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Brain -> RE: HEALTH CARE (8/2/2009 6:04:30 PM)
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Can the US President save the patient? - Telegraph
AMERICAN health care has always been a bit of mystery to the rest of the developed world. Just why does the richest country on earth have an immunisation rate worse than Botswana's? Why do 38 other countries have lower infant mortality rates? And why are there 47 million people out of a population of 300 million without medical insurance?
Barack Obama, perhaps unwittingly, turned to Alice in Wonderland to try to explain the issue to his public, which can find the system as confusing as the rest of us.
"If there's a blue pill and a red pill and the blue pill is half the price of the red pill and works just as well, why not pay half price for the thing that's going to make you well?" he asked, before providing part of the answer. "The system right now doesn't incentivise that."
American doctors tend to prescribe the expensive pill because they are paid more to do so. They may also be over-inclined to remove tonsils, as the President highlighted, because "the doctor may look at the reimbursement system and say to himself, 'You know what, I make a lot more money if I take this kid's tonsils out'."
As a consequence, costs have soared into the realms of fantasy: a sixth of the US economy, $2.4 trillion (£1.45 trillion), was spent on health last year.
The Democrats, however, scored a significant victory in 1964 when President Lyndon Johnson, exploiting the mass sympathy created by John F Kennedy's assassination, managed to push through Medicare and Medicaid, two programmes that belie the myth that there is no free care in the US. In fact, all those over 65 are covered by Medicare, while Medicaid covers about 40 per cent of the poor, most of them children. Another scheme, the State Children's Health Insurance Program, assists children from families of modest income who earn too much for Medicaid. Hospital emergency rooms are also obliged to treat anyone who walks in, no matter how trivial the complaint. As a result they are always packed with sore throats and ankle sprains.
In the boom years, the system worked well – it still does, in fact, from many patients' point of view. It represented the best of America: dynamic, entrepreneurial and driven by consumer needs rather than the diktats of central authority. Now its bad elements have come to represent the worst: bloated, excessive, over-driven by profit and mired in bureaucracy.
In the boom years, the system worked well – it still does, in fact, from many patients' point of view. It represented the best of America: dynamic, entrepreneurial and driven by consumer needs rather than the diktats of central authority. Now its bad elements have come to represent the worst: bloated, excessive, over-driven by profit and mired in bureaucracy.
The US spends an annual $6,000 more per capita than any other industrialised nation on health care, but by almost every measure, its people are unhealthier. The reasons are manifold: insurance is not mandatory, so for a decade premiums for those who do want to be covered have risen three times faster than wages. Rapidly emerging new technologies have driven up costs, while doctors, as the President noted, are rewarded for services provided and not for the health of their patients.
Perhaps the biggest long-term obstacle to bringing down America's exorbitant bills is the attitude of the patients themselves. In a very un-British way, Americans expect the best and the shiniest from their medical providers, without fail.
http://www.telegraph.co.uk/comment/5896153/Can-the-US-President-save-the-patient.html
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