Top Ten Reasons the U.S. Health Care System Sucks

Last week, I got a heavy dose of the latest health care news at the Conference on World Affairs at the University of Colorado. The panel was titled “The Path to Universal Healthcare.” The panelists were: Dr. Susan Love, Val Koromzay, Michael Franc, and Evelyn Resh.

Photo by PhOtOnQuAnTiQuE

Here are the questions and the answers:

10. What’s the public good got to do with it? The purpose of a public health care system, you may be surprised to learn, is to serve the public good not the good of health insurers, doctors, hospitals, drug companies, or the very wealthy. The public good is likely to be the last thing served by our health care system.

9. Why isn’t more better? We have too much health care, too many operations, and are on too many drugs, according to doctor and best selling author Susan Love. “So it’s not just the poor who are getting screwed,” according to Dr. Love, “it’s the people with really good insurance that are getting taken to the cleaners.” “Part of the reason is that the economic incentives are all wrong. All the economic incentives are to do. I’m a surgeon, we get paid only if we surge, we don’t get paid to tell you you don’t need an operation. If you’re a radiation therapist you give radiation, if you’re a medical oncologist you give chemo. We give more chemo than any other country for breast cancer and our outcomes are no better.” “All of the incentives are to do more and we as Americans think more is always better and therefore we’re happy to have more.” Most medical problems disappear if nothing is done. Making lots of money for hospitals and doctors does not equate with quality health care for patients.


8. Why does free medical school buy better doctors? Medical school is paid for by the state in almost every country but this one. Thus medical students outside the U.S. graduate without financial debt and owe a debt of gratitude to the public and therefore are more likely to want to serve the public good. Inside the U.S., the opposite is true.


photo by celestehodges


7. Why don’t Americans get the health care they pay for? Because the money we pay for health care goes to insurance companies. Administrative expenses for health care, costs us almost 12 times more than they cost the French. Out of every $100 Americans pay for health care, $35 goes to administrative expenses. What do Americans get for all that money? You get a system of competing insurance carriers paying big salaries to insurance executives to sell policies and you get staffs of lawyers to fight insurance claims and devise contracts that shift health care costs back to the public. “According to Mike Franc of the politically conservative Heritage Foundation, “People have horror stories about insurance companies for a reason.”

6. Why don’t we have the holy grail of health care coverage too? Unlike most other countries, the U.S. lacks a standard health insurance contract which lets you and your doctor know what coverage you have and don’t have. Under the American system the only way to truly know if your illness will be covered by your insurance coverage is to submit a claim and see if it’s paid. “The standard contract may be the holy grail for Universal Health Insurance,” says Val Koromzay, former Director, Country Studies Branch, Economics Department, OECD. In Switzerland, he says, all insurers are obliged to offer a standard contract to anyone who wants it. If you can’t afford the contract, it’s subsidized by the government. Insurers can’t make a profit on the standard contract but can sell supplemental policies at a premium. That’s what the Swiss system does, it’s expensive but no where near as costly as health care in the good old U.S.A.


photo by PhOtOnQuAnTiQuE


5. Do we even have a public health care system? In a word, no. “Public health is rooted and based in prevention and health education,” says nurse midwife Evelyn Resh who has a masters degree in public health and is the director of Sexual Health Services at Canyon Ranch. Because public health in the U.S. is not based on prevention and education, according to Resh and Love: “there is no public health care system in this country.”

4. Why can’t you blame medical doctors when they blow it? The medical profession and AMA is against electronic medical records and the reason is that it will allow for accountability, says Dr. Love. “Because the big secret in this country is that we have no accountability in health care. Medical practices are a cottage industry. When you get your M.D. you can do whatever you want, to whoever you want, and charge whatever you want, and you’ll get paid for it. There’s no accountability whatsoever in the health care system in this country. If we had electronic medical records then we would be able to have accountability. Doctors are very afraid that people will be looking over their shoulder and figuring out that they don’t know what they’re doing.” “Accountability would be a huge benefit if we had electronic medical records.”

3. What is the best way to ration medical care? All countries ration health care. Medical doctors in the U.S. ration it based on price. If you can’t pay you don’t get it. Other countries ration health care based on waiting lists. Love and Resh believe that rationing health care based on a waiting list makes some sense because most illnesses resolve themselves with time and eliminate the need for costly medical procedures. Dr. Love believes comparative effectiveness research is as good a way to ration health care as any. “So really,” she says, “look at what’s been shown to work and what doesn’t. A lot of what we do as surgeons has been shown not to work, but that doesn’t stop us.”

photo by Barack Obama

2. Why do new medical technologies make us poorer but no healthier? The main reason health care costs are out of control in the U.S. is that the cost of new technologies are so high. Although you’ll pay for these new technologies in your insurance premiums, they’re unlikely to improve your health because they’re designed to help only a few very very sick people. But they make the financial statements at hospitals, doctors offices, and drug companies healthier.

1. Why is shutting off the lights so costly? A relatively large portion of health care dollars is spent on the elderly in their last six months of life. Maybe it’s because doctors have a financial incentive to keep patients alive at all costs. Or maybe it’s because doctors don’t want to have the hard talk with their patients’ families and tell them the final curtain is near, so money is poured down the tube, many tubes really.