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Reforming the U.S. Healthcare System

Related Posts: Physician Salaries on the Decline

This quarter I’m taking a course called “Medicine and Ethics.” The class is taught by Dr. X. (name withheld). There are a number of topics that was scheduled to be discussed and each topic was presented by a group of 3 or 4 students. I ended up in a group of four. Our topic, as you can probably guess by the title of this post was “Reforming the American Medical System.”  

I wanted no part of this topic. I felt that the American Healthcare System is a mess but there’s not much we can do about it. I really wanted to be in the group that would present on physicians and war. But as Dr. X went down the list and waited for volunteers for each topic, it became clear that Reforming the U.S. Healthcare was not the popular one. No hands jumped up at the opportunity to tackle this problem… So I reluctantly raised my hand and said I’d join the group.

I had already heard that the United States spends more money than any other industrialized nation on healthcare. I had heard people complain that the Healthcare system in America is broken. But these were only things I heard. I, personally, had never had any problems accessing healthcare. And so when I actually looked at the stats, well, it was a bit surprising.

Some of the things I discovered in my casual research:

  • The United States is the only industrialized nation that does not have a form of Universal Healthcare.
  • The United States spends at least 40% more per capita than any other industrialized nation on healthcare.
  • The United States spends more than 3 times more per capita than Canada on Health Administration costs alone.
  • Almost 47 million Americans (approx. 16%) are without healthcare insurance.
  • Eight out of 10 uninsured Americans come from working families.

Those are some incredible numbers. And while only about 16% of Americans are uninsured, the majority of Americans with insurance are only one major medical emergency away from bankruptcy. Many are well-aware of how much is available to them under their health insurance policy. And, while it may be enough for your routine physical check-up or the occasional prescription medication, it is nowhere near enough to cover $40,000 that might be billed for cancer treatment.

Why is it that every other industrialized nation can provide healthcare to their citizens at a far lower cost than what Americans spend? Its a shame that the country that won the race to the moon cannot figure out how to ensure that every citizen has access to basic healthcare.

In my mind, there are two major roadblocks preventing the United States from transitioning to a Universal Healthcare system.

  1. Doctors
  2. Big Business

Physicians are afraid of the idea of Universal Healthcare and a single payer system. Why? Because they fear losing control. I believe that many physicians are afraid that a single payer system would negatively affect physician salaries. While it may be possible for the government to force down physician salaries in a single payer system, it is not in the best interest of the government or the nation to do so. If there was not financial benefit to being a physician, most countries would have a huge shortage of physicians. But, under the universal systems in other industrialized nations, physicians do make a decent, comfortable living.

The bloated health care system of the United States benefits big business more than any other party involved. It benefits big business more than physicians. But most concerning, it benefits big business more than the patient. As health insurance premiums continue to rise, insurance companies continue to pull in a profit while more and more Americans find out that can no longer afford coverage.

Greed drives the industry. The sole purpose of a corporation is not to look out for the interests of its customers and ensure customer satisfaction. The goal of a corporation is to make money for its shareholders.

And that is the problem with privatized healthcare. If a corporation begins to lose money, its shareholders get antsy. But when healthcare is federally funded, the government can take a loss for the good of its citizens.

Reforming the healthcare system will probably mean that the big corporations in the healthcare system won’t be making as much money. But America needs to decide, as a whole and through our leaders in congress, that the health of a nation is more important than the pocketbooks of corporations. Hopefully, we decide soon.


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  • Nancy

    “the health of a nation is more important than the pocketbooks of corporations”…you pretty much nailed it right there. Whether we talk about it or not, the problem of the state of healthcare really can’t be ignored anymore! Doctors are going to be getting budget cuts, and people who had to rely on programs like Medicare may not even get that treatment anymore. That’s why I’m working to support AARP in their petition to reform Medicare; go to http://www.thisissoridiculous.com and you can see videos and sign the petition. They even make it easy to write your Congressman and let him know how you feel. It’s time we are listened to!!

  • Nancy

    “the health of a nation is more important than the pocketbooks of corporations”…you pretty much nailed it right there. Whether we talk about it or not, the problem of the state of healthcare really can’t be ignored anymore! Doctors are going to be getting budget cuts, and people who had to rely on programs like Medicare may not even get that treatment anymore. That’s why I’m working to support AARP in their petition to reform Medicare; go to http://www.thisissoridiculous.com and you can see videos and sign the petition. They even make it easy to write your Congressman and let him know how you feel. It’s time we are listened to!!

