In this recent article in the Daily Beast by Molly Worthen, the author writes about how difficult it is to find out what medical procedures will cost and how much insurance will pay. She makes the point that single payer health care would be a much simpler system.
“How can we tell how much we’ll have to pay in total, assuming it’s a routine birth?” my husband asked.
“Oh, I couldn’t tell you that,” Tami said. Despite churning through droves of pregnant patients each year—many of whom are, like me, insured by the Blue Cross Blue Shield state employee plan—she had no information on what anything would ultimately cost. “Call your insurance company,” Tami said.
This is the evil genius of the American insurance system. No one has any information, and no one is responsible. I was reminded of the opening scene in Franz Kafka’s The Trial, when the officials who rouse Josef K. from bed to arrest him on an unexplained charge tell him they have no idea why he is under arrest: “We’re lowly employees who can barely make our way through such documents,” one says.
All are part of the growing economy of people—all very nice people, I’m sure—who have college degrees in medical billing and coding, who make their living feeding the bureaucratic beast that cost consumers $200 billion in excess administrative fees in 2009. Much of that waste would vanish if the United States adopted a public single-payer system of the kind that most developed countries favor.
A truly free market requires all parties to have access to the same information—and the time and expertise to interpret that information. Healthcare, by contrast, is an economy of specialized goods that most lay people don’t fully understand, in which insurance companies and many healthcare providers have a vested interest in concealing prices from consumers. And I’m always surprised by how few doctors seem to know the cost of treatments they prescribe. The Affordable Care Act may be better than no reform at all, but the law subsidizes this broken private insurance system. It also adds over 10,000 pages of regulations to the already byzantine bureaucracy that makes American healthcare one of the least cost-efficient in the world—behind even Venezuela and Iran.
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