Here's an
interesting article I read earlier this year in regards to the issues UK migrants to the USA have in dealing with the US medical system etc.
This our healthcare system in a nutshell:
Gray, on his employer-provided health insurance, needed a US doctor for a checkup. A colleague recommended a doctor’s office housed in “a really grand building on Fifth Avenue in Manhattan. Full floor, incredible views – it looked like a movie version of a New York doctor’s,” he says. “It was just about the friendliest, fanciest place I’d ever been.”
A chatty, relaxed doctor and a glamorous receptionist greeted him on that visit. Though the office was devoted to plastic surgery – the shelves replete with cosmetics, glossy leaflets about Botox treatments and dermal fillers – they treated Gray.
A year later, the reception he received was quite literally chilly. Gray, suffering from a chest infection, cold, exhausted and weak, headed out in a snowstorm and stumbled along to the same doctor’s office.
When he handed over his insurance card, the receptionist’s dazzling smile faded. His employer had changed healthcare providers without Gray’s knowing it. “Sliding the new card back across the desk, she said ‘this is not insurance we accept.’ She turned away. Sixty seconds later I was back out in the snow, bent over double coughing,” Gray says.
Got access? It's like nothing you've ever seen. Take a guess who has access and votes?
Don't have access, its bad. Real bad. Take a guess who doesn't have access and doesn't vote?
As a doc, I will tell you that our insurance system is a pain and it prevents me from making easy choices to treat my patients.
I am not a subspecialist, so the system does not enrich me either. I hate it at a professional level. I have enough money that the system is accessible for me. I get great care, fast care, amazing care. This does not work a population level.
In my world, I'd give everyone medicare (government insurance plan currently free for those 65 and up). Medicare is the base insurance that private insurance pegs there reimbursement against. Then for anything additional or fancy, you can buy supplemental coverage (ie cheaper access to name brand prescriptions). This is how everyone in our country over the age of 65 already does healthcare. Safety net for all. Buy some extra coverage if you want to. Nobody goes without.
Medicare has a lower administrative costs than private insurance too.
We looked at several options for insurance as a country during the "obamacare" debates.
- medicare for all -- roundly rejected as being too far left. It was a non started.
- non-profit insurance entities that would be subsidized by the government. Not free. But cheaper. Think post office and private insurance is Fedex. Republicans said this would be bad because the private companies couldn't compete against this unfair advantage (personal note: who gives a fuck, we are talking healthcare outcomes as the goal)
- Subsidies for middle class and would be administered via private insurance companies. This is what got passed.
So now we have this new law that does a few major things. It says everyone has to buy insurance. It says insurance companies can and can't do certain things. It creates flat premade tiers of healthcare plans so that you can shop apples to apples online and no the fine print isn't hiding anything. It gives subsidies to help lower the cost of your insurance. It gives incentives via taxes and penalties to REMOVE insurance from being linked to your job. It gives incentives for hospital systems to buy up all the surrounding clinics and then eventually start their own insurance company creating horizontal and vertical monopolies of geographic area. This last one is where I, as a physician, am very unhappy. Its all a corporate and insurance handout that will stifle patient choice and will get walmart and CVS into the insurance game. Hospitals will quit bankrupting people, but clinic access will be more "retail" based in that the costs won't be covered by the insurance in a lot of cases. This forces the patient to make some consumer type choices. The idea is somehow that will "lower cost and make it transparent" (indeed, cost in our system is rather random and all fucked up", but what will probably happen is that patients won't go to the doctor more than they MUST and you will lose the benefit of preventative care.
So the current grand experiment is going on. But we didn't pass universal coverage. We passed an insurance regulation bill.