The missing caring in healthcare

The American healthcare system is ever-evolving which makes comparisons with the past difficult and with other countries even more challenging.  From Boiled Alive by Robert W Malone MD, MS.  The subheading is Living with American healthcare.  

I have lived under multiple healthcare regimes, principally American (in its many evolving forms), British, Swedish, and Australian.  When I have been asked in the past, my characterization has been that if you are suffering from any among the top 80% of ills to which the flesh is heir, you want to be in Australia or Sweden.  The care is accessible, good, friendly and cheap.  

But if you are suffering from one of the more rare and exotic conditions, the rarest 20%, you want to be in the US.  The system is enormously accommodating of variance and exoticism.  

In recent years, post Obamacare, the American system has split into three levels.  If you work for a corporation, in general, you are sitting pretty.  Quality is high, costs are (in the scheme of things) low but you have to spend an unreasonable amount of time on the bureaucracy of payments.

If you are in an Obamacare program, intended to make things affordable, you have reasonable access to good quality of care but it costs a lot and the bureaucracy is interminable.  

If you are poor, you can get surprisingly good care for free for the big things but little health maintenance.

I currently have corporate coverage which is dramatically better than Obamacare that I previously had as owner of a small business.  What I have noticed are big changes from care in the 1990s.  More big practices, more integrated data (which is great), more specialization.  On the other hand, continuity of care is miserable compared to thirty years ago.  You get handed off from one specialist to another with no one keeping an overall eye on things.  You have to be very proactive in managing your own health outcomes in a way that you really did not have to be.  

Which is an issue because of the specialization and access to obscure but precise data.  Lack of follow-up or follow-through is pervasive.  You have to determine yourself when this is warranted or an oversight which needs to be addressed.  You have to be your own ruthless advocate.

It is in this context that I read Malone's Boiled Alive in which he is comparing his experience of emergency medical care in Athens, Greece versus his home city of Los Angeles.  Interesting throughout.