I agree this is a complicated issue in the USA, and that no healthcare system is perfect. I'm an American living abroad, and my personal experience with T1D in 3 countries is contrary to the theory that we are limited to just two of the three: good, fast or cheap. I've lived in Uruguay, Argentina, and Spain, using the public healthcare system in all three countries. I also subsidize with private insurance in Spain (a holdover since before I was eligible for public healthcare). Each country's public healthcare system has been incredibly efficient with appointments and procedures, scheduled in days or weeks rather than months, with little to no copays. Facilities are modern, and doctors are compassionate and interested, often taking 30 minutes per patient, and never a worry about claim denials. All the same medications and equipment have been available to me for low/ no cost. Even for private health insurance in Spain, we're paying ~€400/mo for a family of 4, which includes a supplementary cost for T1D, with no additional copays/bills. I would take any of my international medical experiences over the exorbitantly expensive, complicated, and inefficient system in the USA.
Thank you for this ambitious essay on healthcare costs in the U.S.A., with accompanying remarks comparing to other nations' healthcare costs. Your photocopy of a large charge submitted to you in error is hilarious in a very dark way.
You did not even mention the IRMAAs which are one of the most socialized aspects of Obamacare. And yet, for many of us who are more or less "middle-class prosperous", NOT wealthy by American standards, these are a punitive aspect of Obamacare. They have nothing to do with inspiring, or directing resources to, better wellness outcomes.
The popularity of Obamacare rests on the fears of those who suspect that any change will leave them worse off.
That said, I should close by saying that in general throughout my life, I have encountered skilled and caring people in medicine, and I owe their contributions to helping me stay well to their personal commitments, not to any government program.
Another interesting article. As a Canadian though, I confess that I skimmed through some parts. I caught one typo - a missing apostrophe in "were": "...companies don’t typically incur drug COSTS the way were used to...". This is in the second last paragraph, in bold, under the heading of Profit Motives. Cheers.
Along the lines of "avoid getting sick", the author would do well to emphasize that Type 1 Diabetes, an autoimmune disorder, is not preventable and is genetic.
Extra thanks for highlighting that adding pumps to a well-controlled A1C can end up causing worse numbers. I can attest to that...
Additionally, I think there's another solution: no tax benefits for medical insurance or expenses. They just increase costs and shift them around. I've had enough with all the bureaucracy at doctor's and insurance's. I've wasted so much time haggling with insurance for small stuff and I been so much happier when the star surgeon said "this is my fixed fee". I paid it twice. And it was worth it.
Dan, a really great article that highlights the many complexities and nuances of our current healthcare system and associated costs. Now semi-retired, after 40 years as a PCP, I have watched so many initiatives come and go. Our group is currently quite involved in the "VBC world". I have always liked the "water balloon analogy" when it comes to medical costs in the US. You squeeze it in one place and it balloons in another! As you allude, there will certainly not be one easy fix. But your article does bring up a number of great talking points. Keep on writing!
I agree this is a complicated issue in the USA, and that no healthcare system is perfect. I'm an American living abroad, and my personal experience with T1D in 3 countries is contrary to the theory that we are limited to just two of the three: good, fast or cheap. I've lived in Uruguay, Argentina, and Spain, using the public healthcare system in all three countries. I also subsidize with private insurance in Spain (a holdover since before I was eligible for public healthcare). Each country's public healthcare system has been incredibly efficient with appointments and procedures, scheduled in days or weeks rather than months, with little to no copays. Facilities are modern, and doctors are compassionate and interested, often taking 30 minutes per patient, and never a worry about claim denials. All the same medications and equipment have been available to me for low/ no cost. Even for private health insurance in Spain, we're paying ~€400/mo for a family of 4, which includes a supplementary cost for T1D, with no additional copays/bills. I would take any of my international medical experiences over the exorbitantly expensive, complicated, and inefficient system in the USA.
Thank you for this ambitious essay on healthcare costs in the U.S.A., with accompanying remarks comparing to other nations' healthcare costs. Your photocopy of a large charge submitted to you in error is hilarious in a very dark way.
You did not even mention the IRMAAs which are one of the most socialized aspects of Obamacare. And yet, for many of us who are more or less "middle-class prosperous", NOT wealthy by American standards, these are a punitive aspect of Obamacare. They have nothing to do with inspiring, or directing resources to, better wellness outcomes.
The popularity of Obamacare rests on the fears of those who suspect that any change will leave them worse off.
That said, I should close by saying that in general throughout my life, I have encountered skilled and caring people in medicine, and I owe their contributions to helping me stay well to their personal commitments, not to any government program.
Thanks to them, and again to you, Mr. Heller.
Another interesting article. As a Canadian though, I confess that I skimmed through some parts. I caught one typo - a missing apostrophe in "were": "...companies don’t typically incur drug COSTS the way were used to...". This is in the second last paragraph, in bold, under the heading of Profit Motives. Cheers.
Along the lines of "avoid getting sick", the author would do well to emphasize that Type 1 Diabetes, an autoimmune disorder, is not preventable and is genetic.
Extra thanks for highlighting that adding pumps to a well-controlled A1C can end up causing worse numbers. I can attest to that...
Additionally, I think there's another solution: no tax benefits for medical insurance or expenses. They just increase costs and shift them around. I've had enough with all the bureaucracy at doctor's and insurance's. I've wasted so much time haggling with insurance for small stuff and I been so much happier when the star surgeon said "this is my fixed fee". I paid it twice. And it was worth it.
Absolutely correct, Andi. My lived experience, also.
Dan, a really great article that highlights the many complexities and nuances of our current healthcare system and associated costs. Now semi-retired, after 40 years as a PCP, I have watched so many initiatives come and go. Our group is currently quite involved in the "VBC world". I have always liked the "water balloon analogy" when it comes to medical costs in the US. You squeeze it in one place and it balloons in another! As you allude, there will certainly not be one easy fix. But your article does bring up a number of great talking points. Keep on writing!
Best regards,
David