Sunday night I blogged this:
I haven’t been blogging nearly as much as I did five years ago, largely because my early blogging was all about trying to figure out “what the heck is up with the American healthcare system???” … it’s been two years since I had any new realizations.
Why would “figuring it out” make me stop blogging? Because as a change activist who’s also a public speaker, I’m gripped by one question: “What could be said that would make any difference?” There literally is no point in saying anything else. So once I realized how locked-in the system is, how intractable it is to change, I lost interest in flapping my gums and fingers.
But new things are in the wind, and it’s time to start pushing out those top learnings as foundation for what’s next. So, game on – in responses to two tweets, I got ornery:
1. “What would it take to support single payer?”
@ScriptHacker (John Irvine, former editor of the powerful TheHealthCareBlog) asked what it would take for patients to support a single-payer system (vs the US system of many competing insurers, with sneaky private pricing deals among many of them): lower taxes? Better wait times? etc. I responded with snark based on evidence:
I would require clear evidence that every health system in the world with better outcomes AND lower costs than us DOES have single payer. Oh wait, they all do. http://Dave.pt/malignantHC
That link goes to the “malignant tumor” post I blogged about last night, which established both the better outcomes and lower costs of every other developed nation. No matter what politics you prefer about who pays for what, there’s no denying those numbers.
There’s always lots to argue about in health policy, but it doesn’t make a damn bit of difference in getting the job done: you can have good or bad waiting times while your ship is sinking, and what I want (most people want) is better outcomes and lower costs. No other system is like the US, and they’re all better on both those points. Deal with it.:-)
2. Rebuttal to a nostalgic 2014 post
Twitter friend @UriGoren suggested that this 2014 post on KevinMD.com “There was a time when doctors were doctors” could use a patient rebuttal. It’s not a bad post – have a look. My “rebuttal” was not about defending patients – it was about how warped the post was, how half-blind:
I was citing the famous “17 years thing” that people everywhere love to quote (usually without knowing where it came from!!!), and the 2013 figure of 400,000 “premature deaths,” as the article put it, caused by medical mistakes. It would have done no good to complain about docs who are genuinely nostalgic – heck, I’m nostalgic for the days when I was good at typesetting and when I was good at writing software in QuickBasic. But y’know what? If you live long enough, things change! Deal with it.:-)
In short, I’ve lost interest in endless debates about things that are true but don’t make any difference. When and if the system collapses or transforms there will be plenty of messes to clean up and things to do better when we start over, but for now, I’ll call a spade a spade, and start talking about what ordinary people can do to take care of themselves.
Do I sound ornery? Game on.
Did you know that “ornery” is a rural dialect pronunciation of “ordinary”? I learned that in my chorus – we’re learning an Appalachian carol that mentions “poor or’nery people like you and like I.”
It’s the “ornery” people who suffer when the system doesn’t achieve its potential. I stand with them.
Image source: Pixabay free download on Pexels.com
Peter Zawistowski says
What will happen during the interim time between current health care and what it is changed to. More important what will we do? Good work RDdeB
e-Patient Dave says
Pete! So amazing to see you pop up here! (All, I met Pete long long ago when I bought a couch from him, then became a housemate, then … haven’t heard from him in many years, except bumping into him on a plane to Toronto!)
> What will happen during the interim time between
> current health care and what it is changed to.
Well, as I said in the previous post, I’ve given up on figuring that out: I can’t see any credible way that the US system will stop killing itself and the economy. I anticipate some hospitals going out of business and, perhaps more important, us all getting insurance policies with higher and higher deductibles, which means we’ll all basically become uninsured self-pay people, and that will cause an enormous market to spring up of small clinics that are actually worth what they cost!
We already have a version of that with Minute Clinics (though people like the Massachusetts Medical Society tried to regulate them out of business), and with new pharmacy plans (NOT INSURANCE) like GoodRx.com, which I heartily recommend.
Yesterday my wife needed an antibiotic prescription, and the CVS list price was $91, and through GoodRx the price was $11.98 if you didn’t go through insurance and (get this) $4.78 if you’re a GoodRx member for $5/month.
Same store, same consumer, but NINETEEN TIMES MORE EXPENSIVE ($91 vs $4.78) if you go through insurance. Where the hell is that extra money going??
In my previous post I mentioned that I learned some of this in 2017 when I read An American Sickness, and more when I learned about the famous article “Chaos behind a veil of secrecy.”
Your other question: what will we do? I believe we’re doing it here – help each other wise up. And I know of people who have moved out of the US because the health system was killing their life savings, which no other country in the world does to people.