Isn’t this just the biggest question no one seems to have an answer for? What value do insurers add to the health system in the USA? They have tens of thousands of people lobbying to pretending they add value.
The answer seems to be: “nothing good”. They are an unnecessary level of proxy between person (e.g. you, me, the average guy in the street) and medical care provider (e.g. doctor, anaesthetist, pharmacist, ambulance service, nurse).
Now in the field of Software Engineering we often add in a proxy between two things for a number of reasons:
- caching (e.g. the proxy accumulates things so it can supply them quicker)
- auditing/logging (e.g. “a paper trail”)
- for coordinating and performing a number of calls to other things (e.g. to talk to A you need to first ask B something)
- for handling errors and exceptions in a nice way
The downside is:
- increased overhead (memory/performance hit)
As far as I can see the only one of those “benefits” are there.. Increased paper-trail. Which in the case of medical care isn’t really a good thing given how much of one there is to start with.
I mean I live in a country with public health (“socialised socialized medicine”.. only the USA calls it that to incite fear of communism, so the z is appropriate) and I’ve only recently been effectively forced to get additional private health cover because the government is pretty much screwing you if you don’t (via tax penalties and lifetime penalties based on age that will kick in for me now) and I can see just how little private health cover offers if you end up outside certain average needs (e.g. waiting lists for various things, lifetime limits, yearly limits, certain hospitals/providers, gap payments.. ). BUT the difference is a year of the near highest cover level of private costs me about what it costs per month in the USA.
Current system costs an arm and a leg
Over half of bankruptcies in the USA are caused by medical costs a recent study said. Some scary bits:
“Unless you’re Bill Gates, you’re just one serious illness away from bankruptcy,” said Dr. David Himmelstein, the study’s lead author and an associate professor of medicine. “Most of the medically bankrupt were average Americans who happened to get sick.”
and shockingly:
Most of those seeking court protection from creditors had health insurance, with more than three-quarters reporting they had coverage at the start of the illness that triggered bankruptcy.
So it wasn’t even those who didn’t have insurance, it was the ones who did have it but got screwed anyhow!
This sort of thing is pretty much unheard of in the nice public health safety net we have in Australia. It isn’t necessary for me to get private health cover other than to avoid the tax implications and shorten the waiting period if I need elective surgery.
Whether I have private cover or not, if I need treatment (ranging from the “hit by a bus” type situation to developing leukaemia to having a head cold etc) then I’ll get treatment. The same isn’t the case in the USA with private cover needing to cover everything that could happen to you.
I remember during orientation with a US based company: I have never seen so many adults listening so intently to the list of “benefits”. It was like watching kids hearing a fairytale, although this one was about the fantasy of “full coverage”.
Private health-cover in Australia
I’m pretty against the notion of private health-cover in Australia and that the government has to really twist people’s arms to get them to take it up (and they leave in droves when that tax benefit is changed). Having a system that is propped up by people trying to avoid tax is just stupid and means you end up with a bunch of people with pretty much useless cover (e.g. sure, it qualifies you for avoiding the tax break, but can you actually use it? Generally these “minimum cover to get tax relief” schemes provide such poor coverage and high gap payments that you’d have to use the public system)
What it means is that you’re artificially inflating an industry which doesn’t really offer that much benefit and which takes up hospitals which should be available to all for no cost. It also drives a hell of a lot of money to alternative medicine treatments as people try desperately to get some value out of their tax-penalty-enforced private cover. This has three negative consequences in my opinion:
- driving up private health cover further
- promoting health treatments that have no proven benefit whatsoever
- upping the cost of everything because the insurer is paying most of it
Lobbying out of control
This debate in the USA seems to be divided amongst two concerns:
- improving the healthcare provided to all
- maintaining health insurance company profits
Is it just me that thinks one of those is on very shaky ground. What amazes me further is the vast sums of money spent on bribing congressmen from the piles of cash syphoned off the current medical costs (born by US citizens).
Just how many people were denied coverage for something to be able to donate the 9 million dollars to John Kerry’s campaign?
Attitudes need adjusting
One thing out of this whole stupid debate is just how the group attitude of “I ain’t paying for someone else” selfishness covers not only the usual culprits (conservative/republicans) but also many of the democratic/liberal types. I don’t want to further the whole idea that you can only have one of two types of opinion on things (e.g. you’re a liberal or a conservative and that’s all), but I’ve had conversations with people that are furious about a number of usual liberal type issues (same sex marriage, war in iraq, women’s right to abortion, religion separated from state etc) but who on this topic dig their heels in and say they don’t want to be forced to pay for other people’s healthcare.
Perhaps this is one of the weaknesses of the USA’s strength. The cut throat succeed mentality is probably why the USA is the world’s powerhouse economy, although it hasn’t been without casualties. Perhaps now is the time to re-evaluate the situation before the society implodes under the weight of medical costs (and the costs associated with putting off timely medical checkups).
Lots of “socialized stuff” already
Perhaps the people against public health can think about what they currently already pay for in the realm of the dirty socialist concept:
- public roads
- public transport
- public police forces
- public fire fighters
- public libraries
- public utilities
- etc
I really can’t see the same people objecting to healthcare for all taking up arms to protest against “socialised police force” (e.g. police won’t track down your mugger unless you pay for it) or fire brigades run by companies and on an “individual pays” policy (“Oh, your house is burning down.. I’m sorry, your fire brigade insurance only covers week day call outs.. we’ll put it out on monday”).
Some things are never meant to be money making ventures. Ethically healthcare needs to be universal in a civilised society.