The US Healthcare System vs The US Postal Service

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Hello and welcome. I am Dr. George Lundberg, and this is At Large at Medscape.

Back in the old days of discussion about healthcare reform, leaders of the American Medical Association used to warn about a government takeover of medicine by sarcastically describing such a system as combining the "efficiency of the US Postal Service (USPS) with the compassion of the Internal Revenue Service." Such rhetoric was received with loud guffaws by appreciative antigovernment audiences.

Fear-mongering such as that, combined with hefty lobbying, helped prevent significant American healthcare reform for the entire 20th century, except for Medicare and Medicaid. Indeed, that metaphor remains in wide use among certain political groups.

So, I decided to take the 11-factor grid that I have used for comparing healthcare systems since 1993 and apply it to the current US healthcare (USHC) system and the USPS. A perfect score for each item is 9; a perfect total would be 99.

The Scorecard

1. Provides access to basic care for all. USHC: 5; USPS: 9. Some 40 million Americans remain uninsured; another 40 million are underinsured. Everyone can access the post office; it has walk-in service, no appointment needed.

2. Produces real cost control. USHC: 3; USPS: 7. Healthcare costs remain out of control in the United States; they are the most expensive in the world. A first-class stamp costs 49 cents, well below the cost in most other countries.

3. Promotes continuing quality and safety. USHC: 3; USPS: 7. Errors in medicine kill some 400,000 Americans a year; undeliverable mail totals about 4%. Dead letters are very different from dead people.

4. Reduces administrative hassle and cost. USHC: 3; USPS: 8. Obamacare makes it an even bigger hassle. Stick a stamp on a correctly addressed envelope and drop it into a box, and more than 99% get to where they belong.

5. Enhances disease prevention. USHC: 4; USPS: NA. Medicine is improving on this one.

6. Encourages primary care. USHC: 3; USPS: 9. To make big money, docs must specialize. Postal employees have no such perverse incentives, and they make house calls 6 day a week.

7. Considers long-term care. USHC: 3; USPS: 7. Unsolved for medicine; a political football for the postal service.

8. Provides necessary patient autonomy. USHC: 4; USPS: 9. Insurance companies, Medicare, health systems, and physicians still tell patients what to do. By contrast, you can use the USPS, FedEx, UPS, DHL, email, text messaging, Facebook, Twitter, phone calls, Skype, WhatsApp. You decide.

9. Safeguards physician autonomy. USHC: 4; USPS: NA.

10. Limits professional liability. USHC: 3; USPS: 9. Almost all physicians still run scared of malpractice allegations, and defensive medicine rules. Suing the postal service is a non-starter.

11. Possesses staying power. USHC: 3; USPS: 9. Do any of you believe that Obamacare will fix the broken system? Will it prevent more needed health system reform? For the postal service, "Neither snow nor rain nor heat nor gloom of night stays these couriers from swift completion of their appointed rounds."

Remembering that 99 is a perfect score, USHC scores 38 -- pretty awful, but consistent with earlier rankings. USPS scores 74 -- not great; a gentleman's C. But it is a blowout. If this were Little League, the mercy rule would stop the game at 4 innings; if this were boxing, a TKO would be called at about round 3. The USPS, a frequent scapegoat, wins by a landslide. And here is the dagger: The USPS receives no -- zero -- tax dollars for operations. Oh my.

That is my opinion. I am Dr. George Lundberg, at large at Medscape.


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