Hold on to your seat, this is an eight part series (so far); a very deep look into the a complex system than most people don't understand. All factual and backed with real data from government sources and reliable scholarly research.
Hopefully will provide everyone a deeper understanding of all the different parts of the healthcare system and what each is doing to erode its function and integrity.
Only after fully understanding the real problems and weaknesses, can we start looking for solutions.
Great insight to a broken system that seems to ultimately benefit from keeping a population sick rather than prioritizing health first. All the accounts about a single-payer system that I've ever learned, are from patients that had polarizing opinions based on their own experiences within different countries and/or lifetimes. It's nice to learn about why it's not a solid solution in practice as it appears to be on paper. I'll have to do some more research into how the system came to be during wartimes, because I did not know about that!
The other pieces will cover each of the players in the healthcare system and their contribution to the broken system we have today. Hopefully it will give everyone a better understanding of the problem, how the system is deeply interconnected by a series of actions and reactions leading to the unintended consequences that had shaped the system we have today.
The bottom line is: there is not a single villain or victim in all this mess. When I embarked in this project I had my opinions of who to blame, but the product of my research has given me a new perspective I never considered about before.
You are absolutely correct, and the third party is actually a group of several middlemen in fact, as we will explore in future installments in this series.
I can confidently say the third parties not directly involved in the direct medical interactions are in fact making the lion’s share of the money in medicine today. Think of pharmaceutical companies, insurance companies, administrators, bureaucrats, politicians, etc.
The problem is NOT that someone else is making money in medicine; the provision of medical care is very time consuming, expensive and risky for all parties involved. Without a way to get paid for their effort we would have a very different system and not necessarily a better one!
The problem, as I see it, is the manner in which several of this parties, including we physicians by the way, make their money. Many of these parties make money by cutting corners, producing or delivering unnecessary services that not only waste the limited healthcare resources, but also put people at risk.
That way of making money, profit over patient, is what I consider as wrong with our system.
I’m looking forward to this series, as there is certainly a parallel in my experience from medical school 1980-84; surgical residency 1984-89 and in the practice of General & trauma surgery until my retirement this year. My sense is that there is actually enough money in ‘the system’ to pay for every medical need, but the money is poorly allocated.
I have a graph from 2010 which shows that between 1970 and 2009, the number of doctors in the US grew by about 100%; the number of medical administrators grew by more than 3,000%. And that was before the administration of the ACA (Obamacare) wrecked it further. The cost of doctors to the medical system in the US in the late 20-teens was 15th in the western world. Those are both old numbers, but they likely haven’t gotten better.
My contention is this: you are exactly spot on when you recount the gross events and changes that got us here. I would go one step further (which you will probably hit on as we go), in that when an entity, such as Medicare/medicaid (CMS) provides the money, they rightfully conclude they have the right and the need to oversee how the money is used — hence the rules & regulations that strangle patient care by reviews/denials, etc. And hence the astounding growth in administrative costs over the years —a greater portion of which are now dedicated to compliance, so as to keep away from bad things happening due to government audits. Most, if not all, insurance rules and regulations stem from CMS.
The fact that the majority of overseers have exactly ZERO medical training, added into the fact that the Big Medicine-Big Hospital-Big Pharma-Big Government Industrial Complex, with myriads of paid lobbyists, consultants, and others watches out for itself in a never-ending cycle of rules changes. Which all keeps doctors off balance and keeps them from spending time with patients to really find out what’s ailing them. Add to that mix the fact that big organizations need metrics, so doctors’ time, the algorithmic demand for labs, imaging, etc , there is really no wonder that we spend more per capita on medical care in the US, while simultaneously degrading the care and — here we are —sicker and the poorer for it.
I submit again: we’ve got more than enough money in the system to provide really good medical care, but we don’t have the right system to make it happen (too many palms needing grease in between the patients and the doctors).
And that’s not even discussing the fact that we spend trillions of dollars treating chronic diseases caused by the Big Food—Big Agriculture—Big Government Industrial Complex. Getting back to good health should NEVER be a political issue and, as you pointed out, BOTH political parties bear about equal blame!!
I am sure we have very similar experiences indeed, as I finished Med School around the same time as you.
We both experienced the same progressive regression of medical practice through our years of practice.
And to answer your question, yes we have enough money (though not unlimited) but the allocation of government money follows closely the allocation of lobbyists political “donations”.
Keep your seatbelt tight because we are going deep down the healthcare rabbit hole here.
Thanks for caring for 40 years and explaining the "system".