  • http://www.JeffreyMD.com/ Jeff W

    Thanks, Nancy. I did come across that site while preparing for our Medicine and Ethics presentation. I appreciate you reminding me about it.

    It is definitely time we are listened to. It is embarrassing that the wealthiest nation in the world cannot figure out how to provide healthcare to its own citizens.

  • http://www.JeffreyMD.com Jeff W

    Thanks, Nancy. I did come across that site while preparing for our Medicine and Ethics presentation. I appreciate you reminding me about it.

    It is definitely time we are listened to. It is embarrassing that the wealthiest nation in the world cannot figure out how to provide healthcare to its own citizens.

  • http://thedermblog.com/ DermDoc

    Here, here. An insightful post. I am not sure that a single payer system is the way to go, but I applaud you for rightly pointing out that health care for all citizens ought to be an ideal for all physicians.

    -Another Jeffrey, MD

  • http://thedermblog.com DermDoc

    Here, here. An insightful post. I am not sure that a single payer system is the way to go, but I applaud you for rightly pointing out that health care for all citizens ought to be an ideal for all physicians.

    -Another Jeffrey, MD

  • http://www.JeffreyMD.com/ Jeff W

    Thanks, DermDoc. While I pretty much bashed our (America’s) current healthcare system, I don’t believe moving to a government funded single-payer system is the answer either. I think that the solution will have to be a hybridized system somewhere between the market driven system we have now and the universal healthcare system in place across the border to the north.

  • http://www.JeffreyMD.com Jeff W

    Thanks, DermDoc. While I pretty much bashed our (America’s) current healthcare system, I don’t believe moving to a government funded single-payer system is the answer either. I think that the solution will have to be a hybridized system somewhere between the market driven system we have now and the universal healthcare system in place across the border to the north.

  • http://www.frommedskool.com/ CT

    Good to see another medical student taking an interest in health policy.

    Despite the hopes you and I would share, I don’t think there is any doubt that any system with a global budget, funded through tax revenue will drive down physician reimbursement. American physicians (both in unadjusted dollars and as a ratio to the average household income) earn more than physicians in any OECD nation (see here).

    Certainly more than any physician in any country with a single payer or socialized medicine scheme. While America currently doesn’t enjoy a ‘free market’ system, the further and further government takes over as the payer in health care (they already make 40% of health care expenditures) the less and less leverage physicians will have to keep their fees high. Any single payer system will significantly drive down doc’s earnings.

    That isn’t, in entirety, a condemnation of either a single payer of socialized system. Maybe a cut in what physician’s make is a trade off that is worth making.

    In addition we need to realize that the consequences of lack of access to care (e.g. being uninsured), while devastating, are probably less than most alarmists believe. Consider that ALL of America’s discrepancy in infant mortality, as compared to the rest of the western world, can be explained completely by our increased number of LBW babies. These low birth weight kids in turn are largely attributable not to a lack of access to prenatal care but to lifestyle choices.

    I use that merely as an example to say that Americans simply live sicker lifestyles than the rest of the world. See here.

    Certainly, while not the major driving force behind our increased health care spending, it does play a part. It takes more money to care for sicker individuals (and Americans aren’t just sicker because they present later in the disease process).

    With that pet peeve laid out we must admit that improving access (through a single payer or socialized system) would almost certainly improve America’s health outcome measures (life span, infant mortality, cancer survival rates, etc) even though we might not achieve the same levels as western Europe.

    Those who would argue that single payer systems are somehow failing in the rest of the world are deluding themselves. Those systems certainly have draw backs (namely increased rationing) but all evidence seems to imply they improve population sized outcome measurements. The only real logical argument against them (and the one I subscribe to with my relatively libertarian mindset) is a philosophical one…and I’m not sure such an argument sits well with the American people.

    For instance:
    “Sorry you were diagnosed at Duke stage D, but we couldn’t take a few bucks from those living on the rich side of town in order to get you in to see a PCP and get you a regularly scheduled colonoscopy because…well, it’s their money and they really wanted that new big screen television.”

    Oh well, I’ll stick to my guns. Redistributing wealth for something as evanescent as a “right” to health care just isn’t appropriate.

  • http://www.frommedskool.com CT

    Good to see another medical student taking an interest in health policy.

    Despite the hopes you and I would share, I don’t think there is any doubt that any system with a global budget, funded through tax revenue will drive down physician reimbursement. American physicians (both in unadjusted dollars and as a ratio to the average household income) earn more than physicians in any OECD nation (see here).

