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Try Not to Get Sick
November 30, 2008

In the United States 700,000 people per year go bankrupt due to medical bills.  Pharmaceuticals put most of their money and research into drugs which will make them a profit.  We’re loaded with excessive paperwork, which is inefficient and prone to serious errors.  In order to see a specialist, one must get a referral from their primary care physician (PCP).  And there is often a wait to get in to see the doctor.  Insurance is tied to employment, so consumers are stuck with the insurance plans offered by their employers, and many are forced to stay with their employers so they won’t lose their insurance.  The many people who have no insurance simply don’t go to the doctor to seek treatment.  If their health issues become too severe, they’ll end up going to the emergency room.

You would think that I have fairly decent health insurance, being employed by a large hospital.  I suppose it could be worse.  Our former insurance with Bombardier (Learjet) required a $4000 deductible before we could receive any coverage whatsoever.  I have had a recent health concern as a result of my prolactinoma.  It seems my prolactin levels have increased again.  My endocrinologist suggested I get another MRI.  But even with insurance, the price tag is too steep for us.  So we decided to skip the MRI, hoping the tumor hasn’t grown and the medications will be effective in controlling it.

My insurance company (like many others in the U.S.) makes deals with select health care providers, thus allowing them to be on their “preferred provider” list.  We as insurance consumers must carefully select the health care providers who are on this “preferred” list, or else pay out extra money…which quickly adds up.  I was fortunate enough to find an OB/GYN with whom I am very happy, and we like our primary care physician too.  However, both doctors work for a group which just recently merged with a hospital, and I just discovered that all the providers for this company are no longer preferred providers with our insurance company.  Consequently I’ve been searching for a new PCP and OB/GYN.  Meanwhile I have someone from my gynecologist’s office looking into this further for me, as they were surprised that this had happened.  If this is somehow an error that will eventually be remedied, then great (though it’s already been two months since the merger).  I’m pretty fed up with the hassles and headaches of fighting with the insurance companies just to get the coverage I already paid for.

I recently watched a series of videos by Frontline covering five capitalist democracies and their healthcare systems.  The countries with such excellent health care include Germany, Switzerland, Britain, Taiwan, and Japan.

Unlike in the United States, insurance consumers in Germany keep their same insurance coverage if they become unemployed.  Doctors are paid less, but they also have less overhead.  Switzerland just recently reformed their healthcare to which everyone is entitled.  Insurance companies are not allowed to make a profit, and drug prices are set by the government.  In Britain patients have no medical bills to pay.  The doctors get bonuses when their patients are healthy, and their prices are fixed.  Patients in Taiwan can go see a specialist without a referral.  They also have a smart card used to store all their medical history and bill the national insurer.  The Japanese do not have to wait for health care services at all; they may walk in and be seen immediately.  Healthcare providers have fixed prices.  Japan just innovated and built new low-cost machines.  The charge for an MRI is a mere $98, compared to $3800-$4000 in U.S.  Then if doctors were to choose to perform more procedures or do more tests, they are required to reduce their prices.

Note the percentage of gross domestic product (GDP) spent on healthcare by the following countries:

• Switzerland: 11.6
• Taiwan: 6.3
• Germany: 10.7
• Japan: 8
• Britain: 8.3
• United States: 22

The United States should take notes from these countries and their universal health care systems.  If we are to be successful, perhaps these should be the criteria:

1.  Insurance companies must compete and accept everyone, and cannot make a profit on basic care.
2.  Everyone is mandated to buy insurance and government pays the premiums for the poor.
3.  Doctors and hospitals must accept one standard set of fixed prices.

Our healthcare system is definitely broken.  Bush and his cronies can’t get out of office soon enough.  Obama seems to be on the right track for healthcare reform.  Quality, affordable, and portable health coverage for all?  Sounds good to me.  And he’s picking people with intelligence and experience who are actually capable of making good decisions.  It’s about time!