Tuesday, June 16, 2009

The US Healthcare system is like the US Automobile industry

People spend a lot of time arguing about whether or not there should be a single payer system or not - whether a public option is a requirement or treasonous. Yet, at a far more fundamental level, the US healthcare system is increasingly failing. The system is Balkanized, with each constituency only out for itself. The parts of the system do not work together to serve the consumer. If they made a movie about the fall of the US automotive industry, the UAW could be played by the AMA, GM Management by the insurance companies, dealers by hospitals, and parts suppliers by drug companies. The consumer would play the consumer.

Medical records are routinely lost. More money is spent denying claims and turning down health insurance applicants than providing care for many. Patients are routinely given drugs or treatments which have harmful or dangerous effects on each other. Many patients will see over ten specialists but no one has an overview of the process - doctors are incented to refer rather than to treat. There is substantial evidence that because of this, and the propensity to order unnecessary tests, the more that is spent per patient, the worse the outcome. The system rewards inefficiency and ineffectiveness. Unless something is done, it will only get worse.

The wosh for universal healthcare has existed since Teddy Roosevelt. Harry Truman ran up against the rocks trying to make it happen. Saddest of all is that no one has even been able to get efficiency and effectiveness within the existing system.

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