When no one can afford the ‘best health care system in the world’

August 18, 2006

Usually when we talk about the dramatic flaws in the nation’s health-care system, we’re looking at the 45 million Americans (and growing) who lack insurance. It’s a problem that generally effects lower-income families.

But it’s also worth remembering, as Ezra put it, “health care is now a middle-class problem.”

About half of adults in middle-income families reported serious problems in paying for their health care while even those in more affluent circumstances said they had troubles with medical bills, a new survey found.

Forty-eight percent of individuals in families earnings between $35,000 and $49,999 said they had either a somewhat serious or very serious problem paying their medical bills in the last two years, according to a study by The Commonwealth Fund. Meanwhile, 50 percent of adults in that income bracket said they had difficulties affording their health insurance.

Meanwhile, 33 percent of individual in families earning between $50,000 and $74,999 a year said they had trouble paying for medical bills while 21 percent of people in families earning $75,000 or more reported such a dilemma. Fifty percent of individuals in families earnings less than $35,000 annually reported such a problem.

Moreover, when you consider the public’s desire for a large-scale overhaul of the existing health-care system, it suggests — at least to me — that a single-payer system is ripe for consideration.

Indeed, The Commonwealth Fund report (.pdf) indicates that most Americans agree that the system needs “fundamental changes” or should be “rebuilt completely.”

* Nearly one-third (30%) believe the system needs to be completely rebuilt and another 46 percent think the system requires fundamental changes. System views are remarkably similar across income groups and regions of the country.

* More Republicans (35%) than Democrats (11%) see a need for only minor changes, but very large majorities of both parties call for fundamental changes or complete rebuilding.

To quote Ezra again, “That’s the sort of anxiety a savvy politician could make some great gains by tapping into.”

Quite right. And, coupling this data with the fact that the vast majority of Americans already believe the government should spend far more on health care, while individual families should spend far less, suggests that if some bold political figures would step up and start talking seriously about single-payer, the message would land on fertile soil.

And although they may not be ready to admit it, most US corporations would likely love a single payer system put into place–likely less expensive for them, no legacy costs, and much less admin time/expense for them. Dollars saved might even go into investment, and this would provide additional incentive for inbound investment.

  • Problems:
    1) It is easy to demagogue this issue with the terms “socialism,” and/or “socialized medicine.” These terms makes the blood boil & veins pop in the VRW citizens of this country, and there are a lot of them.
    2) This is a complex problem with several large and rich industries (insurance & pharma to name 2) that have a big stake in it.
    3) large and rich companies can exploit the complexity with propaganda (remember Harry & Louise?), and bring the process to a halt by sowing confusion.

    I am not hopeful on this issue. It is THE perfect example of special interests screwing the public.

  • The last attempt at doing this fell to due to the handy work of K-Street Lobbyists and a draconia ad campaign telling the US the horrors of public healthcare.

    Considering yesterday’s story about K-Street betting on Dems, start of a public healthcare system is going to be tough painful fight.

    As a Cannuck, I’m often amused (and angered) about how US health insurance companies and free market types demonize our public healthcare system. It does have problems (some of our own making) but it is very good at regular health issues and prevention but not so much stuff like orthopedic surgery and some heart proceedures where there are extended waiting lists.

    I just had my own health issues the last couple of months. I endured about nine tests (blood and urine) as well as an ultrasound test and a intestine X-ray. Cost to me? About $40 bucks for the dispensing fees. If I were in the States? Probably around several thousand dollars which I don’t have. I can’t imagine the pain a lot of people must suffer thru because they don’t have any or limited coverage. Of course I had to wait sometimes, but we all do. It’s not like the healthcare system was designed specifically just for me…

    I have a friend who worked as an emergency room doc in Virginia and he tells me off the five + hour waiting times for most patients because folks wait till they can’t take it anymore. He thought our emergency rooms were screwed up.

    Sure your taxes would go up (not as much as some folks would like you to believe) but it is a small cost for some piece of mind and some preventative medicine.

    (Not sponsored by the Canadian Gov.)

  • The US has needed a single payer plan for all of recorded history. I am just afraid that something like the Medicare drug plan will end up being the solution; ie just a clearing house for private insurance companies. We need government sponsored and administrated health care. That is the only way to go, but has been demonized by Republican scare tactics so much that I am not sure that it will ever happen. The data on a variety of such plans in a multitude of “industralized” countries is clear; the citizens get more access to better care than in the US. Even our own badly funded and largely ignored Veterans Health System delivers better in terms of health care quality parameters than the “private sector”. This has been established clearly by a number of surprising studies over the past several years.

  • There are a number of aspects to the Health Care ‘Crisis’ in America.

    One, lots of people don’t have insurance and thus ready access to health care.

    Two, even with insurance, health care is difficult to obtain for many Americans.

    Three, even when health care is obtained, the rules enforced by the insures are causing an incrediably high rate of bad outcomes (people dying, being maimed or ending up with cronic conditions).

    I think the third is the real horror. America spends more on health care than any other industrialized country as a precentage of GNP, but we have medical outcomes of a third world country.

    Pound on that one Democrats (paging John Edwards)!

    And yes, the real enemy of Americans is our insurance industry. They have the gateway to health care and they are not ready to let go, even though their administration costs are ten times that of Medicare. (23% to 2%).

  • I won’t go into my full-blown dissertation on this issue, but the ability (and willingness) of those who benefit from the current system to demagogue any regulation of health care as “socialism” is the ultimate problem.

