A System Designed by the Devil: Chaos Comes Face to Face With US Health Care

"Only the devil could have invented such a system." Uwe Reinhardt, Heathcare Economist.

Recently, Chaos took a firsttime involuntary tour of a local hospital on an emergency basis (appendectomy, for the curious, and there were actually two visits, and yes, it hurt). Although Chaos was impressed with the conscientiousness and caring of the physicians and staff (while noting that, in many instances, nurses seemed to be required to perform more menial tasks than one would have thought) as well as the superior technology brought to bear (MRI, lapriscopy, etc.), it wasn't until Chaos recieved the first statement from the insurance company that the revelation occurred: $19,500 (that's dollars, not pesos or yen) for the first three day stay! Yikes!

The U.S. healthcare "system," if one can even call it that, is, by all accounts, grossly dysfunctional, at once wildly expensive and wasteful (the US spends 2 1/2 times more per capita than any Western industrialized nation and a lower life expectancy than Costa Rica), and ridiculously unfair: 44 million or so Americans are uninsured. The US spends three times as much as Canada, for example, just on paperwork. The paperwork can overwhelm even people who are completely familiar with the system, to the point that paperwork "specialists" are available to wade through it for a fee, much like employing a CPA to do ones taxes. It's been estimated that 18,000 people in America die each year as a result of being uninsured. The system has been described as a "hybrid," in that approximately 50% of health care goes through various government programs (Medicare, Medicaid, Veteran's Administration) while the remainder is through private insurance. What this means in practice is that the system is like a game of musical chairs, with each entity attempting to shift the costs to someone else until the music stops. This is what Chaos experienced--"sticker shock," even though the insurance company was paying most of it. The hospital attempts to charge the full "rack rate," (to make up for paying the government much less for Medicare patients) the insurance company negotiates this down a little, and the taxpayers pay for the uninsured, but not before their health problems have so deteriorated that they become a screaming emergency. Of courser, medical problems untreated often worsen (and become more expensive) so that costs for "last minute" treatment are much greater, and people die earlier and more often.

Politicians sometimes defend the current system by claiming that the U.S.can't have a singlepayer system like Canada's because that amounts to "rationing health care." If one ever says this within earshot, box his ears, vote him out of office (yeah right) or throw a shoe at the TV screen. Yeah, there's rationed health care all right: the rich get all the health care they need and the uninsured (notice Chaos didn't say poor, since many people who lose their "good" jobs end up without health insurance) ration themselves by not going to the doctor, and taxpayers have to clean up the mess.

A political solution? Don't bet on it. Powerful forces, who benefit from the current system, will rise up to spew propaganda and corral their paid-for "representatives." Remember the last time health care reform came up? The industry squashed the Clintons easily. Bush's health savings accounts? Great for the healthy and wealthy. Chaos' advice: bet on the current system continuing and invest in health care; it's a sector brokers call "outperforming."


One positive note: following Chaos' release from the hospital, several acquaintances who have been uninsured were persuaded to purchase health insurance. "A ray of light breaks through the clouds..."