Health Care and Cost Ineffectiveness

The health care system in the United States is obviously broken down to the core, and in so many ways that it is clear a complete overhaul is needed. Patches are not sufficient when an entire system is structured and predicated in fundamentally inequal ways, and ways that are also laden with gross cost inefficiencies. Conservatives are fond of harping on these but they don’t seem to recognise that it is their policy recommendations that contribute to these inefficiencies, that there are better ways of providing health care in this country that would be less expensive and would reach more people.

Under the current system, there is a focus on reactive health care and stabilisation of patients, rather than on more proactive prevention and actual curative care. If a person with no insurance is found lying in the street and brought to the hospital, that person will receive basic care, will be stabilised, and then released. It is likely that person will wind up back in the hospital, probably with more expensive health problems, because the hospital was unable to provide more in-depth treatment that could have made a significant difference in the patient’s life. And the patient may well lack other forms of support, like a warm and dry place to sleep that could prevent complications.

This is inhumane, and it’s odd to see the provision of nothing but very basic emergency care to all framed as some sort of progressive, compassionate step for humanity. Here in the United States, we do not allow people to die in ditches by the side of the road, for the most part. Go us. Instead, we haul them out, apply a few bandaids, and then dump them back into the ditch, until they skirt close to the edge of death again and we repeat the process. It is a series of endless patches that do not provide for any meaningful change; no one wants to know why the person ended up in the ditch, if there is perhaps an intervention that would prevent a repeat incident.

Health care approached in this way is ridiculously costly. Emergency stabilization of critically ill and injured people is very expensive. It can require a large team of care providers, expensive medication, the dedication of emergency facilities. When those people are not fully stable upon release and return in short order with even more health problems, they are even more expensive to treat. The costs of treatment mount with each incident and the patient is never really well, simply kept inches away from death. The hospital is the cat toying with the mouse, bound up in policy and the need to address paying patients and the creation of policies that seem to actively promote inefficiency.

Prevention of health problems is demonstrably less expensive than treating them. Community-based medicine and interventions do not need to be extensive or particularly costly before they start to have a real impact, creating a tipping point that tends to promote more health and wellness in the community. Some surprisingly simple measures can go a long way—say, providing youth with something to do in a community that lacks cultural enrichment, so they aren’t forced to turn to self-harm to entertain themselves. This, the prevention of health problems, doesn’t just benefit individuals, but also society as a whole. Less missed work, less unhappiness, a more focused and balanced workforce. For those concerned with money, less monies paid out in benefits and support to ill employees. This is good for everyone.

Actual treatment of health problems on the first visit is also less costly than the current system. Our hypothetical junkie in the ditch might want inpatient rehabilitation services, but could not afford them. The patient with persistent asthma might need to work extensively with a nurse practitioner, have reliable access to medications, to get the asthma under control and develop a long term management plan. This is less expensive than treating that patient at every crash, airways closing and inflammation raging. The patient with poorly controlled diabetes may not actively be dying, and thus isn’t deemed worthy of care, but will experience a decreased quality of life and is more likely to die earlier, and could receive actual concrete care at a relatively low cost when compared with the expenses of hospitalisation for complications.

The framing of emergency care only as progressive or humane is simply incorrect. It’s not just cruel, it’s also more expensive, and creates more of a drain on society; if people want to frame human beings as ‘drains,’ they should look at the kind of care they provide to these individuals. No one wants to lurch from health crisis to health crisis, to require extremely expensive intensive care. People don’t plan or look forward to severe illness and complications, but they cannot access meaningful preventative care or maintenance therapy that might help them avoid serious health problems. Society turns people into ‘drains’ by structuring care and social services in the way it does, creating an endlessly reactive culture of crisis, patch, release, crisis, patch, release.

It is curious to see people who claim to believe in ‘Christian values’ actively advocating for human suffering. I do not think Christ would have agreed that the meek, the humble, the sick deserve this kind of care. I do not think he considered them drains, but people of value who could contribute something and would, if they weren’t endlessly teetering on the brink, but instead were provided with some breathing room. We call it ‘welfare’ as though we are doing people a kindness, when really we’re just killing them slowly and patting ourselves on the back for our compassion.