Health Care in America

People say, “We have the best healthcare system in the world”.
The fact is Healthcare in the U.S. is about twice as expensive as it is in any other developed country. Even though the US spends $3 trillion on healthcare, the World Health Organization ranked the U.S. 37th in healthcare systems, and The Commonwealth Fund placed the U.S. last among the top 11 industrialized countries in overall healthcare.
Why do residents of the U.S. pay more for healthcare and are rank last?

  1. Administrative Costs are one quarter of healthcare costs. Running our healthcare system far higher than in any other country. A 900 bed hospital employs 1,300 billing clerks to deal with multiple insurers. Countries with a single-payer system don’t incur this level of administrative costs.
  2. Drug Costs are higher in the U.S. In most countries, the government negotiates drug prices with the drug makers. When Congress created Medicare Part D, it specifically denied Medicare the right to use its power to negotiate drug prices. The Veteran’s Administration and Medicaid, which can negotiate drug prices, pay the lowest drug prices.
  3. Defensive Medicine drives the higher cost of U.S. health insurance. Doctors are afraid they will get sued, so they order multiple tests even when they are certain they know what the diagnosis is. Everyone pays the bill on this with higher insurance premiums, co-pays, and out-of-pocket costs, as well as taxes that go toward paying for governmental healthcare programs.
  4. Expensive Mix of Treatments used by U.S. medical practitioners who also tend to use a more expensive mix of treatments. People in the U.S. are treated by specialists, whose fees are higher than primary-care doctors when the same types of treatments are done at the primary-care level in other countries. Specialists command higher pay, which drives up the costs for everyone.
    5.Wages and Work Rules drive up costs in healthcare. Specialists are commanding high reimbursements, and the over-utilization of specialists through the current process of referral decision-making drives health costs even higher.
  5. Branding “There is no such thing as a legitimate price for anything in healthcare,” says George Halvorson, the former chairman of health maintenance organization Kaiser Permanente. “Prices are made up depending on who the payer is.”Providers who can demand the highest prices are the ones who create a brand everyone wants. “In some markets, the prestigious medical institutions can name their price.”
    The Affordable Care Act (ACA) has pushed back to some degree against the high costs created by branding. In central Florida, for example, one of the top brands is Florida Hospital. In 2018, ACA policies offered by Humana did not include services provided by this brand. Similar types of contract negotiations knocked out top hospitals in other locations. It remains to be seen whether this will cause those hospitals to reduce prices to get those patients back.
    The Bottom Line
    Most other developed countries control costs, in part, by having the government play a stronger role in negotiating prices for healthcare. Their healthcare systems don’t require the high administrative costs that drive up pricing in the U.S. As the global overseers of their country’s systems, these governments have the ability to negotiate lower drug, medical equipment and hospital costs. They can influence the mix of treatments used and patients’ ability to go to specialists or seek more expensive treatments.
    So far in the U.S., there has been a lack of political support for the government taking a larger role in controlling healthcare costs. The Affordable Care Act focused on ensuring access to healthcare but maintained the status quo to encourage competition among insurers and healthcare providers. This means there will be multiple payers for the services and less control over negotiated pricing from providers of healthcare services.

Democratic Candidates are Currently laying out their Healthcare Plans. Here are a few definitions that might be helpful.
Medicare is the federal government program that provides health care coverage (health insurance) if you are 65+, under 65 and receiving Social Security Disability Insurance (SSDI) for a certain amount of time, or under 65 and with End-Stage Renal Disease (ESRD). The program is funded in part by Social Security and Medicare taxes you pay on your income, in part through premiums that people with Medicare pay, and in part by the federal budget.Once you enroll, you can choose to get your Medicare benefits from Original Medicare, the traditional fee-for-service program offered directly through the federal government, or from a Medicare Advantage Plan, a type of private insurance offered by companies that contract with Medicare (the federal government). Original Medicare includes: Part A (Inpatient/hospital coverage) Part B (Outpatient/medical coverage) If you want Medicare prescription drug coverage (Part D) with Original Medicare, in most cases you will need to actively choose and join a stand-alone Medicare private drug plan (PDP).
Medicaid is the nation’s public health insurance program for people with low income. The Medicaid program covers 1 in 5 low-income Americans, including many with complex and costly needs for care. The program is the principal source of long-term care coverage for Americans.

Medicare For All Act Of 2019 Congress unveiled details of a “Medicare for All Act of 2019” on Feb. 27th, which would create a new federally financed health system. Medicare For All gets rid of debilitating premiums, deductibles and copays, and eliminates crippling out-of-pocket expenses. The bill provides real freedom of choice — with coverage good at any hospital, outpatient clinic, surgery center, physician, lab and any other provider. The bill proposes a simplified healthcare system by moving to a single-payer model, as Congress continues to feel pressure to take action on cutting healthcare costs.
Single-payer healthcare is a type of universal healthcare financed by taxes that covers the costs of essential healthcare for all residents, with costs covered by a single public system (hence ‘single-payer’).
Universal Healthcare is extremely complicated…this website has much information.
-Judith Matherne