Few discussions inspire such vehemence as the discussion about health care in the US. We have been wrestling with what to do with it since the Great War, and we tend to talk big about changes every four years that we have national elections before we go back to (grudgingly?) accepting what we have. Such raving leftists as President Harry Truman called for a national insurance plan that would cover anyone who wished to join. Such level-headed and scientifically-minded groups as the American Medical Association denounced it as the thin wedge of Communism. The debate has see-sawed over the decades between a debate about lost productivity to illness and the individual’s responsibility to earn health care. Of course, it was hot campaign issue in 2008, with then Candidate Obama trying to move the debate away from a social-right to an economic necessity. Though health-care ‘reform’ was passed this past spring, and most Republicans are still planning to use that opposition as a catalyst for their fall campaigns.
Health care is about as personal-yet-public a topic as one can imagine. Health seems like one of those things we will sacrifice anything to retain, and putting mere dollars on our wellbeing seems tawdry. By the same token, the business of America is business. And health care is a business – to the tune of some 17% of GDP in 2009 (though the percentage probably reflects an overall reduction in GDP rather than a ballooning of health care expenditure). What do we pay? And what do we get for what we pay for?
Much of what we get is elective, and many of us can afford it because we are productive in other sectors of the economy (i.e. at our non-medical jobs). John Tamny of Forbes.com argues that the elective quality of much of our health care is testament to the wealth of the private sector and evidence that the government should remove itself from the health economy to allow market efficiencies to drive down costs:
While the life-saving innovations wrought by doctors and pharmaceutical companies can’t be minimized given that humans themselves are economic capital, health care, far from an economic input, is for the most part pure consumption. Unless it saves our lives or heals what we’ve broken, most of what is described as health care doesn’t make us more productive or valuable to our employers. Instead it is consumption and a transfer of wealth no different from buying a house or a movie ticket. It is because we’re rich that we buy a lot of health care, much of it not of the life-saving variety.
For proof, one need only ask how many psychiatrists practice their trade in Pakistan or Bangladesh, or how many citizens of both countries avail themselves of the various anti-depressants marketed by pharmaceutical concerns, including Prozac, Zoloft and Paxil. Getting one’s head shrunk is a non-essential luxury mostly found in rich countries (Argentina is an exception).
And while it’s difficult to imagine a life without glasses, the growing consumption of LASIK surgery (this writer swears by it) is more of a vanity thing than economically essential. Notably, because LASIK procedures are purely elective since the consumer is also the payer, the prices of these procedures continue to drop.
Unfortunately, the ‘system’ we have is part of the market already, and it seems not to be especially efficient either at keeping health-care costs down or at giving us the expected outcome. The Commonwealth Fund has updated its report on Commonwealth Fund Study on US Health Care In International Comparisions in comparison to other industrialized nations, and the report is a stark reminder that we are happy to pay for what we are not getting:
Over the past decade, leaders in the United States have begun to realize that the nation’s health care system is far more costly and does not produce demonstrably better results than any other system in the world.1 It is increasingly clear that the United States has nowhere near “the best health care system in the world,” and that performance often falls markedly short of that of other countries. Despite this awareness, costs continue to accelerate relative to other countries. To do better, the U.S. must search for lessons that might be adopted or adapted to improve its system.
In the first major attempt to rank health care systems, the World Health Organization’s (WHO) World Health Report 2000 placed the U.S. health system 37th in the world. This called into question the value Americans receive for their investment in health care. The U.S. ranked 24th in terms of “health attainment,” even lower (32nd) in terms of “equity of health outcomes” across its population, and lower still (54th) in terms of “fairness of financial contributions” toward health care. In the same report, the U.S. ranked first in terms of “patient responsiveness.”
The the takeaway point of the report can be found on the first ‘league table’ posting in the report, showing that the Number One country in terms of overall health care is The Netherlands (what might this say about what the national soccer team will do in the World Cup Final this Sunday?) and the US is ranked 7th, with no part of the qualification rating above a 4 (Patient-Centered Care and Effective Care). For this seventh-place finish, we pay almost twice as much as Holland ($3837 vs $7290). Such figures do not mean longer lives any more than healthier ones, either. Germans suffer 3.8 infant deaths per 100,000 births, whereas 6.7 babies die in the US per 100,000 (again double). And our average life-expectancy after 60 is equal to that of Britain’s (both at the bottom of the seven-nation list), but the British spend $2992 per person per year for the opportunity.
As we reported yesterday, Americans are twice-over the most generous givers to charities in the world. We also spend more than double our peers on our health care. For the former, we get social interaction and interdependence that helps us build out of many into one nation. For the latter, we get wealthy rationed health care.our stays in hospitals and when our drug coverage is no longer applicable. Health care as it is currently configured is, therefore,
So as we wind down this ‘series’ commemorating the US Declaration of Independence, we end on a subject that clearly will tax our skills to create ‘a more perfect union.’ How can we turn our incredible wealth and technology into sustainable and equitable (not ‘equal’) health care for the millions of people who add to that wealth every day, but who are not really in a free market to buy the care they need? Insurance corporations and the AMA have worked hard to insulate their professions from government interference, and in so doing they have given us the very system Americans do not tolerate in any other context: expensive and rationed. Perhaps another declaration of independence is required from the citizenry? One that reflects the position so eloquently stated by President Abraham Lincoln at Gettysburg in 1863: “government of the people, by the people, and for the people.”