The Craziest Health Care System in The World

The US, without doubt, has the most illogical way possible of paying for health care. Also without doubt, it has the best health care possible.

Since I belong to a listserve for ocular melanoma patients from around the world, I regularly get first hand reports from international patients lusting for a chance to get the treatment for this rare disease that we Americans take for granted. Our emails to the group are about new trials available or angel flights for free travel to receive treatment. One of our member has lived a good life for 25 years since diagnosis and 14 years since the first metastasis. Their emails are about lack of treatment possibilities, waiting for treatment, or sad goodbyes as metastasis to the liver overtakes them.

The US system is a direct result of politicians tinkering over the years, changing a law here and modifying a regulation there. Like changing architects in the middle of construction, the result is a grotesque conglomeration architectural features instead of a well planned building. It started with the 1945 freeze on wages. Employers could not reward workers with raises, so they opted for rewarding them with “free” insurance. The employees received a benefit and the business received a tax deduction. Then politicians stepped in and ruled that while businesses could deduct health care insurance, individuals could not.

Gradually more and more families began relying on their employers’ insurance, rather than buying their own. At the same time, more and more people took advantage of this “free” service and demanded more and more medical treatments. Insurance companies tried to hold down costs with more restrictions and higher deductibles. The physicians had to hire more staff just to process the required paperwork, so they had to increase their costs.

Then the emerging realities of the marketplace dictated that employees readily change jobs instead of staying with one employer long enough to enjoy a retirement party and a gold watch. The employer, of course only paid for insurance on current, not former, employees. So people in between jobs, people who became independent contractors, or people who started their own businesses had to do without insurance or pay higher, non-deductible insurance premiums.

Both costs and services have spiraled upward for the last 64 years with our mish-mash of payment systems and medical services. Yet, no one in America is denied primary medical care and many receive the most expensive treatment options possible because of charitable donations and the willingness of treatment providers to write off debts for uninsured patients.

A rational solution could be to offer insurance that stayed with the person, not the employer and to allow everyone to deduct insurance premiums as part of their medical expenses. An irrational solution would be to force everyone into government controlled health care. That has not worked well anywhere that it has been tried. The inevitable results are less health care available to individuals or more costs to individuals if they choose to pay to get to the head of the line.

If you detest arguing with a desk bound insurance company employee who refuses to cover your anesthesia when a portion of your lung is removed, just wait until you get to argue with a government bureaucrat about whether you get to have the surgery at all.