    Certainly more than any physician in any country with a single payer or socialized medicine scheme. While America currently doesn’t enjoy a ‘free market’ system, the further and further government takes over as the payer in health care (they already make 40% of health care expenditures) the less and less leverage physicians will have to keep their fees high. Any single payer system will significantly drive down doc’s earnings.

    That isn’t, in entirety, a condemnation of either a single payer of socialized system. Maybe a cut in what physician’s make is a trade off that is worth making.

    In addition we need to realize that the consequences of lack of access to care (e.g. being uninsured), while devastating, are probably less than most alarmists believe. Consider that ALL of America’s discrepancy in infant mortality, as compared to the rest of the western world, can be explained completely by our increased number of LBW babies. These low birth weight kids in turn are largely attributable not to a lack of access to prenatal care but to lifestyle choices.

    I use that merely as an example to say that Americans simply live sicker lifestyles than the rest of the world. See here.

    Certainly, while not the major driving force behind our increased health care spending, it does play a part. It takes more money to care for sicker individuals (and Americans aren’t just sicker because they present later in the disease process).

    With that pet peeve laid out we must admit that improving access (through a single payer or socialized system) would almost certainly improve America’s health outcome measures (life span, infant mortality, cancer survival rates, etc) even though we might not achieve the same levels as western Europe.

    Those who would argue that single payer systems are somehow failing in the rest of the world are deluding themselves. Those systems certainly have draw backs (namely increased rationing) but all evidence seems to imply they improve population sized outcome measurements. The only real logical argument against them (and the one I subscribe to with my relatively libertarian mindset) is a philosophical one…and I’m not sure such an argument sits well with the American people.

    For instance:
    “Sorry you were diagnosed at Duke stage D, but we couldn’t take a few bucks from those living on the rich side of town in order to get you in to see a PCP and get you a regularly scheduled colonoscopy because…well, it’s their money and they really wanted that new big screen television.”

    Oh well, I’ll stick to my guns. Redistributing wealth for something as evanescent as a “right” to health care just isn’t appropriate.

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  • P2409

    HI Jeff
    I think you nailed it when you said “The only real logical argument against them (and the one I subscribe to
    with my relatively libertarian mindset) is a philosophical one…and I’m
    not sure such an argument sits well with the American people.”

    Despite living in a country (Australia) with good quality socialised medicine (well actually semi-socialised, there are public and private sectors, but the public is much bigger), I can see that keeping the system fair and efficient requires the right attitudes on all parties: Drs, the government, and society. What are these attitudes? Well on the part of Drs, I think the main two are: no back-breaking debt when you finish uni (fees are subsidised) and (the more important one): a very strong ethical standard in medicine that chasing money is bad. It’s professional suicide amongst the boards (colleges here) to be seen as a dollar doctor. Sure, it still happens, but you can’t have both: a reputation as an outstanding Dr, and a business aproach to medicine. On top of that, advertising is effectively banned in health. On the part of the government and society, I can sum up the attitude as follows: we cherish the public health system, because we know at any time, any of us could get sick. There are howls whenever anyone tries to tamper with the system (which is good and bad, but mostly good). It’s a bit like the UK, but we have a thriving private sector too. What do you get going private? Basically, exactly the same treatment, but a choice of Dr…that’s it. Medicines are subsidised by the govt., and the insurance companies have NO say whatsoever in clinical decision making. This of course relies on Drs not being greedy.
    So, in summary, our system works well for us, but I would be wary of adopting it in America…attitudes, not money or structure make it work or fail, and I think the attitudes in the US might be incompatible with public health. That’s the questons for Americans to address I think, I personally, I don’t believe they’re ready for it yet. But I would encourage all people in the US to have the debate: changing things will take a generation, starting with funding for medical schools – where the almighty dollar rules from the get-go because of educational debts.

  • P2409

    By the way, on salaries, Drs here are very well paid in Australia: a bit more than in the US I understand (I think the average pay is about $200K for a general practitioner). If I had to guess why, I’d say more money goes to Drs and clinical costs and less to litigation or defensive medicine….so good pay and a social health system are not incompatible! But my point still stands, you can’t have socialised medicine without the right attitudes in ALL stakeholders.

  • http://www.jeffreymd.com Jeff W

    Hi Pete,

    The portion you quoted was not actually written by me. It was a comment written by CT.