"Let Death Then Buy A Life" (poem/article) >>> Ideology Is Creating America's Dysfunctional Healthcare System

The American healthcare system generates a lot of political controversy. And there's a reason why. It's a mess. It is a hodgepodge of programs super-imposed upon one another in what can only be described as a dog's breakfast. People over sixty-five get Medicare, a medical program originally copied off of Canada's government-run healthcare system. Medicaid is a similar program for poor children. The Veterans Association provides government-funded healthcare for veterans. Socialized medicine.

Everyone else gets a variety of healthcare insurance coverage through their employers or through private purchase, unless they can't afford it ... in which case they go without. To add insult to injury, "going without" is not free as they receive hefty penalties come tax time. In any event, medical bills have been, for decades, the nation's largest cause of personal bankruptcies - and many of the bankrupt, had medical insurance ... just not enough.       

With respect to medical providers, the system is no less dysfunctional. Providing some kinds of medical care, cardiac care for example, is highly profitable (big reimbursements) while other fields, such as neo-natal care, are perennial financial losers (small reimbursements). And hence, medical providers (hospitals and physician-owned clinics) engage in tooth and nail competition to solicit old people at the end of their lives, while (in many communities) tax-supported, not-for-profit Public hospitals enjoy a monopoly on delivering babies (especially 'problematic births'), at the beginning of theirs. In the medical industry, this practice is called "cherry-picking." With a shrug of the shoulders, "How can we deliver your baby ... we don't have a maternity ward?" How can you call yourself a "hospital" if you can't deliver babies?

Why would the government and insurance companies create such a disparity in profitability between healthcare specialties? Who the Hell knows? It seems self-evidently stupid.

How Do We Compare?

A number of years ago, Singapore decided it wanted a streamlined healthcare system for its populace. So what did the Singaporeans do? They assembled a group of researchers to study the healthcare systems in other advanced economies: The US; the UK; Canada; Germany; France; Japan, etc. The researchers made a list of the pros and cons of each system, then set about preserving the best aspects of each, while minimizing the worst. It seems like an astonishingly simple, and logical, way of approaching the problem.

What they ended up with was a single-payer, government-run program (much like Medicare) ... but with a lot of adaptations to increase operational efficiencies and minimize both patient and provider fraud, which is a very costly problem with Medicare. The results have been spectacular. 

Below are selected countries from Bloomberg's Healthcare Efficiency Index (2014) comparing mortality rates with the cost that each country spends to achieve them.  

Of course, this Index only compares life expectancies to costs and some of the countries, notably Hong Kong and Singapore, are city-states which are hard to compare to nation-states, due to advantages of limited geography. Moreover, there are differences in diet and lifestyle that cannot be blamed on the medical system in question.

But what about the other G7 countries that have similarly disbursed populations and similar diets and lifestyles? Look at the differences in cost. The culture in the United States and Canada are, arguably, the most similar of any two countries in the world. Canada spends 10.45% of it's GDP on healthcare and has a life expectancy of 81.96 years. The United States spends 17.14% of it's GDP on healthcare and has a life expectancy of 78.94 years. That's a 6.69% higher expenditure of GDP to get 3.02 fewer years of life. And, given that the US has a population 10 times that of Canada, it ought to be achieving significantly greater economies of scale with respect to things such as the price of drugs and medical equipment. 

To put the additional cost in perspective, America's 2016 GDP was $18.59 trillion. 6.69% of that is more than $1.24 trillion per year!

But America does everything bigger and better than Canada (except hockey), right? So, imagine that the U.S. could only achieve half of such savings. That's still $600 billion per year. The country could start paying down its National Debt (a novel idea), now in excess of $21 trillion and rising. It could start repairing its infrastructure, which is in a deplorable state of disrepair (while creating a lot of jobs, both directly and indirectly, in the process).

Ideology Makes Us Stupid

So why don't we pull a Singapore? Because healthcare has become ideological and ideology makes people stupid.

The conservatives on the right are terribly concerned about becoming Marxists (so am I, by the way ... it's a nasty and delusional Utopian fantasy). But we already provide socialized medicine to veterans, people over 65 and poor children. Providing the same healthcare to 45-year-olds ... that's what's going to turn us into commies? They're also quite concerned about the push-back from the pharmaceutical companies and for-profit hospital chains that fund their political campaigns.

The progressives on the left would LOVE a single-payer healthcare system ... but without the discipline and accountability that Singapore used in implementing theirs. For example, Singapore issued all its citizens secure credit-card-like healthcare cards that are electronically swiped when visiting a medical provider, whether a doctor, hospital or pharmacist. This prevents patients from obtaining duplicate prescriptions from different doctors or obtaining replicated prescriptions at multiple pharmacies, as prescriptions are checked against a central database prior to their being filled. It also prevents unethical medical providers from creating bogus billings, as all patient data goes into a computer database and is scanned for anomalies (eight visits for an in-grown toenail is not normal ... red flag).    

So what's the progressives' problem with that? 

It would, efficiently, exclude the millions of illegal aliens residing in the U.S. who represent a huge potential, and decades-long, Democratic voting block ... if only they could be legalized. All those sanctuary cities would either have to foot 100% of the bill themselves (causing immediate bankruptcy or sky-high local taxes), or, the illegal aliens would have to pay for their own healthcare or do without. This is how it works in Singapore.

(Yes, I use the term "illegal aliens" because that is the proper legal terminology, utilized even by the Supreme Court. The effort, by the Left, to ban its use is a naked attempt at "rhetorical euphemization" designed to "re-frame the debate" by downplaying the actual source of the political conflict ... that illegal aliens are living and working in the United States "illegally." This is Ideology 101. Both sides do it. I don't. You solve a problem, any problem, by first calling it by its name. By using words to accurately describe what a thing is, not what it isn't.)  

And so, the issue gets "re-framed" with progressives claiming to be concerned about "National ID Cards" on the grounds that they would infringe upon personal privacy. Nevermind those already existing National ID cards called Passports and Driver's Licenses. Nevermind that your medical data is already being collected by the Medical Information Bureau in Boston (and has been for decades).        

When Will This Ever Get Fixed?

It's hard to imagine a single greater source of national and personal savings, or economic stimulus, than implementing a cost-effective healthcare system. Almost inarguably, this ought to be everyone's top political priority. But, as long as the ideologues control the debate, nothing will happen. Practical and pragmatic solutions are anathema to those possessed by zealotry. 

If history is any guide, the pain will have to become unbearable before the Silent Majority finally finds its voice. And, given the healthcare costs associated with an ever-aging population, afflicted with chronic disabilities and neuro-degenerative disease, we can expect the financial pain to become excruciating.      

 Quill

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