‘Mired’ offers an eloquent indictment of America’s health care system
Published Sunday, February 24, 2008
Patricia Davis was a self-employed resident of Ester who was diagnosed with Stage III lung cancer in the fall of 2004. She had previously noticed indications that she was ill, but put off seeking help out of concern over potential costs because she lacked health insurance. Eventually, however, she was overtaken by the symptoms, saw a doctor, and entered treatment.
Patricia’s parents then did what most parents would do under such circumstances: They offered to pay as many of her bills as they could. However, her father, a retired University of Alaska Fairbanks geophysicist named Neil Davis, did something most people don’t do: He examined those bills. And when he had questions about what he found, he looked for answers. And so he found himself, as the title of his latest book puts it, “Mired in the Health Care Morass.”
What made Davis curious was an itemized bill that included two 50-milligram injections of carboplatin, a chemotherapy drug. His daughter was charged $1,224 for the first injection and $1,428 for the second. Researching the drug on the Internet, he learned that it could be purchased for as little as $13.50 a dose. “Clearly,” he tells us, “something was radically wrong here.”
This anomaly led Davis down the rabbit hole of America’s absurdly dysfunctional medical system, where one of the first things he learned was that uninsured patients are routinely billed more than those with coverage.
Davis doesn’t have a problem with doctors being paid well for their expertise. But if he was going to cover his daughter’s bills, he felt they should be comparable to what public and private insurers were charged. He successfully negotiated payment plans with most of Patricia’s doctors based on these pay scales. But before he could get to this point, he needed to understand how doctors get paid in the first place.
It turns out this happens in quite a few ways. Davis spends many pages explaining how our system, such as it is, functions. He warns readers in his introduction that they should prepare to “look at a lot of numbers.”
He isn’t kidding. Parts of this book are mind-numbing in their complexity, but this is not Davis’ fault. He does a commendable job here of trying to make sense of this mess, but even though he explains things in thoroughly straightforward language, it will be hard for mere mortals to organize it all in their minds.
Fortunately Davis spares us this work with an illuminating diagram of the cash flow in our medical system. What it shows is bills getting directed some 30 different ways between patients, employers, insurance companies, providers, pharmaceutical companies, HMOs, hospitals, state and federal governments, the Veterans Administration, Medicaid, and the various branches of Medicare. (If you’ve ever wondered why so many doctors are abandoning private practice, look no further.)
By contrast, on the same page we see a diagram of Great Britain’s universal health care system, in which bills are sent two directions. England’s government-run medical system is notoriously unpopular, even though it ranks higher than America’s. But another diagram shows Canada’s single-payer setup, where the bills flow just five ways.
This mix of public and private health care has a per capita cost running 57 percent of America’s. Overhead chews up just 12 percent of total expenditures, compared to the U.S., where it consumes 24 percent. What Canadians get from the deal are lower infant mortality rates, longer life spans, and coverage for everyone.
For all our insistence on the benefits of the free market, our health care system costs more to administer than any other and gives us lousy coverage in return. Our national health lags far behind that of most developed nations, there is much more bureaucracy in our medical system than can be found anywhere else, and we have some 47 million citizens who have no insurance at all.
Meanwhile, medical bills are the cause of half of all bankruptcies. Our country is going broke paying for a system that isn’t working.
“Every healthcare system has its deficiencies,” Davis tells us, “but the American system takes the cake, and is rightly described as dysfunctional. It is terribly expensive, and getting more so by the year, yet it fails to provide the health care that the citizens of a modern nation should have.”
Davis argues persuasively for adopting a single-payer system similar to Canada’s, but getting there won’t be easy. There are too many interests — primarily insurers and pharmaceutical outfits with deep pockets — who oppose changing anything. And Americans are famous for refusing to do things the smart way (this is, after all, a country that clings to the Electoral College and shuns the metric system). We all know our health care needs fixing, but we refuse to do it at great cost to our society in lost lives.
“The National Academies’ Institute of Medicine estimates that 18,000 people die prematurely each year as a result of being uninsured,” Davis writes. Patricia Davis was one of those 18,000. She died on July 31, 2006.
It is nothing short of immoral that in the wealthiest nation on earth Patricia Davis felt fiscally incapable of seeking treatment when she first needed it. It’s even more shameful that she and her family were put through such a financial nightmare in the last months of her life. Her father’s book is an eloquent effort at gaining some semblance of justice on behalf of his lost daughter. Read it and perhaps you will understand why our country must do better.
David A. James lives in Fairbanks.
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