Cash above Care

      Cash Above Care

      Signups for Obamacare in 2018 are underway, but so far, Congress and the President have failed to agree on major fixes to the program. Elisabeth Rosenthal, a physician and author of "American Sickness", says don't look to insurance companies, doctors, hospitals or the pharmaceutical industry for solutions either.

      Sharyl: You've said that under a healthcare system it's far more lucrative to provide a lifetime of treatments than a cure. What's an example of that?

      Elisabeth Rosenthal: I think the best example of that is diabetes. If you had a cure tomorrow for type one diabetes, you would knock out a major industry of pumps, of monitors, of insulants that are all incredibly expensive. If we're trusting in business models to give us innovation, they won't give us that ultimate innovation of a cure for a disease.

      Sharyl: In the US, is it cynical of us to expect a business that focuses on its bottom line to actually do something that's charitable maybe, that's not best for their business?

      Elisabeth Rosenthal: You know, basically drug companies, pharma, device makers, their primary responsibility is to their shareholders, that's just the reality. So, sure they'd like to do some good things for you and me. But that's not their primary responsibility. Likewise, really for some of the hospitals, we trust so much, and the insurers we trust so much. People say to me, oh, my insurers are in my corner, why are they paying so much? They're not in your corner either, they are for-profit companies that are responsible to their investors. And we can't expect them to act otherwise, we just can't.

      Sharyl: What do you see as the pros and cons of Obamacare?

      Elisabeth Rosenthal: Well I think the pros are pretty clear, it's that it covered people with preexisting conditions who before Obamacare were often having trouble getting insurance, or paying so much for insurance that they couldn't afford it. Major pro.

      Sharyl: What do you see as the primary flaws?

      Elisabeth Rosenthal: The idea of calling it the Affordable Care Act, for some people it made healthcare more affordable, for many others it didn't. I think another issue is that because our healthcare costs are so expensive, and because Obamacare really didn't do anything to control those costs, many people had rising premiums, rising deductibles.

      Sharyl: With health insurance, it seems to me we're basically spreading out the sometimes overinflated cost of services to different people, so you're picking winners and losers, not really solving the problem.

      Elisabeth Rosenthal: I think that the issue is, we keep trying to figure out, well, how can we spread these costs differently and make the math add up? And the truth is, when the sum is so huge and you want all this care, you can't make the math add up with the prices that we pay today.

      Sharyl: Is there, is there a possibility we ought to step back and look outside what we see as our traditional health insurance system?

      Elisabeth Rosenthal: I think ultimately, we need a way to control costs, or, whether that's single payer, rate regulation, total transparency where you know before you go into the hospital exactly what it's going to cost so you can make a decision. I think as every other country, we'll pick a system that's politically acceptable, that's medically acceptable, and in line with our values, which, you know, we do like choice in this country, we do have a very tech-intensive system. But we can't just pretend that nothing costs anything and keep asking for everything and wondering why it costs so much.

      Sharyl: When you refer to American sickness, what is it you're talking about?

      Elisabeth Rosenthal: I haven't found a lot of people who weren't happy with their care, who weren't happy with their results. What they were really unhappy with was the mystery of these bills and these explanations of benefits statements and the calls back and forth to the insurer and the hospital. The amount of bureaucracy in our system, the amount of pain, emotional pain, time wasted that people put into their healthcare that has nothing to do with health, nothing to do with getting better, is really extraordinary. And it's not just patients who complain, it's doctors too.

      Sharyl: And maybe I'm cynical, but, is it even possible for us to have a solution that's like maybe another country that's worked that's best for the people, when those whispering in the ears of those who are deciding, government and Congress, are paying them, quite literally, donations and, and, other forms, to protect them?

      Elisabeth Rosenthal: Well this is why I want people, the patients, the physicians, to kind of rise up, and have their voice heard. Because at the moment I think people in Congress are mostly hearing from the, the business interest, the financial interest in healthcare. Will those financial interests lose some of their sway? I hope so because what's happening now is not sustainable.

      Sharyl: And looking forward, where do you see all of this going?

      Elisabeth Rosenthal: So where I'm looking right now is to see what we're going to do about drug pricing because I think that'll give us an indication. This is an issue which both parties have said we need to deal with in polls at Kaiser Family Foundation, it's people's number one issue. There've been bipartisan bills proposed, and nothing is moving. So, how we solve that problem I think will be a good indication of how we're going to solve the larger medical problem.

      Healthcare and what follows Obamacare is one of our biggest stories we follow on Full Measure. In the weeks ahead, we'll report on the razor-thin dollar divide of Obamacare, and how just a small difference in family income, can mean insurmountable differences in cost. We'll also take a look at some alternatives to traditional health insurance.