on the recent state of healthcare in the us.
- jacob sejersgaard-jacobsen
- Jan 21
- 4 min read
Updated: Jan 22
The grapes of wrath.
A comparative review of 'we got you covered, by Dr. A. Finkelstein, & a Liran Einav,
with notes on the associated H.R. 3421 bill, by some members of the 118th congress.
Reading as a citizen of Denmark, with its typical Scandinavian healthcare system & social security expenditure of in all some 20% of gdp, divided equally among those 2 heavy-weight positions on the public budget - only surpassed by France with its +30% of gdp on similar public services - and where the notion of private clinics & healthcare services were until recently mostly frowned upon, we’ve got you covered offers a comprehensive insight into the intricacies of the healthcare system in the US, where private insurance companies act as gate-keepers to the many authorized providers of healthcare, in a competitive market-place where citizens will have to choose the most promising healthcare insurance, often offered through their most regular employer – in contrast to the nationalized health service in most of europe, where coverage through a primary care unit, referring to specialists, is provided to all with a legitimate address.
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The book offers a sweeping review of the main trends in healthcare policy since the founding of the republic, with references to many continental policies in modern times, and aligns itself with the affordable care act, as it recommends to cut out the insurance companies and middle-men, and expand the age +65 medicare, to all citizens with a legal address, who will then have to choose among the 12.000 licensed primary care units.
Many of these policies were unknown to this pundit on the healthcare sector, who until recently focused mostly on the optimal economy of scale for municipality-wide primary care providers, and county-wide emergency care providers, with trend-lines for annual cases per 100.000 capita in the OECD, and man-hours in consultation, hospital bed, as well as in the operating theater, for most commonly occurring ailments, as a guidance.
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I will not spoil the book by referring in great detail to these policies, introduced with an academics sometimes idiosyncratic didactic, as it reigns in volley after volley of unruly campus-town forever teens, with regular references to popular culture on the subject matter, before it guides the reader to layers of considerable insight in 2-hour sessions –
amongst others on sailors’ insurance come harbor-side in the 1800’s, the bitter across the aisle founding of the NHS after ‘45, the medical professions virulent opposition to nhs in the UK & Canada, the Maynard tv-show A game of life & death, the Rand HIE, and the Oregon Commission, with its 3-layer cost/benefit analysis of 1.600 ailments, where;
a) a year of perfect health is awarded a score of 100, and death a most blissful 0,
b) the cost of treating 1 ailment, i.r.t. its subsequent improvement on health score, &
c) the moral imperative & necessity of treating a fellow citizen to such an improvement,
whereby Rawl the moral philosopher’s concept of reflective equilibrium disclosed itself, alongside the ancient allegory of the good samaritan, and J. Buchanan’s related dilemma.
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While +65 medicare appears to leave the god damn boomers - i.e. our most spoiled & honorable geron - free to choose, insurance companies currently act as gate-keepers for more ordinary 18 to 65 medicaid recipients, who are often at odds with their healthcare providers, as well as with their insurance company, on ailments & adequate treatment.
This dilemma on proper diagnostics is barely touched upon, as the authors leave a pile of shiite in their representatives committee, with recommendations for a separation into ailments covered by universal basic healthcare, and ailments covered by single user pay.
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The book does mention nominated uptake, as the US currently face a shortage of some 96.000 primary care physicians - up from some 60.000 because of the aca - who will be left as the sole gate-keepers, with its recommendation to cut out the insurance company.
With some 12.000 authorized primary care centers in the US, every municipality of some 30.000 inhabitant could be very well covered, if the trendline for most common ailments per 100.000 capita county side, meets nominated uptake at every campus in that state.
It does also reveal, that only about 10% of the population is currently without coverage, which gave way to the title of this review, and equates 25% of superfluous expenditures to flawed diagnostics & treatments, and another 25% to insurance mobs & middlemen.
While the reader is fairly well introduced to these studies & policies on healthcare, the author is also painfully aware her role as a tenured professor, will leave law & execution to the people’s elected representatives in municipality, county, state and federal assembly.
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This here observer recommends the author’s distinction between ailments covered by universal health care, and ailments which should be left to the private market, as well as the distinction between participating & non-participating providers in the H.R. 3421 bill,
and foresees a tremendous saving with annual check-ups at those 12.000 primary care centers, if they emphasize preventive measures, based upon blood & urine samples in county units, more proper diagnostics, and referral to secondary & tertiary specialists –
whereby many of those 1.600 ailments, will never reach the state emergency care unit.
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references;
page 125, not free to choose, on gatekeeping following the RAND HIE.
page 137-40, back on the Oregon trail, on so-called moral equilibrium.
section 340 of the public service health act, regulate those 12.000 chc.
https://www.uclahealth.org/news/article/ preventive-vs-diagnostic-care-what-to-know-and-why-it-matters
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