Note: This post is a more in depth analysis of the healthcare problem, which Kimchi talked about here.
Why is the health care system so bad in America? When and how did it start? Here is a brief analysis:
This is the pay or die health care system used in America that is supported by both Democrats and Republicans.
The United States currently faces a crisis with the rising costs of health care but lacks a proper solution for its self-induced problem of inflating prices for profit. Because of the country’s emphasis on a capitalist free market economy, non profit hospitals that were once concerned about social services to provide help are now concerned with reaping benefits. Instead of viewing patients as diseased people in need of medical attention, doctors dehumanize them into becoming clients for their business. Such treatment of individuals is a result of the corporatization of Medicine that affected both the attitudes of physicians and the government in terms of restricting access to health care. There has been a shift in the power of who controls the medical system from physicians to businessmen that create policies to extract benefit from increasing the need and cost of medical services prescribed to a patient. In addition to the increase of services, because of modern technologies advancement, newer machines are more expensive, which places burden to patients who must compensate for those new gadgets. In effect, the weak structure of the American medical system which does not concern itself with public or preventative health but rather views health care as privilege has lead to a wide disparity amongst those insured and the mortality rates of those uninsured America must resolve the situation by altering the way businesses dominate the current medical model and the system by moving the power back to health care providers.
Since health care is not treated as an ordained right but an honor for a patient, the access of many citizens to it has been restricted. Critics argue that “our health care arrangements are not considered to be a national health care system in any sense” because it does not attempt to allow admission for services or restrict cost containment or help the quality of care received. (Budrys, 109) Federalist attempts at regulating medical coverage for the poor only resulted in the creation of Medicaid and Medicare in 1965. “The reasoning was that expansion would result in an increased availability of medical care or all who needed it.” (Budrys, 110) Though Medicaid is structured to be a “public health insurance program for people over sixty five plus some categories of younger disabled people” it requires the government to produce the money in order to put into existence such programs. In order to compensate for certain costs, Medicare, a different system not restricted to the poor was created.
“Medicare is a “Medicare has two parts: the hospital portion Part A which is free to enrollees, and the medical portion part B which covers doctors’ fees and requires enrollees to sign up. There is a monthly charge for Part B that is deducted from a person’s social security check. Medicare does not cover all costs. There is a copayment for medical care and no coverage for pharmaceuticals and many other necessities. Accordingly, many people buy additional insurance which as come to be called Med-gap. Private insurance companies sell Medi-gap policices but these are not like other privatized policies. There are ten different plans, labeled A-J., that vary in how much they cover and how much they cost.” (Budrys, 111)
The increasing complexity of the health care system in the United States has created a frenzy in which insurance companies will fund services only if they are profitable and will force a patient to pay for services HMO’s do not think require as much medical attention as perhaps a common disease like diabetes. Many suffer from this decision to include certain diseases because if there is no access to the required health care, many are forced to become bankrupt seeking treatment.
Instead of realizing that health care is a complete system that relies on the government’s support, politicians would rather not risk their popularity for a universal health system, and will only for the sake of speaking, promote a less expensive system. However, “US social policies have no concept much less accommodation for a total health care system. The development and possible effectiveness of social policy are ultimately a political process in which powerful interest groups vie to define their agenda.” (Freund, 254) Recipients of Medicaid are often stigmatized as being abusers of taxpayers money and labeled as “welfare cases” that detract people from wanting to use services that may help them. America’s avarice driven medical care, geared only toward profits “fits the ideal type of a laissez faire health care system only in that health care has become highly commodified, and the drive for profits is, indeed a central dynamic making it even more difficult to control or plan to meet the entire society’s needs.” (Freund,257) Not only does the country’s political ideology cause a problem for providing accessible health care, but because capitalism offers no concern for the populous it neglects to be apart of public or preventative medicine. Western medicine’s weight on the actual disease and not on preventing it “ is itself the political product of the relative muscle of various groups.” Attempts to set a broader agenda for the health of the nation are contested by powerful interest groups benefiting from the present pattern spending of medical care.” (Freund 254) America’s negligence toward creating an equal opportunist society, in which the total population is entitled to medical coverage, has made it susceptible to ravenous insurance companies.
