The decline and decline of the US Healthcare System Part 1 (E pluribus unum)

Caduceus - symbol associated with American healthcare

This is an opinion piece

You would think that a developed country like the United States would have the best access to medical care in the world. Sadly though it's a failure and getting worse. This from my perspective of having practiced in Canada and the United States. There are fundamental flaws in healthcare here and certain philosophies are to blame. It's that age old misguided argument of wanting the free market to not be restricted and to keep the government out of Healthcare combined with overuse of diagnostic testing and unnecessary referrals for medico-legal (aka Cover Your Ass) reasons. (I'll write more about CYA Medicine at a later date.) My G_d! What a country. 

Free market is what has made US healthcare unaffordable. Insurance companies, the pharmaceutical industry and Republicans who want these two "free market" forces to not be impeded, ruined what would have been a good start to solving the healthcare crisis in America. 

The government in every civilized country in the world negotiated with the pharmaceutical industry for better pricing on medications in their public systems. This is what free market should look like: compete to come in with the lowest price for medications to win the government contract. Here in the States, the pharmaceutical industry snookered the former Bush government into paying 106% of the average retail cost of medications instead of the lowest wholesale cost. "In his book on Obamacare, "America's Bitter Pill," [Steven] Brill detailed how the pharmaceutical industry lobbied Democrats in the Senate and White House to make sure there were not [sic] provisions put into the Affordable Care Act that would do anything to control the price of prescription drugs." (NewsMax article Sep 22, 2015) This is the American notion of letting the free market do its thing.

A cornerstone of the Affordable Care Act was the concept of making healthcare affordable to many millions of Americans without coverage. The way this was to be accomplished again was by letting free market forces lead to insurance companies bidding with their various products. Again, as with the pharmaceutical industry, this led to industry not losing a penny in the deal while the people namely taxpayers pay the cost. Instead of the insurance companies making less money, they are still getting well paid, getting even more patients enrolled and the government is stuck subsidizing the cost. The insurance companies were supposed to compete to bring costs down. Instead, as the subsidies get reduced each year, patients are facing escalating costs for these insurance plans. They are no longer affordable.

The result is runaway drug costs and insurance costs thanks to the "free market." Drug companies have raised their prices of all their medications while insurance companies keep removing costlier medications form their lists of what they cover. Now we have Republican presidential candidates all calling to scrap the Affordable Care Act. They say we need to make America great again by opening healthcare up to free market competition to drive prices down. Instead, thanks to the current system and free market American values, my ophthalmic technologist has to stay on the phone with an insurance company representative at a call center to explain why our patient will go blind unless they approve the accepted standard of care antibiotic for our patient. Then, the patient has to wait up until 48 hours before the request gets approved, if they approve it at all, risking permanent blindness while waiting. The cost without coverage to the patient for this antibiotic drop - $300 for 3mls. The cost in other countries at full retail, about $40. This is the great success of the American free market in healthcare - prices driven through the roof by two industries who buy their way to making laws in only their best interests. This is not why we as physicians chose to practice medicine. We want to make sure our patients have access to the accepted standards in medical and surgical treatments.

We need the Affordable Care Act fixed to not pander to industry but rather to care for patients. This does not mean tear it up. This means get rid of the concessions that were made in order to get it passed into law. And the notion of keeping government out of Healthcare? Does that mean scrap Medicare, Medicaid and the VA system? On the contrary, we need measures to preserve these government run systems. If you want to make America great, bring back the Affordable Care Act as originally conceived and stop the downward spiral of healthcare in America.