Excellent post, zara.
And to add to your thoughts, I'd like to put in my two cents, being in the medical field, and perhaps having a little inside info to share about medical stuff.
Most folks may not realize just how fucked up the medical insurance game is. Zara pointed out quite eloquently how the system is NOT capitalism. I would like to also state that it isn't even real business.
What I mean is that the prices for our services have nothing to do with production cost, overhead, or anything else which determines price a la supply and demand. Our prices are determined by what kind of insurance you have, and this also determines the level of care you will receive. Different insurance = different prices. This doesn't sound so bad until you realize that two patients with the exact same medical problem to resolve will be paying two different prices for the exact same service or product. Is this like haggling? No, not really... it's like going to a Burger King and being charged ten dollars for a cheeseburger because you're wearing a green shirt, while the folks wearing red shirts pay a dollar.
A hospital will charge as much as they possibly can, dependent upon what is expected from an insurance company, which is determined from a "diagnosis code" for some ailment you have. Nothing to do with what resources you have consumed during your treatment. Oh, those resources are tracked and billed for, make no mistake there: it's just that you may be paying a hundred more dollars for the same lab testing that the patient in the next room is paying.
So what ends up happening is that everything in your care is pre-determined according to actuarial calculations made by your insurance company. The lab tests your doctor orders, the medicine you are offered, the surgery you are offered... everything is dependent upon something we call "the standard of care".
I would say that most of the lab testing I perform, over fifty percent at least, is medically unnecessary. And that is me being very generous here... it's probably closer to eighty percent. This is lawsuit protection for the physicians who are legally responsible for your health and charged with providing the standard of care.
And "cover my own ass" medical waste/fraud is just the beginning of this mess. Many many many patients I see in the ER do not belong there. Some nights, half of the patients sleeping in beds in the ER are homeless drunks being "treated" for their medical problems which amounts to hunger and not having a place to stay the night besides a gutter somewhere.
If you are ever homeless, and you need to eat something, here is the magical phrase which will give you a temporary fix:
"I have chest pain."
Maybe it's chest pain from not having had any kind of solid calories in a week(whiskey only stops hunger pains for so long), but that doesn't matter. Because we MUST provide the standard of care, this bum gets the full workup, including lab testing, free meal, medical evaluation, maybe (if you are sly enough) some pain medication for your possible heart attack. IV fluids will also lessen the effects of the hangover from a week-long cheap whiskey bender. Bonus! We will even call you a free cab in the morning when you wake up.
Will that guy be paying his bill?
So do I have anything to say here besides some bitching? Yes. There is a solution to this, but nobody wants to hear it. This idea is so weird to most of us that I know the only way it might ever come to pass is for something in our system to seriously break, and the next few decades with our baby boomer patient population just might do it.
All we have to do is eliminate the legal responsibility the doctors have for your health. If we make each of us responsible for our own health, and doctors become more like "health consultants", then all the burden on our system starts to wash away. That's right, no more millions and millions of dollars in medical malpractice insurance premiums. No more rabid ambulance chasing lawyers, and the "cover my ass" needless expenditures. Maybe we can start with putting a major cap on malpractice awards? I don't know. But something is gonna have to change... take my word for it.