Health Care Reform - a Public Option to Save America?

The health care debate is raging again, and while everyone seems to agree that something has to be done about the current state of affairs, it seems that for many people the most important aspect of health care is to keep the government out of it.

It is difficult for me to understand the massive protest against the inclusion of a public option to the current health care system, I was born and raised in a country that not only has a public option, but in fact has a full blown socialized health care system. The ultimate nightmare it would seem for many Americans. I feel differently, while you often hear that America has the best health care in the world, to me that is just not true. My personal experience is that health care in the USA is more expensive, harder to get, a lot more confusing, and not of any higher quality then what I am used to from the government run health care system in Norway.

In fact, the American model with privately obtained health insurance is not only expensive and excludes large sections of the country, it also causes and encourages inefficiencies that drive up costs for everybody. For someone half on the outside looking in, the current health care system in America clearly is broken, but is a public option what is needed to fix it?

In my opinion, an affordable public option should be a given. It is not worthy of a country like the USA that there millions of people that are basically without medical protection. I have had the 'pleasure' of needing medical assistance for my children without having health insurance, and the price for moderate routine examinations are jaw dropping. I did not have insurance because at the time we were just visiting relatives in the US, but for many people, they face every day without coverage. Now, most of these cases will be somewhat covered by Medicaid if something major strikes and critical care is needed, but for the day to day health care needs of these people, they are literally rolling the dice every day, where a broken wrist would spell financial doom.

One might argue that protecting your health is the responsibility of the individual, and that being uninsured is a matter of priorities and choice. That the government has no business covering for the people who chose not to get coverage for themselves. I disagree with this stand, in particular because the cost of health insurance is sky high and effectively out of reach for many people. Even for people with more than decent income, having to provide health insurance without having an employer backed insurance plan is extremely expensive. While some might claim that the right to chose if you want health insurance or not constitutes a form of freedom, the opposite is the case in the current system. The model practically forces people into being employed to get anything close to a reasonable price for the coverage they need. The freedom of health care choice becomes a straitjacket forcing people into wage labor. Aside from the obvious consequences this has with an unemployment rate close to 10%, being forced into the conventional model of working for a salary is not freedom. At the very least, health insurance should be removed from the current strong linking with employment. A general public option available to anybody would be a possible way to remove this glaring flaw in the current health insurance system.

So, health care is broken, it needs to be fixed, but will a public option be the right step? I think that for some of the issues that are crippling the American health care system it would, in particular having a uniform insurance base policy would cut down on a lot of unnecessary paperwork as the payment processes would be streamlined. Unfortunately, the problems with health care in America run deeper than this, and amending it with a public option that basically is just a low cost option in the same market will not do anything to fix the real underlying structural problems with health care.

The conventional wisdom is that anything left to the free market will promote the most efficient cost effective solutions due to competition. The theory is that government run programs will be inefficient by default, usually because of lack of competition and no incentive to excel since there is no profit potential in increased effort. This theory is great and holds much of the secret to the incredible success of the USA, and has proven itself in many areas. In an are like health care on the other hand, free market thinking is not going to work. For one thing, demand for health care is very inelastic, meaning that people will need to get health care no matter how expensive it gets. The free market will find the highest possible profit for health care providers, and with the end consumers left without any other options than paying up, prices will just continue rising. This is indeed what is happening currently in the US. Even though health care is insanely expensive, people have no choice but to pay their insurance and hope they never need brain surgery.

When you look at the numbers, the US spends more money per capita on health care than any other nation. Some claim that this is an indication of the US having the best health care system in the world. And in many areas, American medicine is leading the world. For complicated surgery, cutting edge cancer treatment and development of new medications, the US is the leading country. The problem is that high tech surgery is a niche area of health care that effects a very small percentage of people. For the vast majority of Americans, they pay more than anyone else for care, and have a lower life expectancy than most other developed countries. Americans are not getting the quality they are paying for.

In my native country of Norway, health care is organized through a common insurance pool that is run by the government that is financed through everybody's taxes. And while taxes in Norway are higher than what Americans would ever tolerate, when you look at the numbers, what I saved in taxes when I moved to the US was lost again in the cost of my health insurance. Now, a side by side comparison would never be accurate as the Norwegian model includes many other free services than just the common insurance pool, but as a crude overview, for me personally, the cost of health care in Norway and the US came out about even. The striking difference is only noticeable as soon as you actually need your medical coverage.

For my money under the socialized system in Norway, I would pay a set co-payment regardless of where I went or what I needed. For a co payment of about $25 I had access to doctors anywhere in the country for any ailment. If my kids needed a flu shot, or got sick that was free as there is no co-payments for children under 18. When our three wonderful children were delivered, we paid exactly $0 every time. The hotel run by the hospital where my wife gave birth was free also.

