[In response to popular demand (no less than two (2) of my readers have urged me to continue posting, even though we're not traveling at the moment) here are a few random thoughts.]
It seems that on a recent day in San Diego, Mr. Dag-Are Trydal, a Norwegian exchange student at UCSD, was walking through the parking lot to his car wearing the San Diego standard issue footwear (flip-flops), when he stepped on and was bitten by a small rattlesnake. A passer-by pointed out that Scripps hospital was right across the street, so Mr. Trydal stopped by. Anti-venom was administered, he was kept overnight for observation, and discharged the next day. Being bitten by a rattlesnake was no doubt a shock, but nothing to compare with the shock he received upon seeing his bill. Now, just as an exercise, make a guess here as to the amount. I'll reveal it later in the post. But here's a hint: this story made headlines in the Norwegian press.
Of course, Europeans are by now almost accustomed to seeing or hearing about such stories, and they are all repeatedly warned to purchase short-term medical insurance before setting foot in the USA. And why is that, you may ask? After all, as viewers of Faux News can attest, don't we have the best medical system in the world? Surely our magnificent system could extend a complimentary hand to visiting Europeans who happen to be injured or to fall ill while here, if for no other reason than to reciprocate for the free medical care that traveling Americans routinely receive in virtually all European countries?
Well, actually not. It's a nice little fantasy, but the reality, as illustrated by the above story, is that our healthcare "system" is first in the world in exactly one category: cost. And we are way out in front in that category. Spending five minutes on Google reveals that our per capita healthcare cost is more than double the median of all other industrialized countries. Norway, which is by coincidence no. 2, would have to increase its per capita spending by more than 50% to catch us. And what do we get for all that money? Mediocre performance in almost every category, by comparison with other industrialized countries. In fact, in many categories such as life expectancy and infant mortality we are dead last (no pun intended). You can find a recent study by the Commonwealth Fund here. Of course there is one category in which we are in a league of our own: inequality. We are the only industrialized country in the world that does not provide universal coverage. More than 44 million americans have no coverage at all, and many millions more have extremely limited coverage.
The reason for this pathetic state of affairs is obvious. We are the only country with a for-profit healthcare industry. Now, leaving the morality of profiting from human misery entirely aside, it's not hard to see that for-profit healthcare is economically inefficient. In fact, the entire system is mis-incentivized. For providers, the profits are in the treatment, not the cure. Doctors get most of their revenue from the tests and procedures they perform, which is why there are so many expensive and medically unnecessary tests and procedures. Insurance companies are strongly incentivized to insure only healthy people. They spend lots of money trying to figure out who not to insure. Finally, there's the expensive administrative inefficiency of the "billing triangle" consisting of you, your provider, and your insurance company. Your provider often sends you a bill while simultaneously billing your insurance company. Maybe they think you'll be stupid enough to pay it before waiting for your insurance company to "negotiate" it down to something reasonable? Who knows. But there's usually a lot of back-and-forth among the three parties trying to figure out who owes what to whom. Which brings us back to the unfortunate Mr. Trydal, who received a bill for $143,989. Welcome to America!
