The Doctor Won't See You Now

"People don't eat in the long run, they eat every day."  That Hopkins quote is, in a nutshell, why I supported Obamacare.  It did  not solve the increasingly stark problems of medical care in the US, but it made improvements in the insurance system that are already proving for some many Americans to be the difference between getting medical care and not getting it, and therefore, between health and pain, between life and death.

But the successes of driving a stake in the heart of the worst private insurance excesses (like "pre-existing conditions") and making insurance available and more affordable to more people haven't driven the utter insanity out of the system.  Some of the less publicized reforms--in efficiencies and so on--may eventually make some difference.  But the basic system is still out of kilter, and very onerous.

One simple but massive disproportion: There are now diagnostic and treatment methods using expensive technology that didn't exist a generation ago.  According to the true cost of using this technology and the time of skilled personnel, one would expect them to be more expensive, and even "expensive" relative to other costs and income.

But one would expect that procedures that are simpler, that don't require these technologies, would be cheaper--that is, affordable, as they were before.  But mostly they are not.  In America, absolutely anything that requires hospitalization, and almost anything that requires a physician, is impossibly expensive.  What was once a relatively minor illness or injury can easily become financially ruinous.  In this respect and others, affordable medical care for many in America has deteriorated from what it was 40 or 60 years ago.

The cost of medical care to patients has gone up faster than most peoples' incomes, and this has been going on for so long that the disproportion is extreme.  And that's for people with insurance.

Opponents of Obamacare from the left called for a public system dubbed "Medicare for all."  In the debate before the Obama bill was written, I favored this alternative.  But I knew then and I certainly know now that even this is not the solution.  Relative to what recipients receive in Social Security, Medicare is expensive insurance.  It is not free--the part that covers doctors costs in the neighborhood of 15 to 20% of an average Social Security monthly payment.  And there are deductibles and copays, just as in private insurance.  And there are enough holes in coverage that supplemental insurance is a big business (with the usual fraud we've come to expect from insurance companies.)

Moreover, between the machinations of private health care companies contracting with Medicare, and the bureaucracy of Medicare itself,  getting care is at least a part-time job.  And not a nice one.  It's a lot to ask of people who are old and sick as well.

Add to that the tests and procedures that aren't needed, but that involve time, expense and anxiety:

"In 2010, the Institute of Medicine issued a report stating that waste accounted for thirty per cent of health-care spending, or some seven hundred and fifty billion dollars a year, which was more than our nation’s entire budget for K-12 education. The report found that higher prices, administrative expenses, and fraud accounted for almost half of this waste. Bigger than any of those, however, was the amount spent on unnecessary health-care services. Now a far more detailed study confirmed that such waste was pervasive...

Virtually every family in the country, the research indicates, has been subject to overtesting and overtreatment in one form or another. The costs appear to take thousands of dollars out of the paychecks of every household each year. Researchers have come to refer to financial as well as physical “toxicities” of inappropriate care—including reduced spending on food, clothing, education, and shelter. Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm."

This hodgepodge of systems has roiled the world of physicians, clotted their hours with paperwork and thrown everything into chaos.  The money involved means that physicians are clustered in high income urban areas, and leaving places like Humboldt County in droves--there just aren't enough rich people here to make up the low income from Medicare and programs for the non-rich.  The number and proportion of doctors who will not see Medicare patients also seem to be increasing.

Getting sick or injured is always a crapshoot, and so is getting the right medical care for it, especially in proportion to your wealth.  The odds are increasingly against.