I wanted to relay two stories about the US healthcare system that illustrate the complex cost containment and quality issues with both Single Payer (Medicare) and Private Insurance.
Unfortunately, my family are large consumers of medical care. My mom gets through the doughnut hole in January every year with her medications and had had millions of dollars of life saving and quality of life medical care over the past 2 decades that has extended her life for at least 15 years.
I have had 3 complex surgeries on my neck totaling over a million dollars of medical care over the past 9 years which has allowed me to continue to be a productive and taxpaying member of society.
There is no "Silver Bullet" to cost containment in healthcare.
Let me give you 2 examples of cost containment and waste that has happened to my family (who are unfortunately large consumers of healthcare).
Example #1:
Recently my mom with very complex and expensive chronic medical conditions was hospitalized for passing out unexpectedly and shortness of breath (not a usual symptom for her medical ailments).
She is on Medicare with supplemental insurance and is essentially covered close to 100% for hospitalization. She was admitted into the hospital on Sunday 12/26. They did a series of tests and saw a series of specialists over the course of the next 5 days and was stablized and ready for discharge except for some test that could be performed by a nurse in their home.
The resident doctor wanted to keep her in the hospital until the following Tuesday because of the holiday weekend even though he knew this test could be performed on an outpatient basis and was not part of the original problem (it was a pre-existing and known condition). After a huge battle, he released her from the hospital that day and she is fine. If the doctor had not been fought by my father, we all would have spent double the amount for her care with no better outcome (and possibly a worse outcome)Now Medicare pays for all days in the hospital without any incentive for discharge...and low rates for procedures and tests...but I am sure that had nothing to do with the decision...right...
Example #2
On the other hand, I have what most would consider "gold-plated" private insurance with Aetna. I had complications after a complex surgery which the surgeon estimated I would be out of the hospital in 3 - 5 days. After 7 days my surgical drains were still draining too much but they took them out anyway and discharged me.
Now Aetna pays a flat rate for the surgery and hospitalization for the entire procedure...but I am sure that had nothing to do with discharging me after 7 days even though the drains were not completed their job...oh I ended up getting re-admitted with an even worse complication 10 hours later.
And I had to stay in the hospital for an additional 5 days and the hospital got to get paid again for additional services not related to the negotiated rate. They would have received $0 for the additional days if I were not re-admitted. Because of all this I had a worse outcome and more money was spent on my care than was needed.In both of these cases the cost containment caused actual and potential waste in medical resources and costs.
So what is my point?...there is no silver bullet here in healthcare cost containment and doing the right thing by the patient and getting quality care at the most effective cost...both government single payer and private insurance have their problems...
Under other systems of care, I would probably be in a wheelchair by now because my condition was not life-threatening, I would have waited and been an unproductive member of society while my condition detiorated until permanent nerve damage made me unable to walk or write.
My mother would have been admitted to the hospital but I doubt she would have had access to 7 top notch specialists in the course of 5 days to diagnose her complex medical issue and I doubt the expensive medical tests that were performed would have been done since she was stablized within 48 hours and could have been sent home with no other tests and "lets see what happens" Actually as a recipient of a kidney transplant at 65 years old (6 years ago) with a complex medical history and not a good prognostic outcome...she probably would no longer be alive today...