The United States is rapidly becoming the world leader in infection and mortality rates for the Covid-19 pandemic. The argument that countries are not comparable because of the differences in the time that the outbreak reached their respective shores is solved in this video from the BBC, explaining what happened, and who is to blame:
Anyone foolish enough to browse through a medical dictionary is likely to come away from the experience believing that the only affliction that they’re not suffering from is housemaid’s knee. That might be a clue why healthcare in America is running at twice the OECD average.
Visitors to America are astonished at the number of advertisements for prescription medication on television there. Combined with the litigious disposition of patients, it’s no surprise that the country’s healthcare is running at almost 18% of GDP.
Proof, if any is needed, is evident in the 15% of high school-age children being prescribed with A.D.H.D. drugs. A.D.H.D. is historically estimated to affect 5 percent of children. So the other 10% are being incorrectly prescribed the medication by overcautious doctors. The problem is that Americans are increasingly suffering from diseases that are resistant to drugs. For example, the problem of antibiotic resistance has become so severe that the World Economic Forum described it as “arguably the greatest risk … to human health.”
Perhaps a step towards fixing America’s healthcare and financial problems is a law, like with cigarettes, that bans the advertisement of drugs. Call it preventative healthcare.
America spends nearly 17.4% of it’s GDP on healthcare. The Netherlands is second with 12%. America spends $7,538 per person which is 50% more than Norway’s second place with $5,003.
Now, if America’s healthcare were that much better, it might just be acceptable, but that’s not the case.
Rumor has it that this has got the attention of the most senior politician in America. Apparently he’s actually done something about it, although some of his opponents are not happy about the solution. Nor are they proposing a better idea.
If the healthcare in America isn’t better than other countries, then why are the costs so much higher?
It seems that the cost of the medication is part of the reason. When a drug company creates a new drug, it invests a great deal of money into R&D, and the company files a patent to protect that investment. So far, so fair.
The protection lasts for 16 years, during which time the company effectively has a monopoly, and can charge what it thinks the market will bear. Once the patent expires, other manufacturers can produce the drug under a generic name, but not the brand name that the public is familiar with. The price for the generic product is usually a fraction of the cost for the branded product.
The problem is that if you’re insured, you don’t know, and may not even care that the branded product costs $668, and the generic equivalent is $50. So to give you a clue the medical insurers created copays, where the the patient is obliged to contribute a small proportion of the price. After the introduction of copays, the costs started to drop, and by 2003 more that 50% of the drugs people picked up were generics.
In 2007 the drug companies took action. They introduced the Patient Access Card. Patients with the card have to copay the same amount on the branded drug as the generic, and the drug company picks up the rest. So patients can’t tell which drug is more expensive.
Another reason for high costs is administration. The coding of the treatments is so complicated that doctors complain that 25% of their billing costs go into that part of administration. That can be fixed.
There are other things driving up the cost of healthcare. In the 1980s, Jack Wennberg proved that 25% of the procedures in Vermont and Maine were unnecessary. Often the doctors are not the ones at fault.
We want the best healthcare, but what is best? When we know the doctor, and there is a relationship of trust, we usually go with her advice. When we’re in the emergency in a foreign town, and the visible signs don’t look good, and the doctor looks awfully young, trust is not going to help with the decision making, and that’s when it can get really expensive.
Litigation also drives up costs. It’s helped to reduce malpractice, but not efficiently. In other countries, the professional bodies that suspend bad doctors from practice is a lot less costly, and just as effective.
Hopefully these issues will be getting a lot of attention in the coming months.
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