I materially agree with Libby Watson’s op-ed in the New York Times. I agree that to whatever degree Amazon actually thinks it can solve the problems with our health care system, it’s either mistaken or selling snake oil. Here’s the meat of the op-ed:
Any company claiming its innovation will revolutionize American health care by itself is selling a fantasy. There is no technological miracle waiting around the corner that will solve problems caused by decades of neglectful policy decisions and rampant fraud. And a fix aimed at just the upper crust of employer-sponsored health coverage has no hope of making health care more accessible to those who are truly being left behind.
And I agree that we’ve had a half century or more of bad healthcare policy.
However, the problem with our healthcare system cannot be that it is employer-based. Germany’s healthcare system is employer-based. So is Switzerland’s. It also cannot be that we don’t have a single-payer system. Neither Germany nor Switzerland have single-payer systems.
Here’s her conclusion:
Amazon is right about one thing: American primary care is troubled. Reams of evidence show that good primary care improves health and lowers costs, yet primary care is one of the worst-paying fields in medicine. Independent practices are increasingly being absorbed by larger hospital systems, which can more easily make money on referrals to their specialists; this process further drives up health care costs. America spends more than twice what other wealthy countries spend on health care, while also having worse health outcomes. We have it all backward.
This imbalance results from a thicket of incomprehensible financing systems. Hospitals say they lose money on treating Medicaid and Medicare patients, and therefore must charge private insurance more to make up the shortfall. Prices are negotiated with insurers for thousands of individual procedures and services, but even the hospitals themselves might not know how those numbers relate to any real costs incurred. Insurance companies make an increasing portion of their huge profits running Medicare Advantage plans, which have received billions in inflated payments for claiming their patients are sicker than they are. Wealthy hospitals abound in rich areas while rural hospitals close.
Note that the explanation she provides doesn’t point to a way to reduce costs or slow the rate at which they’re increasing. Her explanation also has a hard time justifying why physicians continue to accept Medicare patients at all. Only 1% of non-pediatric physicians have actually opted out of Medicare.
I think the underlying problem is that the U. S. is a very large, very diverse country with very low social cohesion. Wishing that we were a small, compact homogeneous country with high social cohesion doesn’t help.
I wish I had a neat, plausible solution to the problem but I don’t. At least not one that’s politically possible.
Shrooms.
Yes, it is hard to begin. Its so fragmented. We have a single paper, socialized system, VA and military, a privatized system, a single payer system run by the private system (Medicare) and Medicaid which is bastardized between the states and the feds. Creates too many cross incentives. Makes it hard to understand and looks to me like Watson has misunderstandings.
Why do we accept Medicare? Old people get sick the most and its hard to build a practice that takes only private insurance. Some people manage it and make a fortune but not many. If you are linked to a hospital you usually have to help cover call (emergency pts) in some form its hard to avoid Medicare.
Steve
If a physician must accept Medicare because he or she cannot get enough private insurance business, that is another way of saying that Medicare is a cost/price support system for health care which is what I have been saying for some time.
That in turn suggests that one strategy for controlling health care costs is to stop raising the Medicare compensation rate. The reason it is not done is that politicians are afraid of old people who vote.