A New Book Looks at How the Healthcare System Fails
A: I don't like the employer-based system. It's a bad system, but it's slightly less bad than nothing at all.
Q: Is there a system that you like, one that would encourage people to get the regular check-ups, screenings, and other preventive care they need and manage their chronic conditions?
A: I want to be careful not to make promises about what universal healthcare would do. But simply by bringing down the financial barriers to care, you get people in the system, and the doctors and the nurses would push them to do the things that they need to do.
I talked about the French healthcare system in my book. The French provide everybody with basic insurance through nonprofit sickness funds–one for each sector of the economy–overseen directly by the government. They do have high cost-sharing–as much as 30 percent for outpatient services. However, you are also free to buy private supplemental insurance, which can cover part or all of the cost-sharing, very much like our Medicare system. Most of the public does, in fact, buy such insurance. People who are poor can get supplemental insurance free, directly from the government.
They've been clever: If you have one of 30 chronic diseases they've identified, you don't have to pay the cost-sharing. It's for conditions like hypertension, diabetes, etc.–instances where the government wants to make sure people get their preventive and routine care, in order to keep these conditions from blossoming into full-scale emergencies down the road.
Q: It's everyone's worst nightmare: Getting turned away from the emergency department when you need it most. You tell the story of one woman who died after a heart attack when her ambulance was diverted from the hospital that could have performed a life-saving procedure because the emergency room was already at capacity. What, if anything, can people do to protect themselves from such a thing happening to them?
There isn't much you can do. At the end of the day we are all dependent on the system. Try to stay healthy. Try to find out if there's a good underutilized emergency department nearby. Personally, I think people should write their congressmen and say, "Fix this now."
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