None of the Republican bluster about health care is true. While no one argues that our dysfunctional non-system needs change, their solutions are not based in reality.
First, the idea that competition – free market principles of supply and demand – will lower cost is fallacious. Yes, “the market always wins,” but not in health care. When you are considering whether to buy a hamburger from McDonald’s or Wendy’s, the supplier, you, the demander, decides which store to buy it from based on knowing the quality of the product, its cost and that you have enough money to pay for it.
In a health care encounter your provider, the supplier, not you, the demander, is the decider. You know little about the quality of the product or even if what you are advised is correct or necessary. Neither you nor your provider know the cost, what you will be billed, whether your insurance – if you have it – will pay, and what a deductible might be. In most cases your insurance plan, not you, chose the doctor or hospital you see. Furthermore, most health care encounters are not planned, but are emergent, and in that moment you don’t choose on cost, or even care about the cost.
The private sector has recognized the opportunity for profit in health care, and now one-third of hospitals and one half of physicians are owned by corporations and venture capitalists. Health care stocks are the darlings of Wall Street. Following usual business practices of buying and then shutting down competitors, they have created monopolies, which guarantee they can set a profitable price for their product. Competition cannot lower cost because there is no competition.
Second, the notion that 180 million employees are happy with their employer-based health insurance may have been true when there was first-dollar coverage, but not any longer. Today all plans have large deductibles; employers frequently change plans meaning the employee may have to change their doctor; you may have to see a doctor who is not in your health plan and pay out of pocket; the employee is subject to “job lock” as they may have to stay in a job they don’t like just to keep their health insurance; and it is becoming clear that the high cost of employer-based health insurance affects the ability of a company to raise employee salaries.
The third fallacy is “I want to choose my own doctor.” The truth is that your employer chooses your health plan, and the health plan then assigns you to a doctor or you are asked to choose from a list on which most established or well-known doctors’ practices are closed and you have limited, if any, choice. When you are hospitalized there is no choice at all. You will be admitted by the on-call doctor and then see a different doctor each shift. Not to say that is bad, but it puts (the) lie to “choose my own doctor.”
The root problem with our health care is its cost which impacts access and quality. The high cost means millions of people cannot afford to seek care or they delay care until late in an illness. It is a leading cause of personal bankruptcy. Our health care may be the best in the world, but only if you can afford it. A discussion of possible solutions is much too lengthy for an op-ed, but it must address the causes of the high cost; acknowledge that health care is a universal right; make sure everyone “has skin in the game” – pays something; and have the government involved since it pays 70% of its $3 trillion annual cost.
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November 30, 2020 at 02:05PM
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Busting the myth of the ‘free market’ health care system - Albuquerque Journal
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