The disadvantages of a decentralized health care system

Ross Douthat writes for The New York Times about his shift “left” on health insurance.

After suffering from a painful undiagnosed condition, Douthat, a libertarian, realized that what might look like wasteful profligacy in health care is necessary testing to arrive at an accurate diagnosis. But, he still does not understand that our decentralized privatized health care system is designed to keep people from getting those tests.

1. Our decentralized health insurance system generates $800 billion a year of wasteful spending. Lack of centralization means thousands of entities individually making tens of thousands of decisions every year at enormous cost, from who’s in a network, to how much doctors and hospitals are paid, to what services are medically necessary.
2. Most of our wasteful health care spending is not from the quantity of services we receive. In fact, Americans receive on average fewer services than people in other wealthy countries. The wasteful spending stems from the high rates we pay.
3. Higher health care costs mean higher out-of-pocket costs that keep people from getting the care they need, leading to undertreatment and countless premature deaths.
4. To reduce spending on medical care and increase profits, our privatized system leads to widespread inappropriate delays and denials of care and coverage.
5. Consumers cannot avoid health plans engaged in widespread delays and denials, since they go undetected and, when detected and reported, the health plans go unnamed.

A centralized system meets everyone’s needs.

• It spreads risk across an entire population to bring down health care spending for everyone, including the people who most need care.
• It is transparent, enabling us to see and address emerging and persisting health care issues. Covid-19 is proof positive that our decentralized proprietary private health care system leaves us blind and on our heels.
• It is publicly accountable.
• A centralized system will never get everything right. But, it’s more cost-effective than our decentralized system, while guaranteeing everyone access to care.

Here’s more from Just Care:

• Inappropriate Medicare Advantage care denials appear widespread
• Coronavirus: Lack of timely data jeopardizes public health
• UnitedHealth Group found guilty of denying millions needed care, under court supervision
• Ten ways Medicare Advantage plans differ from traditional Medicare
• Coronavirus: Blame corporate health insurers for our failure to contain it