There is no doubt that the Affordable Care Act (Obamacare) has had a rocky roll-out. Delays, computer glitches, frustrations over coverage, gaps in coverage depending on residency, and general political malaise have given the program a very murky and pessimistic start.

While Obamacare focused on getting more people insured, its overall goal was to get more people into the broken health care system. More of a bad thing doesn't fix the underlying problems -- our health care system needs more transparency, better oversight, and the ability to allow customers to "shop" health care (probably the least capitalist feature of the American health care system).

 

Medical research has become an issue where the foxes are in charge of protecting the chicken coup. Drug companies conduct their own studies and then supply the "unbiased" results to the FDA for approval.

One of the ethical considerations in doing research is the requirement to publish negative findings (or findings that do not support what you were wishing to find). Even disproving hypotheses add to the overall common knowledge. Sometimes knowing what doesn't work is as important as knowing what does.

Yet more and more instances are coming out where the drug companies are deliberately skewing the data and conclusions of these studies in an effort to get the drugs to the market faster and/or create a demand for the product once on the market.

Take for instance the wonder-drug, Tamiflu, produced by Roche. Recent investigative research by both BBC and Reuters has found that this drug, with sales of $3 billion in 2009 alone, has about the same effectiveness as Tylenol for treating influenza.

This was determined after a long, drawn-out fight to get the company to release its testing data to a third party for independent research and verification. Once the data was released, it was completely apparent that the manufacturer knew the weaknesses in the drug's trial performance.

What is worse is that the governments of the United States and U.K. were stuck with most of this bill -- with the US government spending $1.3 billion on adding this drug to its strategic reserves and the U.K. government spending $700 million.

Where is the outrage?

Sure, this doesn't add up to the enormous bill for Obamacare. However, this is a case where the U.S. government was deliberately ripped-off by a greedy corporation.

There is the implicit belief that corporations should receive patents for new drugs because they need to recover the R&D expenditures. The thought being that a "better mousetrap's" desirability would make it a target for companies to make knock-offs and counterfeits if the protections didn't exist. Why then, according to the WHO, do drug companies need to spend over twice as much on drug advertising as they do on R&D?

Every capitalist model assumes that companies are trustworthy -- otherwise they would lose business in the long-run. Yet, over and over it is becoming clearer that outright fraud in the prescription drug markets is becoming common place, and not the exception.

 

The "business" of health care likes to target patient satisfaction as its number one goal. Like any other industry, happy, satisfied customers are essential. This seems like a truly capitalist feature of the American health care system. But this is completely false.

Patients need adequate care, and the factors that give patient satisfaction have no bearing on the adequacy of care (i.e. was waiting time too long, nurses rude, proper allocation of medical resources, wi-fi availability, etc.)

A recent JAMA article concluded that:

In a nationally representative sample, we found that higher patient satisfaction was associated with lower emergency department utilization, higher inpatient utilization, greater total health care expenditures, and higher expenditures on prescription drugs. The most satisfied patients also had statistically significantly greater mortality risk compared with the least satisfied patients.

People equate action and personable care as effective treatment -- even when sometimes the correct path is tough love or no treatment at all.

The American Medical Association echos this with its policy statement:

Physicians serve patients not because patients exercise self-determination but because patients are in need. Therefore, a patient may not insist on treatments that are inconsistent with sound medical practices. Rather, physicians provide treatments that are designed to make patients well, or as well as possible.

Part of medical ethics is providing sound practice to people who are not trained to know the difference -- even when it upsets the patient.

Imagine going to a restaurant with your friends. Right off the bat, a few of your friends are told that they can't eat there because they don't have the right contractual agreement. There are no menus with items or prices. And to make matters worse, when you each get the same things, you pay a different price at the end -- ranging from nothing to hundreds of dollars.

We would scream if this was how any other industry was run, but we expect and tolerate this from the health care industry. You cannot shop for health care procedures; almost never are you given a price before the service is rendered (or given cheaper options). Even worse, cash prices are set by the insurance contracts -- so that people paying cash can't get "too good" of a deal.

Try calling around to different clinics asking how much an x-ray will cost you. They will more than likely be unable to tell you (especially if you have insurance) AND they will probably not dispense the service without their own physicians examining you first (instead of relying on orders/records), thereby doubling up on the cost of office visits.

Patients not being able to make informed decisions on the prices of treatment is against every capitalist principle there is. This has been a common theme of medical billing for years -- nothing new or created by Obamacare. Patients should be able to seek alternative treatments or providers, or even choose not to accept treatment.

Now that more people are covered under the same broken system, hopefully Congress with take up actually fixing some of the greater flaws in the health care industry as a whole.