Introduction
It is no secret that one of the most significant difficulties facing the United States today is the infrastructure of its current healthcare program. Healthcare is one of the largest expenses of the United States, taking up a whopping 18% of its GDP. President Barak Obama made the last significant update to the nation’s welfare programs in March of 2010 with Obamacare, and many things have changed in the last 13 years. As one of the only countries in the world that use an insurance-based healthcare system, America is extremely far behind. In other countries around the world, most GDP spending delegated to healthcare is around 10%. In this analysis, I will discuss Dr. Sean Flynn’s lecture, “The Cure that Works – How to Have the Best Healthcare - at a Quarter of the Price,” as well as discuss other issues in the medical industry that limit America’s ability to advance in healthcare.
What does Singapore do?
Dr. Flynn’s lecture discussed America’s healthcare system in relation to other systems that have been implemented around the world. One of Dr. Flynn’s most prominent examples, and the basis of his lecture, surrounded the healthcare system used in Singapore. Singapore uses a healthcare system that only takes up 4% of its GDP. in addition to this amazing statistic, they have one of the most free-market-based medical industries in the entire world. How do they do this? They call it the 3 M’s: Medisave, Medishield, and Medifund. Medisave is a mandatory savings account in which all citizens must put 25% of their gross income into a retirement savings account that cannot be accessed until it is needed for medical expenses. With a cap of $50,000, the purpose of this account is to ensure that all citizens have money saved as they age so that when their body starts to break down over time, they can pay for the care they need. The next step, Medishield, is a high deductible insurance system that is the foundation for their healthcare. Citizens pay $50 per month for their healthcare, which covers all expenses, with the exception of an initial amount and a 10% copay. In the event someone has surgery, the initial amount, $2000, is paid by the patient with the funds in their Medisave account, and anything past that $2000 is paid by the government (with the exception of the 10% copay). This forces physicians to become competitive with their pricing, and opens up the medical industry to extreme competition. The final M, Medifund, was created for citizens who are in unusual circumstances that require a lot of medical intervention. Examples of these circumstances might be rare cancers, severe illnesses, physical impairments that require lifetime physical therapy sessions, etc. Medifund allows patients to submit a request for a grant from the government in order to pay for their medical expenses. In this report, the patient must identify their medical issues as well as give proof that they cannot cover the expenses with the money they have saved. Singapore’s government approves nearly all of these grant request forms and covers the cost of the patient’s treatment. With this system in place, there is constant pressure on care providers to lower the cost of their treatments as well as give excellent care in the process. This is extremely beneficial to the country as a whole because the government covers relatively low-cost medical treatments, lowering the total amount spent on healthcare. This is how Singapore managed to pay so little to provide the best healthcare in the world.
Insurance – Issues on all Sides
Health Insurance in America is extremely complicated and very inefficient. Doctors get paid by insurance companies for the treatment they provide to their patients, rather than the patient paying the doctors themselves. The patient pays a small amount, usually unknown until months after treatment, depending on what their insurance provider does not cover under their plan. In an effort to get the most money from insurance companies, medical offices submit multiple billing codes based on the care the patient received during their visit. Insurance companies have the option to accept or reject the billing codes based on what they deem was covered under the patient’s plan. This system creates many unknowns surrounding how much care costs to the patient as well as when the medical provider will actually get paid. In addition to the stress this puts on the patients, it is already extremely difficult for doctors to be in-network with insurance agencies. In America, doctors must take it upon themselves to decide which kinds of insurance their office will accept (creating more issues for patients with poor healthcare plans). However, this process can be extremely long and stressful. It can sometimes take 9-12 months for a doctor’s request to be approved by the insurance company – per plan. The weird thing about this timeline, though, is that doctors can actually accept whatever type of insurance they’ve applied for before they get the final approval from the insurance company. This sounds great, but actually creates more issues on the side of the provider. For example, if a doctor is waiting on approval from the insurance company, and decides to take a patient with that plan, the doctor will not get paid by the insurance company for that treatment until the final approval is sent. This leaves the doctor without any sort of compensation for their work, with no way to tell when they will actually get paid. This is especially prevalent in therapy, for disorders like depression, anxiety, OCD, and many others. Therapists can typically only accept a few types of insurance (since most insurance companies don’t view therapy as essential medical treatment), and when they actually start to apply to be in-network with new insurance plans, they take an extremely long time. This is the reason why many therapy offices do not accept any forms of insurance and avoid the issue altogether.
Running out of Time
America must figure out a way to fix its healthcare program, quickly. With an aging population, America is facing a multitude of health crises. Diseases like Alzheimer's and other forms of dementia are expected to increase to extremes (the current statistic being 1 in 9 Americans expected to develop Alzheimer's as they age), as well as COPD, CAD, etc. Unfortunately, America is also facing a shortage of doctors, which will be exasperated as the population ages. Within the next 12 years, America is expected to see a physician shortage of between 37,800 and 124,000 physicians. The result of this shortage will be increased difficulties to access medical care, increased time between appointments, patient priority crises, as well as increased stress on medical providers, and shorter times with patients. Even though medical schools have been accepting, on average 35% more students with every term, this growth will not be enough to support the aging population in 20+ years. America cannot afford to lose any more prospective medical doctors due to the problems surrounding health insurance, the price of medical schools, or the stress of studying medicine (4th year medical students are 3x more likely to commit suicide than their same-aged counterparts). Unless the United States can make healthcare more accessible and affordable in the next 10-20 years, the current insurance-based system will not be able to support the stress predicted in the future, and many Americans will be left without lifesaving treatment.
Works Cited:
Andis Robeznieks. “Doctor Shortages Are Here-and They'll Get Worse If We Don't Act Fast.” AMA, American Medical Association, 13 Apr. 2022, www.ama-assn.org/practice-management/sustainability/doctor-shortages-are-here-and-they-ll-get-worse-if-we-don-t-act.
Paturel, Amy. “Healing the Very Youngest Healers.” AAMC, Association of American Medical Colleges, 21 Jan. 2020, www.aamc.org/news-insights/healing-very-youngest-healers#:~:text=In%20a%20recent%20study%20%2C%209.4,as%20their%20same%2Dage%20peers.