by John Hobbins, MD…….
The mushroom cloud has cleared enough to see behind it. The exit polls have shown that the most common reason for voting for Trump was “the economy”, a euphemism for “what’s in it for me”. So a business man has been chosen to provide more for the “me’s” in our country. Never mind that this political neophyte’s rhetoric reeks of misogyny, racism, religious bigotry, and, ironically, a lack of respect for the very people this billionaire professes to represent – the middle class.
It is likely that for the next four years we will be dealing with unabated trashing of the environment, religious and gender persecution, unregulated banks and industry, a shredding of women’s rights, cut backs in NIH funding, a rollback of social programs and, as predicted by some economists, a major downturn in the economy. Hopefully, none of these will happen, but let’s focus on one area that is particularly vulnerable to the type of mass rehab promised by Trump: healthcare.
First, the truth. At present we do not have the best health care system in the world. In fact, by objective measures we are far down on the list of developed countries. However, we are the leader in one category – its cost. Why is healthcare so darn expensive? A major reason is that profit is built into every facet of the delivery of care.
We physicians, sometimes unwittingly, are partially responsible. Our charges, in general, are inflated and reimbursements are grossly unequal for the services rendered. Fancy operations and diagnostic interventions are generously reimbursed. Yet there are minimal rewards for preventive care, the very activity that keeps people from needing these expensive procedures.
Insurance companies exist to generate profit while providing a completely unnecessary service. Some companies operate with up to a 20% administrative cost and profit margin, compared with Medicare, which operates at about a 3% administrative cost.
Hospitals, many of which have robust enough profits to reward their executives with megabuck salaries, have ways to improve their bottom lines by applying ridiculous markups for, seemingly, every activity generated and every item consumed. One can barely keep from laughing at their bills for an MRI or even the charge for an inpatient sleeping pill.
Last, highly profitable pharmaceutical companies have, at will, ratcheted up their prices way above their overheads with little pushback.
So, with profits rising for the health care players it is no wonder that we spend 17.6% of our gross national product on health care. Countries like Sweden, with the next highest expenditures, are clustered at about 11% and they all offer universal health care coverage.
Throughout his campaign, Trump has threatened to do away with the Affordable Care Act- an initiative that since 2013 has provided care for 17.7 million previously uninsured individuals, including those with pre-existing conditions. This program has almost halved our rate of uninsured from 20.3% to 11.5%. Now, realizing that this program has some merits that must have escaped him before the election, he is waffling.
If any plan that gets pushed through does not curtail wholesale greed, it will likely limit access to care for the lower economic class and will result in even more financial angst for the middle class “me’s” who voted these fat cats in.
On the bright side, we can be number one in quality of health care. We have the technology and clinical expertise in abundance. All we need is a creative and fair way to put them into play.
What can we as individuals do to advance this concept? I doubt that Trump will have an epiphany. However, I do think this straw strongman will fold if people organize at a local level to convince our county, state, and federal representatives that we must have an innovative program that provides compassionate care for everyone while cutting costs generated by profiteers. We need to get those conned voters who, hopefully, had only a temporary lapse in judgment, to jump on board.
Why would they do this? Because, after using the wrong pitch for years, now we can use the right one by playing to their strongest suit: self-interest. As my Swedish friend said , “I gladly support my national health care system, not specifically because it provides care for everyone, but because it really helps me”.
John Hobbins, MD is a practicing physician and a medical researcher at the University of Colorado. He was formerly Chief of Obstetrics at Yale and University of Colorado, where he is now Distinguished Professor. Dr. Hobbins and his family have spent winters in Key West for 20 years.