Comment Multiple health care systems (Score 1) 950
The U.S has several health care systems operating in parallel:
- At it's basic, the it's a fee for service business, with distortions from the side effects of various laws, regulations, and other systems. One distortion is that I think all states require that providing emergency services cannot be refused - treat first, demand payment later. A lot of uninsured people get treated this way, and if they're too poor to afford insurance, they're usually too poor to pay. This means a lot of money is wasted on debt collection, and a lot of fees just go unpaid. All prices in a hospital are jacked up to cover the losses - so an aspirin tablet in hospital costs $10.
- The insurance system added on changes things. Insurance is usually too expensive for individuals, so it's almost always through employers. The main expense here is the hospitals and doctors trying to get payment. The insurance companies are adversarial, and try to avoid paying as much as possible. They will hire doctors to claim procedures are unnecessary (often as a rubber stamp to meet a quota of rejections), or reject forms for small technical mistakes, etc. Micheal Moore's movie focussed on this. The adversarial system is supposed to prevent unnecessary procedures, but the malpractice insurance industry pushes for more procedures. Meanwhile, insurance plans are far more complicated than needed, to give more opportunities for rejection. People in this system always experience problems, even when the actual health care that they receive is very good. The people with good (expensive) insurance plans are usually happy with it, largely because their company pays the costs, so they don't see any of it.
- Certain categories of people have government payment acting as insurance. Poor, usually children, qualify for Medicaid, and seniors qualify for Medicare. This is basically the Canadian system as well, only not universal. Physicians can "opt out" like they can in Canada, but in Canada there are few payment alternatives, so in practice almost all doctors are part of Medicare. In the U.S, a lot of doctors don't accept Medicaid or Medicare patients.
- Military personnel are covered by a hospital system operated by the government, through the military while serving, and through Veterans Affairs after. This is basically the same as the U.K's National Health System - government run from top to bottom. It actually works well, but suffers from gigantic bureaucracy typical of any large government organisation (just like the military itself, for that matter).
The reforms are meant to lower the cost of health care and insurance in two ways. First, usually people who don't need insurance (young people) don't get it, so those who do typically cost the insurance companies more, and they have to charge more for private plans. If everyone must have it, the costs should drop - this is the reason auto insurance is mandatory, and the result there. The other is to eliminate the non-payment problems of hospitals and doctors, so prices charged will be lower. Overall, this is the system used in Japan, and it works pretty well. It's not a quick fix though - quick fixes are really wanted these days. And ideological meddling and corporate corruption may prevent it from working at all - the U.S has a shortage of patience and reason when it comes to these things.