Asia: Best Health Care for the Money
America’s health care system
is in the intensive care unit. Its prognosis: Poor. Its recovery:
Doubtful. Medical care is poorly organized, substandard, much too
expensive and unsustainable. Allowing the system to evolve into a
profit-hungry, stock market-watching enterprise is a big part of the
problem. As the cost of care progressively rose in the 1970s and
1980s, many economists and politicians argued that the latest
free-market business practices, e.g., production efficiencies,
standardization, consumer-price consciousness, competition among
purveyors could make health care more accessible and affordable. All
talk!
Ten years ago, the market takeover was already under way, but
it was jump-started when the 1994 Clinton reform plan collapsed.
Many medical ethicists raised concerns then about inordinate focus
on the bottom line and the loss of the “human side” to health
care, but the juggernaut was already rolling and leaders in medicine
felt powerless to stop it. We are now reaping the consequences of
privatizing many medical institutions, including hospitals, HMOs,
physician practices and nursing homes. This conversion to
market-driven medicine caused many of today’s deficiencies.
Except for the minority who can afford the best insurance
policies (and members of Congress who get them for free), the rest
of us face daunting challenges with each medical encounter. We are
confounded by endless attempts to make appointments, struggles to be
seen by the right doctor (or to be seen at all), ever-briefer
visits, bafflement over who is in charge when we’re hospitalized
and demands to leave the hospital long before we’re ready.
Doctors are no less frustrated. They don’t like managed
care, and they don’t like to be managed. They endure stagnant or
falling incomes and increasing expenses, malpractice threats and a
nightmare of administrative hassles from multiple insurers, each
with its own complex rules. Many for-profit medical businesses,
including HMOs and hospital chains have failed, some of them the
victims of fraud. Leaders of industry, which pays much of the cost
of care, are disgruntled with the system.
Substantial variations in quality persist, effective
treatments are often neglected, too many tests are performed, and
the risks of medical mishap are larger than they should be. Clearly
Americans are not getting their money’s worth. We pay far more per
capita than any other country for health care (a whopping total cost
of about $1.7 trillion per year), yet 44 million Americans have no
health insurance, and millions more are inadequately covered.
Meanwhile, Americans are paying a fortune for prescription
drugs, far more than citizens of other industrialized countries, up
to 12% of total health care expenses. Many Americans, especially the
elderly, simply cannot afford to pay the high prices of their
medication and sometimes go without some or all of them. Countless
Americans, even whole cities, are buying cheaper drugs from Canada
and over the Internet despite a federal ban.
Critics indict pharmaceutical companies for profiteering and
fleecing the public. The companies argue that they need their
exorbitant profits to finance research. In fact, they invest far
more in marketing their current drugs than in developing new ones.
Their record in this area in the past five years is unimpressive.
Instead of pushing their research harder as major patents expire,
they manipulate the system to extend their patents, modify molecules
slightly, change a drug’s name, advertise heavily and raise
prices. The FDA, which is the federal watchdog without teeth, is too
close to the industry, partly because it gets some of its funding
for drug assessment from companies whose drugs FDA is analyzing.
The pharmaceutical companies, HMOs and for-profit enterprises
like things the way they are. They have the financial muscle to
resist change through contributions to politicians and employment of
former legislators-turned lobbyists. Nothing is likely to happen
until the public feels enough pain and endures enough expense to
demand reform. Is there an alternative to this mess that has
converted health care in America into big business and is
detrimental to its citizens?
A case in point is India. Three months ago,
Howard Staab learned that he suffered from a life-threatening
condition and he would undergo surgery at a cost of up to $200,000
an impossible sum to the 53-year old carpenter from Durham, NC who
has no health insurance. Taking his cue from cost-cutting US
businesses, he flew 7,500 miles to New Delhi where doctors replaced
his bulky heart valve with one harvested from a pig. Total bill:
$10,000. It included round-trip airfare and a planned side trip to
the Taj Mahal. By the way, India is the largest English-speaking
country in the world.
Another is the Philippines. My wife and I recently went to
RP. While there, we had some dental work done, e.g., X-ray,
cleaning, 2 fillings and 1 root canal for me; X-ray, cleaning, 2
fillings and 1 extraction for my wife; X-ray, cleaning and 1
extraction for her mother. Total cost for the 3 of us: $142. Cost of
round-trip airfare for 2: $1,600. That same work in the US would
have cost at least $2,500. Any work health care providers do here
can be matched (and more) in RP at a fraction of the cost. RP is the
3rd largest English-speaking country in the world. If you
are interested in how to access these services, email me at Rgssoberano@aol.com.
(This
came out in the November 2004 issue of the Asian Pacific American
Times , pp. 2 & 14 of Denver, CO)
