We Deserve a Better and New Healthcare System – InsuranceNewsNet


Our current model of healthcare was conceived in the late 1960s and introduced during the Nixon administration as a not-for-profit managed care system. Wealthy entrepreneurs saw an opportunity to make fortunes, and by the Clinton administration, US Health care was managed by for-profit corporations.

Exceptions were the v.a System, Medicare and Medicaid.

The argument used to turn healthcare into a for-profit industry focused on competition. For-profit health insurers insisted competition would fuel innovation in healthcare and keep rising prices in check.

So how did that work?

According to the World Health Organization (WHO), The United States ranks first in health spending per capita, with almost twice as much as the next closest country (Switzerland). But in terms of results, we rank 37th overall out of 191 countries surveyed. This ranking is by far the lowest of the 11 most advanced industrial nations and does not compare well to many third world nations.

The ranking at number 37 has remained unchanged since then WHO began making comparisons for the first time in 2000.

So what went wrong? Where was the competition for innovation and lower prices?

Since managed care came into force in 1970, the number of physicians in America has increased by approximately 200%. But the number of healthcare managers (administrators) has increased by over 3,800%. Over the same period (1970 to 2019), healthcare costs have increased by 3,100% or per person $353 1970 to $11,582 in 2019 (dollar amounts adjusted for inflation). See healthsystemtracker.org. There are now 10 administrators for each doctor in The United States.

Ironically, competition and innovation are the reasons that prices and the number of administrators have increased.

To make healthcare a profitable business venture, insurance companies have used competition and innovation to drive down their costs. Because a health insurer’s expense is sick patients and their medical claims, health insurers have found innovative ways to reduce the number of unhealthy patients they cover while aggressively rejecting as many medical claims as possible. They’re not competing for lower prices, they’re competing for a larger percentage of healthy patients (fewer medical claims), inventing new ways to decline medical claims, and inventing ways to eliminate their most medically needy patients from their insurance plans!

To achieve this, they have hired more and more managers or administrators to find ways to decline requests from doctors and patients to pay for tests, services and medication. The additional cost of hiring additional managers is more than offset by the money saved by paying out fewer medical claims. The for-profit system of health insurance is designed for people WHO don’t need much medical care.

Responding to medical claim denials creates unnecessary paperwork for everyone involved: hospitals, physicians/clinicians, and patients. This denial of medical claims has prompted doctors and hospitals to hire their own army of administrators to respond to the extra paperwork being generated by insurers. This further drives up the costs within the system. Many patients have faced the complexity of this paperwork and simply given up or given in to the insurance companies and accepted being denied the services, tests and medications they needed.

That makes some of them stand out WHO‘s ranking. But the sheer cost of healthcare in the US has kept millions of Americans from getting health insurance at all. The unequal distribution of health care accounts for the majority of this 37th place. Most of us know at least one person WHO have died prematurely or have developed serious medical complications due to lack of access to any form of healthcare (a healthcare provider, appropriate tests or medication).

The enormous number of administrators (non-medical personnel) remains the largest single item in our medical system. But drug prices come second.

Americans spend more money on drugs than any other country. It’s not that we use more medicines per capita than in other countries, on the contrary, we tend to use less. It’s because the medicines we buy are so much more expensive than other countries.

We owe this to the lobbying work and the large political donations from the pharmaceutical industry. Where other countries have limited the amount of profit a company can make from a life-saving drug, the US leaves that up to each individual pharmaceutical company. Instead of lowering prices, these companies have been offering gimmicks and coupons. Even with these discounts, we still pay more per drug than citizens of other nations.

The medical business has transformed the medical profession in the United States. Physicians, nurses, and other medical clinicians often must balance the quality of care with the patient’s ability to afford the right treatment. Also, they get paid for how much they do, not how they do it. For example, two doctors can successfully treat the same medical problem, but one doctor can do it in two visits while the other doctor needs four visits. Because reimbursement is based on the number of visits, the system rewards the doctor who needs more testing and more visits.

None of these problems would exist in a universal health care system. Since every person would need to be covered, the competition would aim to find ways to prevent people from getting sick in the first place, and then minimize the number of visits to hospitals or doctor’s offices required to maintain a functional lifestyle.

Both v.a The system and Medicare work that way to some degree, but because of Congressional limitations, neither has reached the full potential that a true universal system can attain when it comes to prevention, access to care, and the breadth of services provided .

New Hampshire Physicians have expressed concern and frustration at the limitations managed care has placed on their ability to effectively treat everyone in the Granite State. In a recent survey by the Medical Society of New Hampshirean overwhelming majority of doctors advocated a universal health system.

The medical society survey shows that in all medical disciplines (primary care, surgery, specialty care, etc.) New Hampshire Physicians favored a system of medical care that gave all Granite Staters equal access to providers and hospitals, regardless of income or the amount of care needed.

For the enormous cost of medical care in The United States, we shouldn’t have a medical system at #37. The highly profitable pharmaceutical and health insurance industry has made false promises of better care and lower prices. After 52 years, it’s time to change the narrative. We deserve a better healthcare system.

Jacob Fieseher MD from Dover is a recently retired General Practitioner.

It’s your turn

DR Jacob Fieseher

guest columnist


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