Sunday, December 16, 2007

2015, The Pessimistic View

In the previous article, I referred to some of the things that would need to happen for us to see a different, more positive image of U.S. health care in 2015. In this article, I will look at the possible scenarios whereby the situation could look far worse in 2015.

So, we're looking at a system in 2015 where health care costs are spiralling out of control (20% of GDP and rising), more people than ever are uninsured, the nursing shortage is deteriorating further, etc.

"Business as usual" could have produced this result, as we are currently in a trend towards increasing health care costs, and also decreasing levels of insurance.

The incentive for full insurance coverage was mainly political, and the president largely realised their goal of insurance for all. However, this insurance was poorly finance and so uninderinsurance became an even more serious problem. Many people were bankrupted despite having paid premiums, and compulsory health insurance was called into question. Their reasoning was "why pay premiums if the premiums are useless when we get sick." Americans refused to pay high premiums for substandard health insurance, and so coverage became even more of a problem.

At the same time, malpractice suits increased and doctors felt compelled to practice very conservatively, liberally calling for expensive tests because they did not know their patients' health care histories and could not easily judge whether or not a test was really warranted.

Nurses' jobs were unpleasant. They felt as though they were constantly coding for various procedures to act as gatekeepers between patients, health care institutions, and insurers. This problem of billing was compounded as nurses were in ever-scarce supply, and the profession became increasingly unpopular.

As the financing of health care and the health care itself was increasingly disjointed, health care costs increased. Doctors felt that it was inappropriate to make decisions based on money.

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