Quando saúde é um negócio então o sistema é que está doente
A new year begins. The competition for my health care spending dollars shifts. I pivot from just the usual payment plans, monthly out-of-pocket bill payments, and payment of my premiums to health solutions that do not require doctor visits. For many Americans insured through private insurance plans, deductibles are now reset to zero. It is the time of year that many in the U.S. worry most about as an illness or injury could be a really bad way to usher in the new year and make the remainder of the year stressful and difficult.
In the United States, our health care access is often subject to payment of thousands of dollars in deductibles and other out-of-pocket costs that make millions of us do everything we can to avoid needing care. This does not mean we don’t need care. It just means we avoid it and the bills that come along with being human enough to get sick or hurt. That has not changed much under the ACA/Obamacare.
We suck up over the counter medications for everything from the common cold to allergies to digestive troubles to fevers to rashes and lots of other health concerns. We diagnose our own ailments as much as possible using the Internet and trying to guess our way out of the need for a doctor’s visit.
Some argue that a health system that relies on market competition makes health care better and drives down costs as consumers (patients) shop for the most affordable care options. This just doesn’t work. Many of the most intelligent people in our nation know that a public, universal health care system would be far superior in almost every way — economically and in terms of health outcomes. And poll results just this week reinforce that the American voting public still favors a single-payer system.
Publications all over the world—other parts of the world, that is—feature the writings of educated Americans celebrating the virtues of a system that is very unlike the one we have in the U.S. One recent piece was published in the U.K.. It was written by Amartya Sen, a Nobel prize-winning professor of economics and philosophy. By all accounts, it seems Professor Sen is a pretty decent thinker. He posits that universal health care is an affordable dream. He doesn’t seem like he’s anti-American or anti-profits.
In one excerpt from the article in which he argues that universal care is an affordable dream, Sen writes, “In the absence of a reasonably well-organised system of public health care for all, many people are afflicted by overpriced and inefficient private health care. As has been analysed by many economists, most notably Kenneth Arrow, there cannot be a well-informed competitive market equilibrium in the field of medical attention, because of what economists call ‘asymmetric information’. Patients do not typically know what treatment they need for their ailments, or what medicine would work, or even what exactly the doctor is giving to them as a remedy. Unlike in the market for many commodities, such as shirts or umbrellas, the buyer of medical treatment knows far less than what the seller – the doctor – does, and this vitiates the efficiency of market competition.”
Let’s state that again. The buyer (you and me) knows far less than the seller (physicians and other providers) about the care or treatment that may or may not be needed and this intensely unbalanced knowledge/experience level destroys what many people claim would be the efficiency of free market competition. Our health care system cannot rely on providers to be fully honest about what they know. The health industry’s pressure to score profits means that we cannot trust everything we are advised to do in terms of treatments.
The doctor-patient relationship most of us would prefer is tainted by too many hands in the profit pot. From insurance brokers and even the ACA exchanges to the insurance companies to Big Pharma to corporate providers, financial services groups and collection agencies and beyond, scores of profit-driven forces stand to gain or lose based on what our doctors advise us — or even convince us — to do to get and stay healthy. Oh, wait, staying healthy isn’t a way to make the biggest profits, is it?
And woe be to the patient (consumer) who questions his or her treatment options when something seems “off.” Many of us have been dismissed by providers who act insulted by even the suggestion that money or profit is playing a part in the delivery of our care. We are to be obedient servants of the medical-financial-industrial complex. The playing field isn’t free, and it will not get any more free until health care is handled as a universal, public good in which every one of us is invested in the best outcomes and not just the shareholders who only desire their own enrichment.