Hold on to your seat, this is an eight part series (so far); a very deep look into the a complex system than most people don't understand. All factual and backed with real data from government sources and reliable scholarly research.
Hopefully will provide everyone a deeper understanding of all the different parts of the healthcare system and what each is doing to erode its function and integrity.
Only after fully understanding the real problems and weaknesses, can we start looking for solutions.
Great insight to a broken system that seems to ultimately benefit from keeping a population sick rather than prioritizing health first. All the accounts about a single-payer system that I've ever learned, are from patients that had polarizing opinions based on their own experiences within different countries and/or lifetimes. It's nice to learn about why it's not a solid solution in practice as it appears to be on paper. I'll have to do some more research into how the system came to be during wartimes, because I did not know about that!
I'll be on the lookout for the next part!
Thanks.
The other pieces will cover each of the players in the healthcare system and their contribution to the broken system we have today. Hopefully it will give everyone a better understanding of the problem, how the system is deeply interconnected by a series of actions and reactions leading to the unintended consequences that had shaped the system we have today.
The bottom line is: there is not a single villain or victim in all this mess. When I embarked in this project I had my opinions of who to blame, but the product of my research has given me a new perspective I never considered about before.
What appears to me is that there is a third party in the middle of the one on one clinical relationship trying to ( and making ) a profit.
Hi Nan.
You are absolutely correct, and the third party is actually a group of several middlemen in fact, as we will explore in future installments in this series.
I can confidently say the third parties not directly involved in the direct medical interactions are in fact making the lion’s share of the money in medicine today. Think of pharmaceutical companies, insurance companies, administrators, bureaucrats, politicians, etc.
The problem is NOT that someone else is making money in medicine; the provision of medical care is very time consuming, expensive and risky for all parties involved. Without a way to get paid for their effort we would have a very different system and not necessarily a better one!
The problem, as I see it, is the manner in which several of this parties, including we physicians by the way, make their money. Many of these parties make money by cutting corners, producing or delivering unnecessary services that not only waste the limited healthcare resources, but also put people at risk.
That way of making money, profit over patient, is what I consider as wrong with our system.
— Carlos
I’m looking forward to this series, as there is certainly a parallel in my experience from medical school 1980-84; surgical residency 1984-89 and in the practice of General & trauma surgery until my retirement this year. My sense is that there is actually enough money in ‘the system’ to pay for every medical need, but the money is poorly allocated.
I have a graph from 2010 which shows that between 1970 and 2009, the number of doctors in the US grew by about 100%; the number of medical administrators grew by more than 3,000%. And that was before the administration of the ACA (Obamacare) wrecked it further. The cost of doctors to the medical system in the US in the late 20-teens was 15th in the western world. Those are both old numbers, but they likely haven’t gotten better.
My contention is this: you are exactly spot on when you recount the gross events and changes that got us here. I would go one step further (which you will probably hit on as we go), in that when an entity, such as Medicare/medicaid (CMS) provides the money, they rightfully conclude they have the right and the need to oversee how the money is used — hence the rules & regulations that strangle patient care by reviews/denials, etc. And hence the astounding growth in administrative costs over the years —a greater portion of which are now dedicated to compliance, so as to keep away from bad things happening due to government audits. Most, if not all, insurance rules and regulations stem from CMS.
The fact that the majority of overseers have exactly ZERO medical training, added into the fact that the Big Medicine-Big Hospital-Big Pharma-Big Government Industrial Complex, with myriads of paid lobbyists, consultants, and others watches out for itself in a never-ending cycle of rules changes. Which all keeps doctors off balance and keeps them from spending time with patients to really find out what’s ailing them. Add to that mix the fact that big organizations need metrics, so doctors’ time, the algorithmic demand for labs, imaging, etc , there is really no wonder that we spend more per capita on medical care in the US, while simultaneously degrading the care and — here we are —sicker and the poorer for it.
I submit again: we’ve got more than enough money in the system to provide really good medical care, but we don’t have the right system to make it happen (too many palms needing grease in between the patients and the doctors).
And that’s not even discussing the fact that we spend trillions of dollars treating chronic diseases caused by the Big Food—Big Agriculture—Big Government Industrial Complex. Getting back to good health should NEVER be a political issue and, as you pointed out, BOTH political parties bear about equal blame!!
I am sure we have very similar experiences indeed, as I finished Med School around the same time as you.
We both experienced the same progressive regression of medical practice through our years of practice.
And to answer your question, yes we have enough money (though not unlimited) but the allocation of government money follows closely the allocation of lobbyists political “donations”.
Keep your seatbelt tight because we are going deep down the healthcare rabbit hole here.