    Unfortunately, Americans by and large are economically illiterate. Even the biggest advocates of the “free market” among true economists (as opposed to politicians or politically-compromised economists) admit that there are certain requirements for a market to truly be “free,” and if those are lacking, there will be market failures that make a “free market” inappopriate. The health care market suffers from huge failures of key criteria for free markets. There are significant barriers to entry in cost and limited numbers of professionals; there is a serious lack of “perfect information” – and even if the information flowered adequately, most non-doctors would not have the tools to evaluate or compare it. The biggest and most obvious market theory problem, however, is that for much preventative care the market is highly price elastic (i.e. if price goes up, people will quickly purchase less) while acute care is virtually inelastic — I will agree to pay whatever it takes to save my life if I am in mid-heart-attack; I wont stand there and haggle with you over the cost or do several hours of comparison shopping. (I could go on for pages about critical market failures but I’ll spare you. . .)

    As a result, this market can neve rtruly be “free,” nor under any apolitical economic theory should it be. But those with vested interests can spend tons of money to convince nationalistic Americans that the “free market” is the American way, and anything less is downright French! If we regulate health care, the terr’ists win!

    Yet another problem that would be easier to solve if the general public were keeping up its end of the bargain by being much better educated citizens. Several mandatory economics classes would be a nice start. . .

  • I pay about $1000 a month for health insurance. Plus I pay several hundred dollars each month in deductibles.

    This is more than my house payments!

    I’ve been paying into health insurance programs for many years and essentially never went to the doctor. Now that my family actually needs the services it is almost impossible to afford it.

    Single payer is the only system that makes sense.

  • Yes I will agree that there are no shortage of problems. And I might be inclined to think some ‘form’ of National Plan might have to be put into place one day. I just keep coming back to the problem I guess and that is ‘Why are medical bills so high?’

    I am not sure what all the reasons are, but I would be willing to bet that a lot of the problem seems to be because we pay such AMAZINGLY high rates for Drugs. Especially when you know countries like Canada, their drugs/prescriptions are capped. And yet we still pay 2 and 3 times for the same drugs that other countries do.

    I mean, is that a valid reason, can someone else point out a flaw in that argument or some better arguments?

  • Stephen (#8) – It is hard to point to any single reason; as I mentioned above there are numerous market failures. Let me give one example of where the free market is a problem.

    I live in a midsized midwestern community with two major competing hospitals. They compete aggressively, and neither runs at full capacity.

    Hospital A buys a PET (positron tomography) scanner, at approximately $1,000,000. Lets say that machine will only get used at 40% of its capacity; still, it is to the public’s benefit to have one in the market. But Hospital A starts running ads that they are the better hospital, because of the PET scanner.

    Hospital B starts losing patients. To respond to competition, Hospital B goes and buys a PET scanner – another $1,000,000 although now both machines are used only 20% of capacity. One machine could easily satisfy a market of this size, but because they are competing in the “free market” they each feel the need to spend $1,000,000 on their own PET scanner. That $2,000,000 has to come from somewhere, so the per night bed rate and all other day-to-day charges on all patients (few of whom use the PET scanner) goes up.

    Magnify this times dozens of types of equipment, specialists, etc. and it adds up quickly to massive over-expenditure based on the need for competitors in a free market to respond to one another. The only way to stop this would be to regulate such expenditures. (Which is, in fact, the only way to remedy market failures of most types — deregulation is not always a good idea.)

    I am not saying drug costs aren’t a huge part of it – Big Pharma and Big Insurance have each turned in big profits in the past several years – but there are a lot of reasons that are all in play and all adding up.

  • Very interesting stats. It would seem like a smart politician could make up some pie charts and get through to the average idiot that this is a problem that has to be solved and is killing way more people than alQaeda ever will.

    The biggest problem I see is that discussions require information. And the only large information portal (TV) is paid for in large part by the corporations which would take the largest hit by single-payer. How is a thorough discussion of the evils of big pharma going to happen when the commercials are largely for drugs? It’s not. Even PBS is compromised, they are sponsored by insurance companies.

    And which politician is going to cut themselves off from the drug and insurance money?

    All problems lead to one solution: Clean elections.

  • I have a brother-in-law who works in hospital billing. The cost of a clot-prevent blood-thinning drug to the patient is $3000. Does it costs that much for the Hospital to buy and dispense the drug? Nope.

    They have you by the balls. Do you want to live? Pony up $3000.

    It – is – as – simple – as – that.

    The hospital is shifting costs. With your $3000 pill, you are paying for the emergency room visit of some indigent person.

  • A local paper had a great article that was roughly tiltled, “Can you afford to survive a medical crisis?” While we may brag about the quality of healthcare in the US, I constantly hear of ill or injured people trying to avoid using it because of all the insurance hassles and expensive surprise bills.

    The cost is so out of line with what people can afford and yet while costs keep rising, no one seems to able to pinpoint what’s driving the increases in expense. It’s capitalism at its worst: everyone has a stake in the profits, but no one has a stake in the cure, except the patient. The problem with finding a solution is that for Republicans as long as someone is making money – there is no problem. The attack on entitlements and Bush’s “ownership society” BS couch the concept that if each us looks after only our own self-interests, we’ll be in better shape. Until that concept is thoroughly debunked, the the time for healthcare reform isn’t yet here — but it’s ripening.

  • “Well, it’s not like the Republicans care about those 45 million people.” – brunson

    Not if they can pass a voter fraud law that says you have to have proof of health care insurance to register and vote 😉

  • The shriek of “socialized medicine!” has worked for decades, so it’s going to take some doing to get past it. It seems that one objection to “socialized medicine” is that it would be plagued with bureaucracy and confusion. Excuse me, but standard insurance is NOT plagued with bureaucracy and confusion?

    Doctors and hospitals simply cannot afford to treat sick people anymore. The medical cabal, like the Defense Department, is out of control and sucking up far more money than it merits.

    I’m always darkly amused when I hear some say, “I have ‘good’ insurance.” Obviously we have a disparity, and ‘bad’ insurance is becoming more common.

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