by Paul Craig Roberts, Paul Craig Roberts:
The US health system is the most high cost and dysfunctional health care system in the world. The reason is that it is privatized. In the rest of Western civilization the system is socialized.
The reason health care is socialized in civilized countries is not only to provide health care to citizens who otherwise could not afford it, but also to reduce the cost. In a privatized system, a profit has to be turned at every level: the general practitioner, the specialist, the diagnostic facility, the ambulance service, the emergency room, the hospital, the hospice, the health insurance company. All of these levels of profit build up the cost.
In the hybrid system with which the US is afflicted, regulation drives the cost even higher. It is not only government regulation because of Medicare and Medicaid, but also private regulation imposed by private insurance companies. In America, alone in the world, medical care comes second to paperwork.
Doctors working in medical clinics have to dictate the results of each patient seen, the diagnosis, the treatment, and so forth, in sufficient detail to satisfy the payer of the bill, whether public or private. The dictation time eats into the doctor’s treatment time. In other words, the paper work requirements reduce the amount of time the doctor has to see patients. The paperwork also requires nurses to organize and compile it. And this is not the end of it.
Health care corporations employ people to monitor the doctors to make sure the physican dictates enough to create a record that Medicare, Medicaid, or the private insurance company will accept as evidence of billable service.
Even a libertarian economist who views the massive costs upon costs of the American system cannot find any economies to attribute to private enterprise.
In a socialized health care system, none of the many levels require a profit in order to continue to operate. As there is no billing of Medicare, Medicaid, and private insurance companies by private corporations, there is no need for the high cost of preventing fraud. Nurses and doctors can attend to patients instead of paperwork. Of course, in any system cost-saving regulations can expand cost-producing bureaucracies, and no system will work well without moral and virtue rules that instill a compassionate and responsible attitude on the part of health care providers.
There is no doubt whatsoever that the cost of health care in the US would diminish dramatically if the US had a socialized health care system in which there is no profit, no paperwork, only health care. And this is why it will not happen.
In the US system, health care is profitable to private interests. They are concerned with their profits, not with the cost of health care to people. It is profitable to all the fraud prevention, public and private, bureaucracies. It is profitable to the members of the US Senate and House of Representatives, as private health care companies are major donors.
If you doubt this, consider that Democrats, or many of them, say that they are for a single payer health care system, by which they mean a socialized health care system in which there is no profit and no regulatory cost. But they are not really in favor of such a system as the Speaker of the House, Nancy Pelosi’s health policy aide made clear to private insurance company executives. Pelosi’s health care adviser, Wendell Primus, pledged Democratic Party support to the insurance industry in the fight against single-payer health care. https://theintercept.com/2019/02/05/nancy-pelosi-medicare-for-all/?utm_source=The+Intercept+Newsletter&utm_campaign=0df09bdfa1-EMAIL_CAMPAIGN_2019_02_09&utm_medium=email&utm_term=0_e00a5122d3-0df09bdfa1-131966649
Pelosi’s plan is to achieve “universal coverage” via the Obama Affordable Care Act. This misnamed legislation achieves health coverage for Americans by mandating that they purchase private insurance policies for their health insurance. Many Americans have not, because the premium, together with the deductible and co-pays are so high that few can afford to use the policy. The perfect deal for a health insurance company is to collect a premium on a policy whose deductibles and copays make it too expensive to use.
What we need to ask outselves is: Why can’t we Americans get affordable health care? A socialized system could pay high salaries to doctors and nurses to guarantee their commitment. Their education could be subsidized. Pharmaceutical companies can be nationalized. Scientists dedicated to finding cures don’t care who they work for. The entrepreneural argument is a red herring.
The answer is that government does not serve the citizens. Government is just another private business that serves those whose campaign contributions put senators, representatives, and presidents in office. What liberals, conservatives, and libertarians do not understand is that government is a private activity like a capitalist business, not a public organization.
Government is just another privatized sector. It serves those who pay. As people needing health care can seldom pay, the system is in the hands of the private insurance companies.
The only “health care reform” that America will ever have is the reform that drives the cost of healthcare even higher.