Why Socialized Medicine Makes Sense: The System

Here in the United States of America we have free enterprise in every conceivable area, even when it is not appropriate. Medicine is one of those inappropriate areas.

Why is medicine an inappropriate sector for "free enterprise"? Let's look at the system.

Rich people don't have (or see) the problem. I'm just a whiner to them. They have enough money to go to any provider, seek any treatment, try any drug. Their only real problems are those that money can't solve. People who don't have enough money, must have some moral failing that keeps them poor; thus, they deserve all the adversity that comes their way.

Then there are the folks in the middle.  

We earn enough to buy medical insurance from my husband's employer. Essentially, that means we make enough money to pay about $600 each month toward medical expenses, on top of any car or house payments and living expenses. That's a hefty bill, and not one everyone can afford.

Because we can afford this health coverage, there are times we think we can afford to go to a doctor, when really we cannot.  Last year, the four of us went to the dentist. Four sets of x-rays, check-ups and tooth-cleaning came to about $1200. I was appalled that it cost this much. To make matters more interesting, our dental plan only covered part of the cost, leaving us responsible for the rest. An example of what "the rest" included: $22 each for a fluoride rinse after having our teeth cleaned. 

We had used an "in-network" dentist on the approved list of dentists. Our old dentist was not on that list, and consequently, the cost of seeing him became prohibitive. Our dentist was balance-billing, which is unethical, as well as a violation of the contract with our plan administrator. So long as we and everyone else pulled out our flex and credit cards without asking questions, they were getting away with it.*

I call this kind of trouble "the shell game." There are lists, schedules, networks, coverages, exclusions, and formularies, and besides everything else in your life, you are supposed to know who to go to, what to let them provide, what drugs are and are not covered, usual and customary charges, and on into the sunset. . . which of course no one can do, and so the docs and the insurance simply siphon away more money each year, while providing less and less. 

Think about it. For $7200 per year, a family of four healthy people ought to be able to pay their own medical bills. And we would, except that my husband and I are prime heart-attack age. One major medical emergency can destroy in a day or two the work of decades. A typical heart attack without bypass surgery can cost $150,000. God bless you if you need open-heart surgery. We cannot afford to jeopardize the tiny net worth we have built up over the last 22 years. So we pay the premiums. 

Then there's the poor folk:

There was a time when we had to choose between having a dependable vehicle and health insurance. Everytime there was some sort of serious medical problem, there were payments and bill collectors for months or years afterward. Lots of people are in this boat. They go to the emergency room at the local hospital, and walk away from the bill.

These same people do not take care of their health in ways that lead to more disease, and more need for healthcare; they neglect their teeth, don't get screened for cancers, don't get annual check-ups. As they age, if they don't change their approach to health care, they will become part of the 20% of people who consume 80% of health care services.  

Every time one of these people walks away from a medical bill, the cost of doing business with the hospital or doctor goes up for everyone else. A broken wrist costs $20,000. Twenty minutes in a dry whirlpool for the same wrist costs $100. That is $5 per minute! What is wrong with this picture?

The problem does not lie with the patients. The problem lies with insurers and providers.

Providers will freely admit that they consider past-due bills to be loans and think they should bear interest. So-called charity (non-profit) hospitals are in business to stay in business and improve market share.**  Do not be fooled. The purpose of almost every non-profit entity is to stay in business and provide jobs for its principals. 

Insurers and "plan administrators" pressure providers for the purpose of cutting costs. They create their forms and lists and schedules and send them to everyone. The language is purposely confusing. If you answer the questions wrong, they pay out less. The less they pay out, the more profit they can report to their shareholders (and pocket). The snowstorm of papers that every doctor visit generates is intimidating and complicated, and it is meant to be that way. Divide and confuse. 

 The healthcare system in this country is not about medicine; it is about profit. Doctors get sucked into the vicious cycle of having to support a huge staff to service enough patients to pay the bills, live, and pay the malpractice premiums we all hear so much about. The trouble with the system is that it should be about health. 

Next: Why socialized medicine isn't the big bad boogie man they tell you it is. 

 *We figured it out and went to the plan administrator, who is now auditing the dentist's accounts with the other 800 employees in the plan. We received a refund of something over $100. I believe it may be time to pass the Tums.

**My friend, formerly employed at the local charity hospital, calls the nuns who administer the facility the "Sisters of Perpetual Greed."