Five MORE Failures of the American Healthcare System

Second part in a series.

Supporting direct care is imperative to American healthcare success. It’s about empowering patient and doctor, and yes, taking back control from healthcare’s crony oligarchs: insurance & government. The fact is, if we use insurance for primary care — things like a physical, blood panels, monthly prescriptions, a splint for a sprained ankle — the only buyer and seller is the insurance company and/or the government. Why? It’s because we’re looking at a subsidized system involving the general public.

Here’s a simplified explanation of American fee-for-service medicine (insurance-based medicine): A patient pays for “coverage.” This coverage makes them eligible to see a doctor, and determines which doctors they can see. This means the patient isn’t shopping; they are being “allowed” to take from a selection of healthcare providers. In turn, these businesses aren’t charging to recompense and profit from specific goods and services. No, they vary their charges at will just to stay in business.

And get this, it costs practices money just to get paid by the same insurance companies that “referred” their customers i.e. patients. And, docs don’t get paid for all the work they complete, even when they deserve it. In turn, they are forced to pull a rather shady trick of charging uninsured patients absurd out-of-pocket prices as a punishment for not playing along with a broken system. In a way, this is usury — a manipulation based on buyer’s ignorance (kind of like if you went to buy your husband or wife a nice, vintage guitar, but didn’t know anything about music gear; if someone tells you an American 70s Strat costs 10k, who are you to argue?)

This current model makes sense for events that are unpredictable — a fire, or a car accident, or cancer. But the public would NEVER do business like this to buy guitars. It would be verifiably insane.

Yet this is how we do primary care in the U.S. And it’s failing, along with the rest of the healthcare system. Here’s five more things that aren’t working:

6. Fewer Americans Are Receiving Health Care

Americans have shorter waits for non-elective surgeries, compared with other developed nations. Only four percent of us wait more than six months, considerably less than the Canadians (14 percent) or Brits (15 percent). However, when you consider how many Americans lack access to any health care at all, the wait-time advantage goes away.

Almost a third of Americans are uninsured or underinsured. Twenty-five percent don’t visit a doctor when they’re sick, due to cost. Twenty-three percent can’t fill their prescriptions. This is way worse in America than in any of the other countries surveyed. In Canada, only five percent skipped care, and in the UK only three percent. If you become acutely ill or injured, lack of access to care is devastating. That’s why we want direct care to be common. For a price you can afford, $10-$50 per month, working adults can see a doctor anytime, with no additional copay.

7. We Don’t Pay Physicians in Proportion to Their Quality of Care

Most other countries reward physicians for good care with financial incentives. For example, in the UK, 95 percent of physicians are paid, at least in part, according to the quality of care they deliver. In Australia, it’s 72 percent. The US scores lower than anyone else, at 30 percent. We’re not even a fan of this bureaucratic approach. Instead, we believe in direct care’s core value of free market competition. We want patients to enroll in Atlas MD because they get excellent care. If we don’t deliver, we believe their should be a competitor down the road who’s working to give better care at a better price.

8. Our Health Care Is Inconvenient

Americans’ access to after-hours services (early in the morning, later in the evening, and on weekends and holidays) is mediocre. For access to evening hours, we lag behind Australia, Canada, Germany, and New Zealand. A full 67 percent of Americans—more than in any other country—say it’s difficult to get care on nights, weekends, or holidays without resorting to the emergency room, where care is costlier and, if your injury is not life threatening, inefficient and time consuming. Only 30 percent of Americans report that they can access a doctor on the very day they need one, as opposed to 41 percent of Britons and 55 percent of Germans.

Direct care is an answer to this major failure. For a fraction of the cost, patients get something desperately lacking — 24-hour access.

9. American Physicians Don’t Listen to Their Patients

About 70 percent of Americans are satisfied with their physician’s “bedside manner,” which is lower than the Canadians, Australians, and New Zealanders. Americans are less happy about how well their physicians explain things to them, how long they spend with them, or how smoothly their appointments go, with respect to things like coordinating records and scheduling.

We can do better here. Step one is cutting the red tape. If we stop tripping over the bureaucracy, quality of care will improve. If doctors get paid for working, they will be less stressed, and they will do better work.

10. Most Americans Are Dissatisfied with the Current System

Americans were the least likely of seven major industrialized countries to report relative satisfaction with their health care system.

Only 16 percent of Americans report being happy, compared with 26 percent in the UK and 42 percent in the Netherlands. Thirty-four percent of Americans want a complete overhaul in the health care system, whereas only 12 percent of Canadians and 15 percent of Britons say the same. So we pay the most for our health care, but we have the lowest satisfaction ratings—even lower than those who spend more time “waiting in line.” Ezra Klein of the Washington Post makes an excellent point:

“There is no other area of American life where we collectively accept such a bad deal. We spend more than any other nation on our military, but our military is unquestionably the mightiest in the world. We spend the most on our universities, but our universities are the best on the planet. But we spend the most on our health care—twice as much as anyone else—and our health system is mediocre-to-poor, with 47 million of us lacking the insurance necessary to easily access it.”

And now you know why we went the way of direct care. Every revolution started with an idea, and brave men and women who stood by its virtues. Do you believe in direct care? Add your name to our growing map of fellow supporters.