Tuesday, May 12, 2009

Spend More Get Less-The Formula for the American Health Care System

I just had to listen to part of a commercial from Conservatives for Health Care Choice (or something like that) about how "Americans know best when it comes to health care" and that we wanted to preserve choice of doctor, choice of treatment, up-front costs. I have been holding back from writing this post for awhile since I was not sure if I had anything to add, but listening to that group pandering to American's tendency to want choice over any other feature.

To make it absolutely clear, I am pro universal health care, and I think that the benefits of a private system-much less a "hybrid" system have been greatly overstated. The primary lines of attack against a public system are two: lack of choice and quality of care/health care cues. Both of these issues, especially the former, provide a distraction from the real issue at the bottom of the debate. Health care costs nearly twice as much in the US as it does in the next highest country (either France or Germany). US life expectancy and other important health indicators such as infant and maternal mortality are higher in the US than in Europe, in spite of our much higher spending. While I am not advocating accepting wholesale the European system, I do believe that it has some advantages that should be examined. For disadvantages, a public health system is usually said to be inefficient with long waiting periods. This is true for a couple of reasons: first, there is more demand due to everyone having health care. This means that everyone, no matter income levels or anything else, can get care. One reason our system is so costly is because our care has huge disparities between rich and poor/middle class, leading to many people using the emergency room for basic care, to hospitals having to eat the costs, to our poor health-care indicators (we have infant mortality rates among some minority populations that equal that of the developing world). This bias is, I believe, a fundamental injustice when the resources exist to expand coverage, just not the will. The other point that is cited, lack of choice, I believe to be a complete red herring. Our current system does not leave us with significant choice. We are already controlled by our health plan's favoring of some doctors over others up to the extremely restrictive HMO. "Choosing" treatment also only really applies to those capable of paying the huge sums necessary or those who have excellent insurance that covers basically everything. In other words, being rich in the US system means great care, for most people, it is not nearly as good. The US health care system is a hybrid system in which somewhere around 50% of health care is covered by the government (medicare, medicaid, veterans benefits, etc). This system is the least efficient out there because it allows insurance companies to cherry pick the least risky while leaving the poor and the sick to the government. When John McCain proposed a health plan of government insurance for those who could not get coverage, I was stupified because this basically amounted to an increase in the subsidy (us providing insurance to the uninsured through medicare, medicaid) to insurance companies by allowing them to get off not paying. Beyond these problems, there are several other issues. One is that insurance encourages doctors to be greedy and charge extra amounts. This is in part to pay for the lack of coverage in some, but also because they can charge it. Another problem is the cost of insurance to doctors, and another is the huge debts that medical school leaves with doctors. These challenges would have to be met during health reform but they MUST not be resolved without it since the provide leverage to get things done.

My second point is rather simple: health care is an uproductive addition to GDP. While we add health care "production" into GDP, I feel that it is inherantly flawed to do so. Health care does not, unlike machines or education, increase capital-human or otherwise, it merely prevents it degredation. At a time when health-care expenditures amount to nearly 1/5 of GDP, we have to think seriously if our growing health care industry based on overconsumption and growing at effectively a detriment to other productive growth is worth while. I say at a detriment because health care costs are a huge burden to the middle class and put hundreds of thousands to millions of people every year. Recognizing the inherent flaws in using health care as a valuable part of the economy will help us to make the tough choices when it comes to reorienting our economy away from the health sector and toward other sectors. This will be tough because the entire industry is the fastest growing in the country (even now in this recession). While I do not favor eliminating most of it, I feel that the insurance industry and medical services industries need to be reformed by whatever means are necessary.

One of our chief problems with health care costs is our dependence on our employers to provide it. This, not taxes or environmental, or labor regulations is the chief cause of our lack of competitiveness in the US. If we fail to remake our system, it is our employers that suffer the most. Today, fewer and fewer employers are able to provide comprehensive coverage, while those that still do, such as the auto companies, are making as deep of cuts as possible. Changing the place from which we get health coverage should be a number one priority for the health of the economy as well as of our actual health.

The ads on TV and radio right now that attempt to dupe Americans into fighting universal health care are really to me nothing more than disguised attempts to allow the continued accrual of huge profits by an industry that has forgotten its primary duty is to people, not cash. As I mentioned above, the argument of choice is flawed because our current system does not preserve choice, we are just controlled by insurance company officials instead of government officials. Also, the fact that we spend so much and get so little from our system should be a cause of concern. Instead, we are happy to rail against government health services and then, after we have failed to save enough for a major operation, or after we lose our insurance through some injury or medical history, we depend on the government or public hospitals to provide us care. The hyprocrisy, while typical of us who demand services and refuse to pay for them, is something about which we need a national dialogue.

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