Healthcare: Affordability and Access

I make a point in my book about Collective Social Intelligence, that healthcare will improve if we are able to refine the links between government, institutions, ourselves and the community. I am about to visit some very influential people working in healthcare in the US, so I thought I should reflect on what I wrote and bring in some of the ideas in Dr Jim I. Jones’ book, Optimising Healthcare and his related blog post on our web site.

I’ve had recent experiences that exemplify contrast between the Australian health care system and the US healthcare system.

About 5 years ago I had food poisoning.  It was awful.  I felt like I was dying.  The test results showed I was in pain, and not that I am a “wimp” with a low pain threshold.  Luckily, or not, it was something I ate in Melbourne, Australia. The fact that you can get food poisoning in a 1st world country aside, the hospital system in Australia is good. I had private health insurance, but still went to a public hospital.

I was in gastric isolation. In my own room for five days. I had two nurses 24/7 keeping me comfortable and experimenting with pain killers. Turns out morphine doesn’t work on me.  The good news was they found that tramadol and a combination of paracetamol and codeine worked.  Whew!  And not endone either. Perkiest is the equivalent in the US, I think. Endone was weird. I was still in massive pain, but no one would know because I was just “spaced out” and didn’t really care.

Australians all think they have a wicked sense of humour, especially if they can play practical jokes and give you a good “ribbing”.  So, here’s me. The American, paranoid about what all this was going to cost and them revelling in the fact that they could take me on a roller coaster ride by telling me it was going to be sooooo expensive and stick the metaphorical knife in deeper, while keeping me painless with my tramadol, paracetamol and codeine.

After five days and two full time nurses, guess what?  I left with a bill for $33.00, for pain killers.

Contrast this with our recent experience in the US.  My wife fell and cracked two ribs. Now all the rhetoric about the US healthcare system makes it sound like, if you go to hospital, you’ll be entering the equivalent of a third world country. She really DID NOT want to go.  I assured her that this was certainly not the case, but even I had my doubts after being away for many years.

We enter a hospital in New York City. An obviously successful ‘business,’ as it is nothing quite like a ‘public’ hospital here in Australia.  It was clean and there were professionals at the door to either greet you or assist you, depending on your condition.  We were assisted immediately and then went through a series of tests, procedures and questions, all of which were administered by very professional, very knowledgeable people.  People who cared very much about what they were doing and took their job very seriously.

The only real issues we had was at the end.  They asked us if we had health insurance.  We said “yes, but it’s travel insurance and we will have to pay and then get reimbursed.”  We got the bill. OMG! Thousands of dollars later, we were still being administered by helpful people. At first, they couldn’t get the credit card machine to work.  “Ha Ha” I thought.” Foiled the system. hehehe.” Eh! Eventually they got the card to work and we are still chasing the travel insurance company a few months later.

Why I mention this?  Well, both systems are great, in my experience.  It’s just that only one of them is affordable, which also makes it accessible.  The US system is particularly good at everything from experience to actual care, but by God! No wonder people get sick and die. They can’t afford to do anything else unless someone like their employer is able to spend a fortune on private health care insurance!  Imagine if my wife had been in a US private hospital for five days with two full time nurses like I was in the Australian public hospital?  That would have been worse than the college loans I finally paid off at 32, and the college loans for my eldest daughter that my wife and I are still paying off today.

At this moment, the main way it seems to absolutely afford healthcare in the US is to not get sick.  Now I know that in the US, the ACA has done A LOT to make care accessible and affordable and in Australia, new legislation encourages people of a certain age to purchase private insurance, but then you get a little income tax break for that and EVERYONE pays 2% of their total yearly salary towards the national healthcare system.

Studies are showing that compared to other OECD countries, U.S. healthcare costs are one-third higher, or more, relative to the size of the economy (GDP). According to the CDC, during 2015, health expenditures per-person were nearly $10,000 on average, with total expenditures of $3.2 trillion.

The amount keeps increasing, but most of the increases are due to higher prices, not increased use of services.  Hmm!

Many of you might recall that our Systems Engineer, Dr Jim I Jones, was a keynote speaker at last year’s Health-in-Hand Symposium. This year Dr Jones has completed his new book on optimising health care, expanding the white paper he presented in Melbourne.

His rationale for writing the book includes how to “fix” health care, including senior care, because the costs have reached 17.9% of GDP in the U.S, and 10.3% in Australia. It is continuing to climb at an alarming rate in nations throughout the world.  Dr Jones integrated information system based on the methodologies presented, will allow for the inclusion of social and cultural elements into healthcare overall.  This will serve as an optimisation and adaptation mechanism and has the potential to reduce overall care costs by more than 30%, while providing for telemedicine and an integrated management capability for health, home and hygiene.

But is 30% enough?  Does that provide for accessibility and affordability?  I’m not sure. I am both an American citizen and an Australian citizen. After being in Australia for over 20 years, I am considering a pilgrimage back home. In Australia, access and affordability are built into “the system” and there are budgets at both state and federal government levels which means the system does truly provide access and affordability to everyone.  I’ll admit that comparing the two country’s healthcare systems is unfair because the size of these two countries is vastly different, however the size of the Australian population is not markedly different from the size of any given state in the US.  And the ONLY thing that worries me about living in the US again is how on earth will I afford healthcare insurance and even then, will it actually make care, if I need it, affordable?

I’ll end with one final comment, even though I have much more to say.  The US healthcare system is one of, if not the  best system in the world.  Access and affordability will mean pricing different and will likely mean less money going to the people who currently control the system and by all accounts it seems to be mostly the insurance companies.  Being the best is only relevant if people can afford to use it and unravelling the mess of pricing is going to be an incredible challenge. Stay tuned…