As the heated debate over Obamacare rages on in Washington and across the country, we can all seem to agree on at least one thing: Health care is complicated.Despite some of the policies instituted by the Affordable Care Act, Americas medical system is still plagued by problems. Insurance premiums and drug prices have skyrocketed, leaving Americans struggling to accessaffordable care. A 2016 survey of 11 countries from theCommonwealth Fundfound that U.S. citizens were far more likely to go without care because it was too expensive.The U.S. is alsoone of the onlywealthy, industrialized nations that does not have universal health care. American health care prices are at least two to three times what they are in other countries, and nearly two-thirds of all bankruptcies in the U.S. are due to illness and medical bills. How did we get into this mess' Former Harvard physician and veteran New York Times reporter Elisabeth Rosenthal breaks down the evolution of American medicine ' from an industry in the business of providing care to one thats geared entirely toward maximizing profits. With her new book An American Sickness: How Healthcare Became Big Business And How You Can Take It Back, Rosenthals goal was to start a very loud conversation about an institution in crisis.The current market for health care just doesnt deliver. It is deeply, perhaps fatally, flawed, Rosenthal writes. Even market economists themselves dont believe in it anymore.Rosenthal, who also authored the Times popular Paying Till It Hurts series, has become a vocal advocate for patients rights and consumer education. Her book includes a glossary for medical bills and explanation of benefits,a list of pricing tools, and templates for protest letters to hospitals and insurance providers, among other resources for concerned patients.We sat down with Rosenthal to learn more about how this dysfunctional system came to be' and how a critical mass of educated consumers can create real change.How did we get into this mess' Was there a particular moment in American history that health care really took a decisive turn for the worse'When I started researching the book, I knew the outcome ' prices are really high compared to the rest of the world, and our outcomes are worse ' and I wanted to know how we got to this crazy place that the patients hate and the doctors hate. I found that there was a long chain of events over decades' decisions that looked smart when they were made, and good ideas that got perverted when the profit motive came into play.At some basic level, you could say that the problem started with insurance, but thats not to say that insurance is a bad thing. What those insurance policies did was to separate the payment from the services, and in the early days, we became blind to what was paid because we didnt pay it ourselves. Up until a couple decades ago, if you had good insurance, your insurer pretty much paid everything. Now, thats not the case anymore because people have higher co-pays and higher deductibles, and suddenly theyre saying, Whoa, how did things get so expensive' This allowed the system to become so costly, because consumers didnt notice for a long time.Another event was the entrance of businesses into the hospital space. Over the years, business jobs have become more common and much more powerful in health care. The people running hospitals are usually no longer doctors ' theres a layer of MBAs that didnt used to be there. Now, you find companies run by businesspeople who often have very little knowledge of the needs of medicine. They are, in the end, for-profit companies, and their goal is to maximize their revenue. I think theyve done that very effectively.How does the American health care system stack up compared to other developed countries'Well, the single most startling difference is that Americans think about cost and bills and whether they can afford a medical procedure ' and thats just not even in the conversation in other countries. I started this book while living overseas, and Ive interacted with many other health care systems. My experience in those other countries has been, for instance, profuse apologies for having to pay $100 for stitches. I remember thinking, You dont even know how lucky I am, because if I had gone into a hospital in New York with this, Id come out with a $500 copay, and my insurer would be billed thousands of dollars.Money is very much not part of the individual calculation in other countries, and its become the center of the conversation in ours.Where is all the money going' Who profits the most from this system'Its kind of everything and nothing. When you look at salaries of hospital, pharma or insurance CEOs, theyre really high ' millions, often tens of millions, annually. Thats one issue. But what I learned as I was researching this book was that its everything that contributes to the cost, and the money goes everywhere ' except to patients! Its basically being pulled out of our wallets.The money goes everywhere, but it often doesnt go towards what the patients really want or need or care about. On the whole, we see from our health outcomes that higher costs doesnt lead to better care.How can patients protect themselves'The first principle is that youre not helpless. The first step is to feel empowered, and not just to write the check but to start asking questions ' even before you see the doctor or go to the hospital.One thing I always ask my doctor now is, If youre going to send me for blood work, can you please send out the samples to an in-network lab' Ive seen so many patients with in-network doctors who send blood to an out-of-network lab, and the prices for something simple can be literally 20 times more what they would be if they were sent to one of the commercial labs thats in-network. Another question that patients should ask is, Why' Do I really need that extra X-ray' Will the X-ray change what we do' And if the answer is no, then maybe you hold off for now.So if you start demanding transparency, there will be pressure on hospitals to provide it.Are you hopeful for the possibility of change'I would say were at a tipping point where its become pretty unsustainable. We saw this at some of the town hall meetings recently, when people started to realize that repealing the Affordable Care Act would affect their own insurance.People are really struggling. But I do think theres a kind of groundswell of recognition that things are really not working well for most Americans with health care. The ACA shifted the dialogue on what the governments role is in ensuring that people get the health care they need. Now were back at the drawing board again. I echo what Obama said as he was leaving office: If the Republicans can provide real health care to all Americans at an affordable price in a different way, then great. Lets see it. President Trump says hes a good dealmaker, and were getting a really bad deal. -- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.
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