Craig's Blog of Destiny

The other day I had occasion to call AAA –kind of a funny story that Sam or I may have to tell sometime.  I keep my AAA card in my wallet, in the same wallet sleeve as my health insurance card.  As I was pulling the AAA card out, it struck me as poetic that the two cards are right there together – and yet I have such diverse feelings about them.

I appreciate my AAA card.  I use it, not necessarily that often, but I do use it.  Enough that calling them isn’t a unique experience, I’m comfortable calling them.  My AAA coverage costs me somewhere between $100 and $150 dollars a year for the family – maybe ten or eleven dollars a month.  I’ve used them because we’ve locked keys in the car, because we’ve had flat tires, or because I needed a vehicle towed.  I appreciate my AAA coverage.

In contrast, I do not appreciate my health insurance card.  I do not like making claims with my health insurance card.  I hate trying to get health care.  My health insurance card costs me almost $700 a month, or about 70 times* as much as my AAA coverage.  I don’t like visiting doctors and typically avoid it.  I begrudge the fact that I have to have that insurance card.

But the problem with my health insurance card isn’t the insurance.  It’s the thing the insurance is covering that causes the problems.  Yes, this post is about health care in the United States.

Health care in the US is broken – broken big time.  But what’s broken about it is not that some people don’t have health insurance or that health insurance isn’t available to everyone.  What’s broken about health care is the cost of health care.  I really wish that those trying to address the problem would stop trying to treat the symptom of insurance coverage and instead work on fixing the actual problem:  the cost of health care.  The insurance is expensive because the care is expensive.  Requiring people to have insurance may actually hurt the problem in the long run as insurance companies have exhibited a lack of ability to control costs.

The cost of health care in the United States is unreasonably expensive.  Google “health care costs per capita” and you’ll get all kinds of numbers and studies that boil down to this:  in the United States our per capita health care costs are roughly double that of comparable countries.  And the country that is second highest, Luxemburg of all places, spends only about two thirds what we do in the United States.

Some would try to argue that we have better care and are healthier because we spend more.  But the argument has no basis in reality.  We are certainly not twice as healthy as Canadians, or almost three times as healthy as the Japanese.  Again, Google relative healthiness and you’ll find lots of support for the idea that in the United States we’re actually less healthy than many other countries.

I’m not saying anyone in the health care industry is overpaid (with the possible exception of pharmaceutical companies, they do seem out of control to me).  In fact I believe the majority are probably underpaid.  But we have got to find a way to reduce the cost of health care.  Medical litigation would be a first target.  Those drug companies that are selling product in the United States at many times the cost they’re selling it for in other countries would be another.**  We have got to shift from reactionary medicine to preventive medicine – which could be an entire debate all on its own.  In some way, the cost of the care has got to be addressed.

My suggestions:  
1.     Stop trying to treat the symptom and go after the disease.  Stop messing with the insurance and start fixing the cost of health care.  I do not believe socialized medicine will work in the United States, (the United States government is inept at actually profitably running anything except itself) but health care does need to be regulated, in the same way the government regulates utilities.  The free market system doesn’t work for utilities and it isn’t working for heath care.  Regulation is in order.  
2.    Malpractice liability has got to be addressed.  No one likes to place a value on life or quality of life, but the excessive judgments in health care litigation have got to be curtailed.  
3.    The cost of medication needs to be brought in line with costs in the rest of the world – if that means pharmaceutical companies earn less, so be it.  If it means a relaxation on FDA requirements for approval of drugs, so be it.  But in some way, get our drug costs in line with the drug costs in other countries.
4.    There must be a fundamental shift in how we view health care and our health, away from reactionary medicine and towards preventive medicine.  It’s considerably cheaper to repair a roof than it is to fix the damage resulting from a collapsed roof, yet when it comes to health care we are consistently waiting until the roof collapses before we do anything.

We have got to make some hard decisions about health care.  I wish those that are making those decisions would actually make them, make the hard decisions, instead of simply covering the whole thing with political maneuvering and rhetoric.  Sometime in the future I would like to pull those two cards out of my wallet again and have the feelings I currently have about the AAA card also apply to my health insurance card:  I’d like to feel good about its cost and its value and actually want to use it.

*Seventy times as much.  Seventy times would make a delivered pizza cost just over a thousand dollars.
**Last December I made one of my infrequent visits to the doctor.  My insurance provides coverage for doctor visits with a moderate co-pay cost.  I had some pain in my ear which I suspected was an infection so I went in.  Sure enough, the doctor diagnosed an infection and prescribed an anti-biotic.  Even with my insurance the cost of the drugs he prescribed was absurd – somewhere between twenty and forty dollars a pill.  I elected not to have the prescription filled and let my body deal with the infection on its own – which it did.  I was feeling fine within a week.