Affordable Healthcare in the U.S.

by Errington C. Thompson, MD

The Patient Protection and Affordable Care Act turned three last week. Depending on which channel you were watching, the ACA was hailed as one of the greatest triumphs of mankind – or the giant first step in the downfall of western civilization.

Fortunately, the Affordable Care Act, also known as ObamaCare, is neither. This piece of legislation perfectly mimics the American population: We are all over the place with regards to our feelings on healthcare and healthcare reform, and ACA reflects our confusion and apprehension.

According to a recent Gallup poll study, most Americans believe that there is a health care crisis in the United States. So just for a second, let’s step back and look at health care, a $2.8 trillion business.

What do we want from healthcare? I have talked to Americans about healthcare – and specifically healthcare reform – over the last five years. I’ve consistently heard that healthcare needs to be affordable, it needs to be portable and it needs to be accessible. For now I want to focus on affordability.

Affordability

The reason that health care is so expensive isn’t the doctors, the nurses, the respiratory therapists, or even the hospital administrators. Healthcare is so expensive because of other stuff. It is hard to get a handle on this large group of suppliers. They include pharmaceutical companies, but also the folks that make hospital beds, operating room tables, and IV fluids.

One of the current crazes (medicine goes through fads just like everything else in the United States) has to do with sanitation and cleanliness. Several studies have been published suggesting that hospital personnel may carry bacteria from one patient to another and that hand sanitizers can prevent this problem. In response, every single hospital in the United States has placed some sort of hand sanitizer dispenser in almost every patient room. Now, the companies that make hand sanitizers are swimming in money.

Because these hand sanitizers are mostly alcohol-based, hospitals began complaining that there were stains on the walls and on the floors where the sanitizers had spilled or splashed. This caused everyone to run out and buy a simple little footplate that snapped onto the sanitizer and prevented spillage. I have no idea how much these companies charge for this little plastic footplate, but I suspect that, like most things, these little footplates cost a few pennies at most to manufacture in bulk. I do know that they’re charging hospitals a lot more than a few pennies.

This is where the money is in medicine. It is very difficult – almost impossible – to force these product manufacturers to charge less. Whether it is titanium rods to fix a broken fracture or the new bio-mesh materials used to fix hernias or CT scanners which cost over $2,000,000 apiece, health care is expensive. If we had a single-payer model, it would be possible to negotiate prices that are a little bit more affordable for all of us.

Quality standards

One of the biggest problems in medicine is developing quality standards. Personally, I don’t think that medicine has done a good job in defining quality. Every physician in the country can talk to you about the variability of patients. Yet, at the end of the day, we have to figure out a way to quickly and accurately diagnose the patient’s problem and render cost-effective care.

Why is this so important? Not only does it affect the patient’s quality of life but it also affects overall costs. Complications cost money; they also lead to longer hospital stays. They lead to longer periods for recuperation and, in some cases, to higher mortality rates.

How can we assure that a 40-year-old male in Tupelo, Mississippi who presents to the hospital with signs and symptoms of a myocardial infarction gets the same high-quality care that is delivered in Miami, Florida, Portland, Oregon, and Independence, Missouri? How do we accomplish this?

Size does matter

Only a single-payer system will be able to wrap its arms around all of these issues and more. Only a national system will be able to ensure that you, the American citizen, get high-quality, affordable and available healthcare no matter what part of the country you live in. Only the government can bring enough financial firepower to negotiate prices with tens of thousands of diverse suppliers whose primary interest – after all, it’s the basis of capitalism – is making a profit for their shareholders and owners. Just as Medicare has the clout to negotiate lower costs and more affordable reimbursements, a single-payer system will have the power to fulfill its primary interest of ensuring the best care for the most people at the fairest prices.

We do need true healthcare reform in this country. We haven’t gotten there yet. When you hear the talking heads arguing for or against ObamaCare, you need to remember that ObamaCare is only a first, timid step toward improving quality and reducing healthcare costs. We need more, and we need it soon.

(And just in case you’re wondering, I guess I should reiterate, and remind you, and establish once and for all, that there are STILL no death panels in ObamaCare.)