For the same money in the US, when my daughter needed stitches on a day trip, the 10 minute doctors visit cost us almost $100 since we had to get the service 'out of network'. The initial bill was closer to $250 as the insurance company decided they didn't want to pay anything. The result was that after countless letters and phone calls, the insurance company agreed to pay their fair share under our policy after all.

This highlights the most critical flaw in the current American health care system in my opinion. The inefficiencies introduced by having to deal with the many different coverage plans, and the notorious tendencies of insurance companies to cover as little as they possibly can. If you have ever shopped for health insurance you will now that there are hundreds of different plans available, with different co payments and benefits, linked to different networks of providers. Trying to find the best plan is confusing at best, and when it is time to actually use health care and evoke your policy, it gets downright impossible. The amount of time that is wasted by medical clerks every day on taking insurance information and finding the correct payments is staggering, add to that the time wasted every day by patients trying to get the insurance company to cover what they feel they should and you have a massive inefficiency.

The scary part is that this inherent inefficiency is not even the worst time and money waster in the current system. Inefficiency is engraved in the DNA of American health insurance. One of the first things I noticed when I transitioned over to the American health care system was that no matter what you go to the doctor for, you are sent through a number of unnecessary steps, from something as meaningless as measuring your weight if you have a cold, to more blatant waste as taking unnecessary x-rays and excessive medication. It seems impossible to see a doctor without getting a prescription for three different types of medication. This has always been puzzling to me, but it was not until my daughter broke her arm that I realized what is really going on, and how much time and money is wasted every year.

When my girl broke her arm, she had to have x-rays and eventually have her arm put in a cast as you would expect. Then we were scheduled for a follow up x-ray appointment 2 weeks after the cast was put on, strange, but we went along with the doctors advice. For the six weeks that she had to wear the cast, we had to go back to the doctor two more times, and while this seemed pointless, we still kept scheduling appointments as advised by the doctor, you don't want to take any risks with the health of your child, right? When the day finally came that the cast went off, the x-rays showed that the bones had grown together perfectly, a little muscle exercise and her arm should be good as new. Yet the doctor kept making follow up appointments for x-rays "just to make sure it keeps growing right". We showed up for two of these post cast exams before I finally got smart.

For each of these follow up appointments, we had never seen the doctor for more than 5 minutes, he would stop by after we had been all around the hospital for hours filling out papers and getting x-rays taken. All of this even though my daughter had no pain in her arm or any other indication that the bones were not healing properly. I realized that we had become a very convenient cash cow for the doctor, by rescheduling a series of unnecessary appointments he was able to bring in a very nice income for himself without doing any work. We followed along since the insurance covered most of the expenses, but for every appointment we had to schedule, I had to miss at least half a day of work, and our insurance company would be billed who knows what outrageous amount for x-rays and doctors consultations. If I had not had experience from Norway where a broken bone heals itself even without bi-weekly x-rays I might never have realized how my daughters accident was being exploited for profit. Under the guise of providing the best possible care, the doctor and the hospital was actually wasting my time and the money of my insurance company on unnecessary runarounds.

I don't think my experience is unique, in fact since making this discovery I have noticed that many routine conditions require a lot more medical attention in America than what it would require in Norway. While some might argue that this just means that you receive better care in the US, this is not backed up by statistics as the US scores low on many health indicators, not the least being life expectancy. In fact, the current insurance driven system rewards doctors for wasting time, and this doesn't even touch on the questionable practice of over medication. The result of this culture of scheduling unnecessary appointments drives health care costs up for everybody as insurance companies have to increase their premiums to stay profitable. The end result is clearly visible for anyone who cares to look. A health care system that is unsustainable.

So, would a public option solve the most serious problems with the American health care system? Probably not, the institutionalized practice of over providing care would not change just because more people have government backed insurance plans. The way to stop this trend is either for health care consumers to be more educated about what care is needed and what is just a waste of time and money, and a stricter follow up from the insurance companies when it comes to paying for consultations that are not needed. Stronger possibilities for prosecuting doctors and hospitals that deliberately drain money from the system in this way should also be considered. Sadly, I think that none of these measures will be enough to control the problems facing American heath care. Ultimately, I believe that the only way to make sure that health care is not used for profit gouging is to down the path the rest of the world is following. Through a true socialized health care system.

When you see the furious reaction to something as uncontroversial as a government run insurance option, it becomes clear that socialized medicine is an impossibility in America. Even though a well functioning government run health care system is the corner stone of some of the most successful countries in the world, the concept faces massive opposition in the US. I believe that the best way forward for America and Americans would be a government run basic health care system, complimented by private hospitals and insurance policies for those who want to pay for additional care. Basically the model that is implemented by most countries in Europe and Canada. Having grown up in a country where such a model is in place, I have seen first hand the quality of life and security this model offers, and I believe that Americans deserve the same. When considering the fact that the broken American system is actually more expensive than any other health care system in the world, it seems very strange why more Americans are not looking abroad for other approaches to health care.