For Your Healthcare, Forget Obamacare and Take Charge Yourself

When it comes to their healthcare,
are patients too trusting –
or too complacent?

There’s a post by Richard Eskow on The Huffington Post today entitled “Healthcare’s Forgotten Crisis, Part 1: Families Can’t Afford Medical Care” that mirrors much of what I write about here, specifically how healthcare is increasingly unaffordable for many Americans and will remain so despite Obamacare.

He delves into Obamacare’s shortcomings and embraces my view that it’s better than the “free-market” alternative its opponents espouse. But a cure for America’s healthcare spending it isn’t.

Here’s an excerpt from his article:

“The real healthcare battle in this country isn’t the one being fought over the bill everyone now calls ‘Obamacare.’ In fact, it’s not a battle between Republicans and Democrats at all. The real battle is the one millions of Americans face every day as they struggle to pay medical bills that now average nearly $10,000 per year — if they’re ‘lucky.’…

“The United States is now the only developed nation on Earth where the average family with insurance pays more for healthcare than it does for groceries. That includes both the family share of premiums and out-of-pocket costs for medical treatment. In fact, those out-of-pockets costs alone exceed a family’s average yearly cost for gasoline, according to a new study…

“That study found that the average household medical bill for a family of four with ‘good’ PPO coverage is nearly now (sic) $9,144 per year. That’s a crippling and unsustainable expense for most family budgets, a burden which is crippling the economy and ruining lives…

“This struggle seems to have been forgotten in all the back-and-forth over Obamacare. Who’s fighting for these American households as they wage their losing battle against healthcare costs?”

Who, indeed?

Certainly not our politicians. At least the Democrats made an effort with Obamacare. But by the time its watered-down approaches were further watered-down in  the political back-and-forth to get it enacted, it lost any real teeth in terms of cost controls. Its biggest step to review and control hospital costs doesn’t even start until 2020.

That doesn’t mean that none of its provisions will help. Requiring non-profit hospitals to stop gouging their uninsured patients with hyper-inflated charges is itself a big step forward for those often driven into bankruptcy by such unethical billing practices.

But it does nothing to slow the growth in healthcare spending that now exceeds $22,000 a year for a family of four – with almost $10,000 a year of that coming out of the family budgets of Americans fortunate enough to have employer-based health insurance.

And given the partisan gridlock in Washington and Republicans’ determination to do everything possible to deter and impair Obamacare’s implementation to further their political chances in 2014 and beyond, there isn’t the otherwise reasonable expectation it might be improved as it’s implemented (see “Wonkblog: GOP’s dangerous Obamacare strategy” in today’s The Washington Post for more on this).

And should this obstructionism prevail and the GOP ever get its way, their free-market “solution” will only accelerate the growth in healthcare spending, making us long for the inadequate but constructive steps of Obamacare.

The Healthcare Market Is Unique

“Free-market” is an alluring term because it sounds so American – and so “free”. Who doesn’t like free? But like so much corporate packaging, it’s deceptive.

There’s nothing free about free markets. Free markets mean unregulated markets. And as I outline in my Obamacare book, the least regulated states in America are the highest cost and worst performing states in America.

Free markets may work in most other markets, but in healthcare, it’s a prescription for disaster. That’s because healthcare is the only market in which suppliers are allowed to effectively dictate their own demand. That’s not a free market, that’s a broken market – a market ripe for exploitation and corruption. And we see it today in our least regulated states, where medical excesses are given free rein.

Nevertheless, as Mr. Eskow observes in his piece on The Huffington Post, “It’s (Obamacare’s) not evil. But it’s not enough.”

So if it’s not enough and its opponents so-called free-market approach would be even worse, who’s going to bail out us poor consumers from a future of healthcare servitude in which the money we once spent on groceries, clothing and entertainment is diverted to our ever-escalating healthcare costs?

The obvious answer is that no one is. No one is in a position to do so even if they were so inclined. Not the government – regardless of which party’s in power – nor the private healthcare industry that thrives on our higher healthcare costs.

Maybe it’s time we started fighting for ourselves, as my reply to Mr. Eskow’s article attempted to suggest (what follows is the “unabridged” version – a bit longer than they allow for comments at The Huffington Post).

Time to Stand Up For Ourselves?

This article feels like “deja vu all over again” for me, as I’ve written extensively along these same lines on my blog and in my books on Obamacare and Our Healthcare Sucks. Even ACA proponents expect healthcare costs to double over the next decade or so, meaning Obamacare doesn’t even stop the bleeding. Its opponents can snark all they want, but their “free-market” alternative is even worse – granting a free ride to healthcare’s most abusive providers.

So Obamcare’s a lesser of those two evils. But that ignores the single payer solution that’s the only true solution – and even that would fail to address many of the most egregious provider abuses that routinely jeopardize patients with unneeded high-risk medical interventions.

The missing ingredient in all the hand-wringing I see about Obamacare, pro and con, is the refusal to challenge medical caregivers themselves. We allow spinal fusion surgeries in some parts of America at twenty times the rate of other parts of the country. Twenty times!

And the same phenomenon occurs across the medical spectrum. Why are we still paying for all this unneeded care that simply pads the incomes of unscrupulous doctors and hospitals? Are we so driven by fear of disease that we must cling to childish views of doctors as all-knowing and benevolent when all the evidence tells us they are the core drivers of our medical misspending.

Nothing happens in healthcare – not a dollar spent or earned – without a doctor’s order. Unless we wake up to how much of our medical care isn’t care at all, but profiteering by doctors and hospitals, no political solution will correct our medical spending trajectory.

We need to stop looking to politicians for solutions and take responsibility ourselves by learning to say no when our doctors order tests and procedures we or our loved ones don’t need. That means we have to put in the time and effort to educate ourselves to be much smarter medical consumers.

It’s too bad. It shouldn’t have to be this way. We should be able to trust our doctors to put our interests before their own. But those days are gone – “medical ethics” is fast becoming an oxymoron. Being a grown-up means recognizing such realities for what they are rather than clinging to outdated and naive trust in institutions and professions that no longer deserve that trust.

There is no other answer. Unfortunately, the only true answer requires more effort and responsibility by we consumers than most of us are willing to accept. And we”ll pay the price accordingly – not just financially, but physically as well. More Americans die needlessly every day from medical errors – many of them occurring in tests and procedures that aren’t needed in the first place – than die in all our wars, street violence, drug overdoses and suicides combined.

We’re just too trusting (see “Are America’s Healthcare Patients Too Trusting?“) – or complacent – to recognize it.

A good place to start educating yourself is the Choosing Wisely website, which lists tests and procedures you may be better off avoiding – as well as when they’re most appropriate. These are provided by the relevant expert medical specialties, so you can be pretty sure they’re reasonable cautions that you can review with your physician if they’re relevant to your care or that of a loved one (thanks to Twitter follower Claudia Williams for suggesting this addition).

John Lynch: John Lynch was founder and CEO of Medical Diagnostics, Inc. - twice named to Business Week's "Best Small Companies" in America. He's since founded MedSmart Members to publish consumer health education publications.
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