Wednesday, February 11, 2009

The U.S. health care crisis

A conservative friend recently forwarded an email complaining about potential health care rationing under President Obama's proposed health care program.

So I decided to do some research on my own. (My comments are in red.)

Here's what I found out:

US Health System Ranks Last Compared to Other Countries: Studies
May 15, 2007 WASHINGTON

"The US health care system ranks last among other major rich countries for quality, access and efficiency, according to two studies released Tuesday by a health care think tank.

"The studies by the Commonwealth Fund found that the United States, which has the most expensive health system in the world, underperforms consistently relative to other countries and differs most notably in the fact that Americans have no universal health insurance coverage.

"The United States stands out as the only nation in these studies that does not ensure access to health care through universal coverage and promotion of a 'medical home' for patients," said Commonwealth Fund president Karen Davis.

"The US ranked last in most areas, including access to health care, patient safety, timeliness of care, efficiency and equity. Americans were also last in terms of whether they had a regular physician.

"The US spends twice what the average industrialized country spends on health care but we're clearly not getting value for the money," Davis told AFP.

"The United States is also far behind in adopting modern health information technology, which translates into spiralling costs and poor care."

U.S. Health Care Spending: Comparison with Other OECD Countries - published May 2007 by the Congressional Research Service (under the BUSH administration):

"...countries that spend less than the United States on health care nevertheless enjoy similar high levels of reported health status. In particular, New Zealand, Ireland, and Canada spend a half to a third as much as the United States, yet the percentages of their populations who report a "good" or better health status is nearly identical to the United States.

"The average life expectancy for a person in the United States is 77 ½ years — slightly below the OECD average, and 4½ years less than top rated Japan. Life expectancy is nearly 2½ years longer in Canada than in the United States. The United States is ranked 22nd out of 30 countries on life expectancy at birth.

"The United States has a higher rate of deaths from natural causes than 17 OECD countries. The higher U.S. number of premature deaths (before the age of 70) from all causes except external causes (e.g., accidents) results in an average of 35.9 years of life lost per 1,000 people in the United States — a loss of roughly 7 additional years compared to the OECD average of 29 years of lost life per 1,000 people.

"Death rates for heart disease in the United States are the 17th worst in the OECD, despite the fact that the United States performs substantially more invasive heart procedures than all other countries in the OECD. "In terms of respiratory diseases, the United States ranks 24th out of 30 countries, with twice as many people dying from respiratory diseases in the United States compared with the top-ranked countries, France, Switzerland, and Italy.

"The United States has the third-highest rate of deaths from medical errors, among 26 countries reporting."The United States has the third-highest infant mortality rate in the OECD, after Turkey and Mexico.

"In 2004, the United States spent more than twice as much on health care as the average OECD country, at $6,102 per person (compared with the OECD average of $2,560). Health care spending comprised 15.3% of the U.S. GDP in 2004, compared with an average of 8.9% for the average OECD country. Although a country's health expenditures are highly correlated with GDP, U.S. health spending is nevertheless 60% greater than its GDP alone would predict.

"The United States spends more on prescription drugs per capita than any other OECD country. The United States also consumes more prescription drugs than most OECD countries, according to a nine-country study. That study found that the United States paid more for brand name drugs but less for generic drugs than other OECD countries."Spending on health administration and insurance cost $465 per person in the United States in 2004, which was seven times that of the OECD median."

NY Times July 17, 2008
While the U.S. Spends Heavily on Health Care, a Study Faults the Quality
"American medical care may be the most expensive in the world, but that does not mean it is worth every penny. A study to be released Thursday highlights the stark contrast between what the United States spends on its health system and the quality of care it delivers, especially when compared with many other industrialized nations.

"The report, the second national scorecard from this influential health policy research group, shows that the United States spends more than twice as much on each person for health care as most other industrialized countries. But it has fallen to last place among those countries in preventing deaths through use of timely and effective medical care, according to the report by the Commonwealth Fund, a nonprofit research group in New York.

"Access to care in the United States has worsened since the fund’s first report card in 2006 as more people — some 75 million — are believed to lack adequate health insurance or are uninsured altogether. And within the nation, the report found, the cost and quality of care vary drastically.

"The study, which assesses the United States on 37 health care measures, finds little improvement since the last report, as the cost of health care continues to rise steadily and more people — even those with insurance — struggle to pay their medical bills."

So things continue to get worse.

From McKinsey Global Institute: (See here for the complete study.)

"…the United States spends $650 billion more on health care than might be expected given the country's wealth and the experience of comparable members of the Organisation for Economic Co-operation and Development (OECD). The research also pinpoints where that extra spending goes. Roughly two-thirds of it pays for outpatient care, including visits to physicians, same-day hospital treatment, and emergency-room care. The next-largest contributors to the extra spending are drugs and administration and insurance.

"It's not clear whether the United States gets $650 billion worth of extra value. Parts of the US health care system, such as its best hospitals, are clearly world class. Cutting-edge drugs and treatments are available earlier there, and waiting times to see physicians tend to be lower. Yet the country lags behind other OECD members on a number of outcome measures, including life expectancy and infant mortality. Furthermore, access to health care is unequal: more than 45 million Americans lack insurance."

So you could say this is a $650 Billion tax that weighs down our economy and as a result makes the products and services that we might export that much less competitive, costing more Americans their jobs (and health insurance) in a continuing downward spiral.

From Wikipedia:

"The health care system in the U.S. has a vast number of players. There are hundreds, if not thousands, of insurance companies in the U.S. This system has considerable administrative overhead, far greater than in nationalized, single-payer systems, such as Canada's. An oft-cited study by Harvard Medical School and the Canadian Institute for Health Information determined that some 31% of U.S. health care dollars, or more than $1,000 per person per year, went to health care administrative costs, nearly double the administrative overhead in Canada, on a percentage basis.

"Enrollment rules in private and governmental programs result in millions of Americans going without health care coverage, including children. The U.S. Census Bureau estimates that 45.7 million Americans (about 15.3% of the total population) had no health insurance coverage at some point during 2007. Most uninsured Americans are working-class persons whose employers do not provide health insurance, and who earn too much money to qualify for one of the local or state insurance programs for the poor, but do not earn enough to cover the cost of enrollment in a health insurance plan designed for individuals.

So THE U.S. CURRENTLY HAS HEALTH CARE RATIONING. The problem is that the rationing is done on the basis of income and employment. If you're unemployed like a significant and growing percentage of Americans, then you lose your health care. Few unemployed people have the resources to pay for private coverage, so their families go without health care. The U.S. could experience a real public health crisis in the event of a pandemic, because so many will lack the ability to afford immunizations or treatment.

"A lack of mental health coverage for Americans bears significant ramifications to the U.S. economy and social system. A report by the U.S. Surgeon General found that mental illnesses are the second leading cause of disability in the nation and affect 20 percent of all Americans. It is estimated that less than half of all people with mental illnesses receive treatment due to factors such as stigma and lack of access to care."

So the U.S. health care system costs too much, delivers too little, hamstrings the US economy with excessive costs that drag down our economy - and is also unfair, failing to provide for the basic health care needs of millions of Americans.

The Obama program may not be perfect, but it's well past time for arguing about whether fundamental change is needed. The sooner we get started the sooner we'll arrive at a better future for our country. I want my grandchildren to grow up in a healthy world.

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