as this is their raison de e'tre.

 

I worked within Australia’s Universal health care system. It has its flaws but……. We, like every country that has introduced such a system, will fight tooth, nail and hair follicles to keep it.

Thing is once the government becomes responsible for paying for healthcare they suddenly develop a real and abiding interest in keeping people healthy in the first place.

We were one of the first countries in the world to mandate seat belts - why? Because medical officers went to the government with facts and stats on “central flail chest” injuries which even then was roughly 6 weeks icu.

We have government ads for health and how to stay healthy but also there are government programs funding “bowel cancer test kits” which are posted free to every Aus citizen over 50 every 2 years. Breast screen vans tour the country with free mammograms every two years, free Pap smears etc etc etc

 

Come to Aus for even a few months - see what works and what doesn’t

 

OK, back to basics (and the thread topic): a single-payer health care system could work very well... but the problem is that in order for it to work, everybody enrolled in the system must PAY. Far too many people just want healthcare (and nearly everything else in life) to be free, and pay little or nothing for it. Any system built on a population of "takers", slackers, and other parasites will fail. Brutal truth.