There has been a shift in power from health care providers being in charge of administering medical provisions, to companies whose objective is to reap profit. It is a fact that within a globalized economy, any country “paying for citizen well being reduces corporate profit and international competitiveness.” (Freund, 259) However, even though all nations struggle with this problem to “provide for their citizens well being” the United States stands apart in that, it has never “had an adequate safety net to protect its citizens.” (Freund, 259) Since America is so careless toward its citizens, it almost promotes corporations to feel guiltless when taking power from nonprofit hospitals. This removal of power from physicians and its movement into the hands of business owners has created a “Doctor’s loss of autonomy and control of patients’ care” (Freund, 267). Previously, doctors who lived in communities would charge fees for their services accordingly to their patient’s income. If the patient could not pay, then the doctor would assume that a probono case would increase his respect within the neighborhood, but this social exchange of help for status has declined. (Freund, 264)
Instead, doctors have teamed with insurance companies who now pay their salaries and in turn are beginning to commit white collar crimes such as over billing of patients, perverse incentives and other forms of medical malpractice. The structure used to be that physicians were paid on a fee for service payment but “few contemporary doctor patients relationships are so simple” because majority of physicians are paid “through third parties such as the government or insurance companies.” (Freund, 267) Now physicians inject their fees with “perverse incentives” which are “built in financial encouragements to treat the patient inappropriately by increasing services, overprescribing medications and diagnostic tests, or to choose treatment sites according to physician rather than patient interests” which perpetuate malpractice toward patients which isn’t necessarily regulated. (Freund, 267) The next form of abuse by doctors is receiving “secondary income from the treatment” which happens when physicians own or have investments in a facility such as an imaging company or nursing home, they profit any time they refer a patient to one of those sites. (Freund, 267) While many clinics and hospitals are overpriced, many also reduce the quality of their care in order to gain even more capital. In an example regarding a dialysis center, it “maintained profits by reducing their operating costs, they substituted less skilled staff for RN’s, used dangerously obsolete dialysis equipment, and reused dialyzer fluids on multiple patients.” (Freund, 273) These criminal acts continue because rather than police and place fines on companies that mistreat clients, the government turns its face toward such acts because as long as insurance companies take the responsibility of providing coverage, they also have unrestricted freedom.
There is a need for better management that will not only identify malpractice against patients, but will challenge the current structure that physicians and businessmen have crafted. The fact that it was thought that only doctors could review one another has allowed American medical boards to relax in their system of authorizing disciplinary action against physicians. There is an idea that because only another doctor can comprehend the profession and challenges another one faces, there are no other qualified personnel to oversee the actions of physicians. This idolizing status given to physicians needs to be abandoned, for it is giving doctors special rights to abuse patients. The lack of regulating medical management, has lead to specialists claiming the right to overcharge.
“The oversupply of specialists has not led to competitive pricing. Indeed, rather then competition driving physicians’ fees down” the higher number of physicians has kept prices soaring because they claim the since each has fewer patients, they must compensate by having higher rates. (Freud, 269) Physicians are no longer heroes that society turns to for help, but have become charlatans, who base their prestige on self-righteousness and argue that because of their talents, they have the right to sell themselves at inflated prices to the public.
Other less obvious sources of the increasing health care costs is the rise of technology in producing new medication but also improved better software and machines. In effect, the “proliferation of sophisticated and expensive technologies has” been aimed at purchasing new expensive instruments which are not fully utilized. (Freund, 320) For instance an MRI machine may be purchased by several hospitals and only needed rarely could be shared within an area but since this reduces how the hospital appears; they have to overcharge in order to appear progressive, and as a better prospect for being a primary health care provider. With the rise of new technology, there has also been an increase in the type of drugs that are manufactured. Since insurance companies assume the right to set prices for services, as well as place time constraints on the length of time a physician can spend with a patient. Doctors are pressured to treat their patients with a quick cure, such as a pill that will eliminate symptoms, but not stop the illness necessarily. This has lead to an increase of expenditures for prescription drugs” which rose in “1999 by 19.2 percent, 17.3 % in 2000” only augments the suffering of patients who pay for services and drugs out of pocket but are not actually receiving proper treatment for their illness, and may need to return later.
There needs to be an awakening of the inequality within the medical system, that even with the enormous amount of spending the American government spends on health care, it is not managed as effectively as it should. There should be a standard by which services can be charged, and if it is going to be dependent on health insurance companies, they should not find methods of over pricing. Furthermore, there needs to be less discrimination in insurance companies for those with chronic diseases like asthma or diabetes; it should not be granted only to “healthy people”. There should be a reemergence of nonprofit hospitals that are created in order to assist in the general well being of the public and not for the profit of its staff. It is necessary to deconstruct the power of the current medical structure from being overtaken by entrepreneurs, for health and social services are not of capitalist nature. Though a nationalized health care system has its drawbacks, such as faulty method of administering priority to its patients, the American medical system needs to assume responsibility for its citizens. In a country that requires its workers to undertake any risk and treats them as slaves to the state, it is ironic that it is not willing to extend any concern for the protection of its assets. The power of health insurance companies needs to be restored to that of physicians or at least organizations that are concerned with an egalitarian society that promotes health coverage not as a privilege but as a right in order to erode social inequalities.
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