Friday, April 22, 2005

Timely article from Krugman


The United States spends far more on health care than other advanced countries. Yet we don't appear to receive more medical services. And we have lower life-expectancy and higher infant-mortality rates than countries that spend less than half as much per person. How do we do it?

An important part of the answer is that much of our health care spending is devoted to passing the buck: trying to get someone else to pay the bills.

According to the World Health Organization, in the United States administrative expenses eat up about 15 percent of the money paid in premiums to private health insurance companies, but only 4 percent of the budgets of public insurance programs, which consist mainly of Medicare and Medicaid. The numbers for both public and private insurance are similar in other countries - but because we rely much more heavily than anyone else on private insurance, our total administrative costs are much higher.

According to the health organization, the higher costs of private insurers are "mainly due to the extensive bureaucracy required to assess risk, rate premiums, design benefit packages and review, pay or refuse claims." Public insurance plans have far less bureaucracy because they don't try to screen out high-risk clients or charge them higher fees.

And the costs directly incurred by insurers are only half the story. Doctors "must hire office personnel just to deal with the insurance companies," Dr. Atul Gawande, a practicing physician, wrote in The New Yorker. "A well-run office can get the insurer's rejection rate down from 30 percent to, say, 15 percent. That's how a doctor makes money. ... It's a war with insurance, every step of the way

Yesterday I had to get my wife to see a medical person (a chiropracter, preferably) because her back went out.

Here's one of the big untold stories of those new suburban developments about which David Brooks is always praising: there's a chronic shortage of medical people in places like Vancouver, WA. There's a shortage of funeral directors and butchers, too, but I don't think they're all related. At least I hope not.

Anyway, she was finally directed to an "urgent care" place that reminded me of a massage parlor, complete with what seemed to be exotic dancers moonlighting as receptionists (Richard Bennett, I can tell you the location of the place if you ever need it.) I've no problem with exotic dancers moonlighting as receptionists, but it wasn't the kind of professionalism I have in mind when I or a loved one is seeking out health care. My wife got codeine (she has a bad cough, too, which threw her back out in the first place) cough medicine and a hot pad, but that was it.

When I was a kid, if you got sick you saw the doctor, who made house calls. Yeah, he really did. Health care in the US is increasingly sucky, especially for "urgent care.

Nobody here has a right to complain about Canada or "socialist" health care; heck I've got killer health care coverage, and I or my wife can't see a competent doctor when we get sick.

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