[lit-ideas] Re: The flu

> The thing that I don't understand at all, is how you
> can spend that much on healthcare and still not have
> universal coverage?

ck: I hope some thinktank is working on this one. In the meantime, I'll
proffer a few guesses related to corrupt fat cats, lack of regulation, and a
astonishing amount of unchecked greed. For one thing, prescription drugs in
the US are more expensive than anywhere else in the world. (How much more?
Double, triple, etc. Depends on the drug.) Other factors are the extremely
well-nourished insuranceb(health and liability) and pharmaceutical
industries themselves, which enter into the overall healthcare costs in many
studies.

The issue of health insurance coverage used to be separate from actual
healthcare in the US, to some extent. That distinction collapsed in the
early 1980s, with the advent of health maintenance organizations. Many
people used to pay out-of-pocket for a doctor's visit and prescription
drugs. The wealthiest people in the US still do that, eschewing health
insurance. (By contrast, my parents were middle-class, never had health
insurance, and didn't seem to lack for health care as needed. I didn't have
health insurance either...)

In pondering my answer to Teemu's question, I'm realizing that I really
don't know why health care costs are so high. Paul Starr's book, "The
Transformation of Modern Medicine," did a pretty good job of explaining how
medicine was practiced and paid for in the US, to the brink of the 1980s.

But some pretty serious economic diddling went on in the early 1990s, and
suddenly I was among the 45 million Americans who were deemed "uninsurable"
because of an underlying health condition. More to the point, a visit to the
doctor, with standard lab work, cost me $800--compared to the $50 to $100
I'd been used to paying. And the costs have been uphill since then. (Same
with dentistry, only more so. Nice-looking, functional teeth in middle age
will soon be a status symbol, if it isn't already.)

But why have MDs raised their rates so dramatically? Why can't MDs afford to
maintain small private practices the way they used to--and as many still
want? True, some technological advances are awfully expensive...Okay, why
so? (Why should an in-office ultrasound cost a patient more than a few
bucks, for instance?)  What's really driving up US health costs, such that
unwealthy, uninsured people aren't fixed up for nominal costs--or at
all--when they have lower-tech infections or broken bones? Somehow, I don't
think the real answers are all that fancy.
Best,
Carol




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