Healthcare Should Be More Like McDonald’s
Imagine this scenario. As you hang in your driveway a large tree branch snaps and falls directly on top of you. You survive, kinda like an episode from the Oregon Trail, but need medical care. You think you’ve broken your arm. A broken arm, unless broken in multiple and unusual places, is pretty simple to treat from a medical standpoint. The arm needs to be isolated and prevented from moving so that the bone can heal and fuse back from whatever break exists. Ninety-percent of the time, that means a splint or cast. Yet, I bet, none of us know in advance, how much it will cost to treat the simple broken arm.
A quick check on google reveals countless stories of broken arm costs. $12,000 and counting here. $20,000 here. Granted both stories involve surgery and pins, but nothing out there in a 20 minute google search revealed a price list, national or local, that outlined what the cost of a broken arm should be. That is the underlying problem in healthcare right now. Despite all the talk about nationalizing healthcare, universal healthcare and free markets, no one is talking about the obvious flaw in how medical care is priced. You don’t know until you go, and rarely if ever, do you get an estimate for what that care could cost. In short, we don’t really have choice in healthcare once past the “choice” we make in health insurance provider.
Meanwhile, when it comes to nationalized health care, if you actually look at the numbers, we are pretty much there. Daniel Gross writes in a 2006 New York Times article that after looking at the numbers, we tax payers already pay for healthcare for about half of all U.S. workers. Is this right? He explains:
Out of a total population of about 300 million, 35.6 million elderly Americans were on Medicare in 2005. Of the working-age population, which reached 257.8 million in 2005, some 45.5 million were covered by Medicare, Medicaid or military health programs, according to the benefits institute. An additional 18.2 million workers had health insurance through jobs in the public sector, which includes state, federal and local governments, public schools and state universities, according to Paul Fronstin, director of the institute’s health research and education program. Millions of those workers’ dependents are covered as well. Even if those dependents are not included in the tally, taxpayers paid the bill for almost two-fifths of all Americans with insurance in 2005.
When you total up all these federal expenditures, you get the startling conclusion that government spending alone, exceeds the spending of nationalized healthcare programs in places like Canada, at least according to the experts quoted by Gross:
The government spends money as if there were a national health insurance program. In 2004, government spending on health care equaled 9.6 percent of the gross domestic product, compared with 6.9 percent in Canada, which has a single-payer universal health care program, said David Himmelstein, associate professor of medicine at Harvard Medical School. And yet some significant components of federal support are not efficient methods of providing health insurance to the people who most need it. Higher-income workers are likely to have higher rates of coverage, higher premiums and higher taxes, all of which means that the tax break for compensation disproportionately helps the well-off.
“We’re paying for national health insurance, but we’re not getting it,”¯ Dr. Himmelstein added.
So if the numbers don’t lie, the arguments for or against federalized healthcare are somewhat false. The better argument would be how to make what federal dollars we do spend obtain better results. So we’re paying for national healthcare already, yet aren’t getting any of the benefits of service, unless you are a senior or veteran.
The truth about the health debate is that healthcare costs are beyond the control of government as long as the present system of private insurance is used to pay for basic health care. There is no debate that serious health issues require the common good of shared costs distributed through some form of insurance. But basic care that includes things like broken bones, colds and flus, sprains and allergies should be delivered in more cost effective formats.
That’s why we really need to take a look at an industry that has figured out how to commoditize basic stuff, like food delivery. I don’t mean Walmart, but McDonald’s. Immediate medical care facilities that offer fixed price care for a menu of services. Fast, no waiting service and 24 hour service would fill the need to support people who have difficulty fitting in a visit to the doctor. The ability to refer more complicated cases that would invariably come in to other care givers whether hospital or private practice. Sure, there are more details to be sorted through, but the framework exists in other industries and once did for healthcare too. Manufacturing plants were once well aware that providing low cost on premise healthcare to its workers kept the plant productive.
But this scenario will not work as long as the payment for services trickles through the insurance middlemen. There is no incentive for health care providers to reduce costs when they have to play the game of filing paperwork in order to get paid, if they get paid. There is no incentive for patietns, that is you and me, to pick the most cost effective treatment because we don’t know what the treatment costs are.
The insurance industry should be required to pay bills submitted by any facility that posts a fixed fee for treatment immediately. Why not eliminate the administrative costs of the basic most routine care? Why force itemization of treatment on a broken arm?
Affordable basic care should be available to everyone, and under our health care insurance system its not and won’t be until the industry and government starts talking about how the consumer can see what the costs truly are. Under proposed health care reform, the cost of a broken arm is still unknown. That is a problem.
New York Times National Health Care? We’re Halfway There By DANIEL GROSS Published: December 3, 2006
