Hunger Games and US Healthcare
Opinions and ideals have much less to do with a wealthy nation’s approach to healthcare. Healthcare requires a business model for a basic public population need, much like electricity or education. Imagine if electricity you buy was from a free, open profit market with prices based on electricity’s value, not its cost. The disparity of who gets the electricity they need and who does not would be stark. Or imagine only going to school if your parents worked for a company large enough to have education as a fringe benefit. We would be in a Hunger Games world with the Capital utopia and the Districts: dystopian rural, suburban and urban ghettos for everyone else.
Failing to accept that a wealthy nation must have a healthcare system for its population means you are a Hunger Games Capitalist in the district of Panem. You live in an elite bubble and are pleased to ignore the needs of the population. You no doubt are covered in one of the US’s three different healthcare systems. 1) You work with an employer large enough to provide you and your family great health benefits through Private Insurance. Or 2) maybe you are in the military or retired military with the highly successful US Single Payer healthcare system. Or 3) possibly you are over age 65 where, by age status, your population is automatically covered by the US Government Managed Health Plan, Medicare, which is the lowest cost per capita and most efficient plan of all. Imagine how even more efficient if Congress would allow Medicare to negotiate lower drug prices.
Population Healthcare Systems Widely Used in Highly Developed Countries.
In his 2010 book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, T.R. Reid describes three-major healthcare business models, with examples of their respective use for universal healthcare in virtually every developed nation. Written during the debate and passage of The Affordable Care Act, Reid’s analysis remains largely accurate today.
The Three Models:
1) Mandatory private Insurance (typically through utility-like regulated non-profit or for-profit insurers). In the US, this is most like the largely for-profit insurance industry that serves most who are under 65 and work for a company large enough to provide insurance as an employment benefit.
2) Single Payer. In the US this is the system used by the Military for all-armed forces personnel and veterans.
3) Government sponsored. In the US, this is closest to Medicare which has high satisfaction[1] rates and low costs, more comparable to most other wealthy nations. The government ends up acting as the insurer, while the private sector provides the medical services. Costs are low in large part because administrative fees (i.e. the portion that does not contribute to actual care) are just 4%.
In comparison the administrative costs of the US Private health care system is in the 17% — 18% range with a very large portion of that cost going to advertising, essentially unique to the US system. In fact, TR Reid points out that a key difference in population healthcare in the US is that it is more a Healthcare Marketplace, than a Healthcare System.
Another key reason why healthcare costs per capita in other similar developed nations are so much lower than the US is the efficiency gained when countries use only one of these systems universally for its population’s healthcare. In the US, we use all three of these business models, though none are universal.
The 4th Population Healthcare Model
However, there is also a 4th model. The 4th model is used in the US … and also dominates the poorest and most underdeveloped nations. Reid describes it as the Out-of-Pocket model. However, that moniker makes it sound more positive than the “have” vs “have-not” system it is.
If instead of life in Panem’s Capital, you find yourself in one of Hunger Games’ dystopia Districts — those rural, suburban and urban ghettos — your healthcare system would be most like this 4th model.
In the US, the leading cause of bankruptcy, 62% in fact according to a Harvard Study, is due to out-of-control medical debt. And, like countries around the world which are too poor to provide any kind of mass healthcare system, this 4th model of healthcare is pervasive. These are dystopia healthcare “Districts”. As described by Reid, “the basic rule of this [4th model] in such [poor] countries is that the rich get medical care and the poor stay sick or die.” Or they accumulate healthcare debt beyond their means — a social and public cost that hides elsewhere in the GDP, but remains a large sinkhole in the nation’s health care cost.
Slow and Costly Progress in the US
Prior to major healthcare reform in the US which began national rollout in 2013, between 15% and 19% of Americans lived in that virtual “District” without healthcare insurance. In just 3 years this number has reduced dramatically to about 10%, the lowest level in our brief health insurance history — yet still egregiously too high for a wealthy nation. Those without healthcare coverage then … now … and as a result of any future changes to the ACA, occupy virtual ghetto “Districts” in US healthcare policy. They are US citizens left to fend for their and their family’s own healthcare.
In the US, our healthcare is gobbling up the highest percent of GDP and the highest costs of healthcare per capita, double that of most other developed countries according to the Peterson Kaiser Health System Tracker. However, fixation by Congress on who is “in” vs who is “out” of healthcare plans ignores the elephant in the room of care delivery. Congress must attack health cost and efficiency for all Americans with a unified system like all other first world nations. We neither address nor reduce US’s out-of-control healthcare costs by changing who gets covered, covered for what and who does not. We simply move the GDP money around, hiding how everyone gets health care under a moving shell. Yet the consequences of HOW we pay those costs — costs that never go away — messes ruinously with the lives and livelihood of citizens — particularly marginalized Americans. Those we cast to a dystopian Hunger Games Healthcare District.
