Dr. Martin Quirno: How the US healthcare system compares to Brazil and Argentina

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Martin Quirno, MD, is a fellowship-trained spine surgeon and clinical assistant professor of orthopedic surgery at New York University Hospital for Joint Diseases in New York City.

A Brazilian citizen, Dr. Quirno moved to Argentina as a teenager and graduated from CEMIC Medical School in Bueno Aires before moving to the U.S to further his career.

SpineLine, the main publication for North American Spine Society members, recognized Dr. Quirno in its '20 Under 40' list of top spine surgeons for 2019 in August.

Here, Dr. Quirno compares the Brazilian and Argentinian health insurance systems to that of the United States and outlines what regulatory change would the biggest impact on the U.S. healthcare system. 

Note: Responses are lightly edited for style and for clarity

Question: How does the U.S. healthcare industry compare to that of Brazil and Argentina? What major regulatory changes would you like to see implemented in the U.S?

Dr. Martin Quirno: The U.S. healthcare system is very different and unique compared to both Argentina and Brazil. Argentina and Brazil also have a significant private health system that in general provides excellent medical coverage with minimal out of pocket responsibilities. Most affluent people, especially the ones with the top-tier versions of these insurances, have direct access to the best healthcare. In general, only high-paying jobs will help pay for such insurances, but the individual can choose the insurance policy they believe fits his or her needs, instead of only being able to select among the ones provided by his or her job. This allows for competition between health insurance companies and a decrease in their prices. 

Unfortunately this is not the case for the immense majority of the population, which cannot afford private health insurance. For the rest of the population there are usually two separate systems. One is provided by the employers through different unions which is called "obras socials" in Argentina. These systems usually have their own hospitals, rely on mostly federal money and tend to be corrupted by their administrators. The other is the public or state system, which covers the remainder of the population. This is a very poor and depleted system with limited resources where patients have to line up for days to be seen in large clinics by an underpaid and overwhelmed physician. Because these two systems cover the majority of the population, the general level of healthcare is poor with very limited resources and orchestrated by corrupt managers. 

Everyone involved in healthcare in the U.S. agrees that changes have to be made, and soon, since the system is currently not solvent. I am a firm believer in a free capital market, but at the same time I don't believe that large healthcare corporations should be making record profits at the expense of people's health. I believe the decision of which health insurance you have should be decided by you, not your employer. The employers should provide you with a credit amount that can be applied to whatever insurance you decide to obtain. This would enable you to shop around for which plan fits your needs better, enabling health insurers to compete against each other for your health insurance credits, therefore providing better care for less money. If you want to obtain a better insurance plan than what your credit allows, you could always pay extra for it.  By lowering the cost of private health insurance, there would be a significant increase in people who could afford coverage.  

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