WHY IS HEALTHCARE SO EXPENSIVE IN THE USA?

Part One

A few days ago I came across a video entitled, The Real Reason American Healthcare is So Expensive. Almost 3 million people have watched it, You really should, too.

The Real Reason American Healthcare is So Expensive

In typing this just now, I couldn't help watching it again -- which made it my fourth time viewing it (it's that good).  What it shows is that the high cost of healthcare in this country is NOT because of what we spend on Medicare, Medicaid, and VA healthcare -- our versions of socialized medicine in this country. In those public expenditures, our costs are right in line with other countries. Where we exceed them is what we spend privately. That's where we go through the roof.

I love the enthusiasm of the young man in the video, who says he's "obsessed" with this data. He points out that we hear all the time that the government "can't say no, it's corrupt, it's inefficient, it's slow; if you want something done right you give it to the private sector. That is what we hear in America all the time," he says, "yet here we are, with the biggest private sector, spending the most."  And it's not because we Americans go to the doctor more, he says, showing that if anything, we go less. He goes on to state the obvious, that the capitalist free-market model, while it may be great for selling things, simply cannot work when providing healthcare to people, who, when they need it, are in no position to comparison shop for the best value, even if they knew the best thing to shop for. And when presented with a sky-high cost , they are in no position to say "no." We are left with a graphic of our healthcare system -- symbolized by a huge hospital building with many lines of "influence" running from it to the Capitol Building in Washington, DC,  Although there are no arrows to show in which direction the lines of "influence" are flowing, and the young man doesn't say so explicitly, I gather that they are flowing not from the Capitol, but to the Capitol, and that influence is in the form of dollars. Our healthcare system has grown so powerfully wealthy, he says, that it's going to be very hard to trim the cost of doctors and the services and medicines they prescribe. 

It's almost as if there has descended on us, like a poisonous fog, a culture of money, a phrase I borrowed from Atul Gawande's famous New Yorker article, The Cost Conundrum. You should read it: 

The Cost Conundrum

Here Gawande describes the medical goings-on in the small, not-very-prosperous McAllen Texas, which had -- at the time of Gawande's writing (2009) -- the most expensive healthcare market in the country. Many healthcare markets -- such as El Paso -- were far more prosperous yet spent on medical costs only half the money spent in McAllen. With all this money spent in McAllen, one might suppose that the healthcare delivered there was superior. Not so -- in fact, Gawande reports the reverse: 

"Medicare ranks hospitals on twenty-five metrics of care. On all but two of these, McAllen’s five largest hospitals performed worse, on average, than El Paso’s. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it’s delivering better health care."

Why then? Gawande quotes a general surgeon: "'We all know....there is overutilization here, pure and simple.' Doctors, he said. were racking up charges with extra tests, services and procedures."  It got to the point, he said, where “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?”

Gawande contrasts all this with the practice at Mayo clinic, where doctors are not paid by procedure, but are salaried. The time they spend with patients is not a predetermined slot of 15 minutes,but is determined by the patient's need. And they regularly consult with other doctors in the practice, so that the outcome is a joint effort. Gawande writes that "No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs." 

It's no accident that in my recent posting [Good News ... Sort Of], Mayo is one of the hospitals cited for combining with others to establish CIVICA RX, a company which will produce generic medicines that the current cartel has attempted to price out of reach of many people. Intermountain Healthcare, also cited by Gawande for good practice, is another co-founder of Civica. Are they exceptions? As far back as 2009, Gawande pessimistically predicted that the Mayo Model seemed to be losing traction, whereas the McAllen model seemed to be winning.

Despite the remarkable surge in demand for Single-Payer, it may be too soon to tell which model will win. As we saw in the video above, Bernie Sanders proposes a transition plan to ease us into a full scale Single-Payer, but from my point of view, the crucial question will be whether or not Bernie or anyone else can succeed in putting price controls on Big Pharma. That is the epic struggle to come. Meanwhile, NYHA has such controls written into it, and it behooves us to push for it, publicize it, and do everything we can to hasten the day when Single-Payer will be the law -- if not of our country, then of our State.

PS: If you'd like to leave a comment -- and I hope you will -- just click on the number of comments area and share your thoughts in the "comment box" that appears.

PPS: My surgery went well, and I'm doing fine. But an amusing thing happened. I heard one nurse comment to another that the downside for working for an eye surgeon is that while before surgery, some patients mention how nice looking they are,  they hear no such remarks after surgery, when the patients can see. And on a more serious note, both doctors present said Single-Payer was "inevitable."  More on that later, perhaps.