The symbol you see here is a Caduceus which is an icon adopted by most commercial interests in the health care industry. The Asclepius, which is pretty much the same except for it’s derivation and the fact that it only has one snake, is representative of most health care professionals…doctors, nurses, etc. Interestingly there is no symbol that represents the most important constituency of the health care industry…the consumers…me and you. The derivation of each symbol, and how it came to represent the various factions (which I will not bore you with) makes about as much sense as how we consume and pay for health care in the United States today.
Can we all agree at the outset that health care in America is a mess, and no one knows for sure whether the most recent health care legislation (Obamacare to some of you) will make it better or worse. Let me give you some facts:
1. According to George Will, who normally gets his facts right, individual consumers of health care pay only 12% of total costs for services provided. Someone else, insurers, government, employers, etc, pay the other 88%. Twenty-five years ago individuals paid 47%. Granted, it cost a lot less then, but you get my point.
2. The US leads the world in health expenditures per person at approximately $4500, but is last of all developed countries in life expectancy.
3. We are second in the league tables for MRI machines per million of population after Japan, but we’re last in number of deaths per 1000 live births for all developed countries.
4. US health care costs as a per cent of GDP are the highest in the world by a wide margin at 17%, but the per cent of health care costs paid by the government is the lowest at 45% compared to other developed countries who range from 67-82%.
5. And finally, while it’s widely agreed that if one has enough money, one can get the best care in the world here, that care is not accessible for most of our fellow citizens. To wit: life expectancy in the US, in spite of spending over $2 trillion dollars a year (about twice as much as any other developed country), is dead last of all developed countries.
Something just ain’t right. And it’s going to take us to the poor house, if it hasn’t already. Like the Caduceus and the Asclepius, the reasons for all this are complicated, and even if you understood it all, it still probably wouldn’t make much sense. If the facts stated above are a surprise to you, you’re in good company. In the recent debates about health care reform, I recall no discussion in which the parties started with a clear statement of the problem before launching in to their particular brand of political rhetoric. Let me take a crack at what they didn’t do…clearly describe the problem succinctly without political polemic.
WE ARE SPENDING TOO MUCH AND GETTING TOO LITTLE FOR TOO FEW.
The $64,000 question….no, the $2 trillion question is…whyzzat? Let me give you a clue. We are part of the problem. Of the three major constituencies who consume health care, two of them don’t care what it costs. The fully insured (those with private insurance provided by their companies or medicare), and those who rely on public institutions at no cost to them, have no motivation to question the cost of their care. The cost of care is someone else’s problem. The third constituency, those with high deductible, limited coverage insurance care a lot about cost, and they behave as very well educated consumers should behave. They shop around, they ask about costs, they ask about alternatives, they ask about medical necessity, and they ask about outcomes. Most of you reading this piece will belong to the first (fully insured) group. Be honest. Can you tell me the last time you had a conversation with your health providers about costs. And if you did ask about cost, could they tell you. I thought so.
Those of us who are willing to face the fact that the system is broken know that there are many reasons. I’ll name but a few:
1. Too much bad government regulation
2. Not enough effective government regulation
3. Fraud and abuse by unscrupulous providers
4. Defensive medicine
5. Runaway legal costs for medical malpractice torts
6. Rapid proliferation of new medical technologies
7. High development and marketing cost for new pharmaceutical products
8. Fee for service billing practices not tied to outcomes
9. Inefficient private insurers
10. Inefficient public plans (medicare and medicaid)
11. Misalignment of financial incentives of medical care providers
12.Lack of individual accountability
13.Poor consumer behavior
14. Too much use of emergency facilities for the primary care of uninsured consumers
The odd thing is that most knowledgeable people would agree on most of these causal factors, but still can’t agree on a course of action to address the underlying problems.
The harsh reality is that about one in six (slightly over fifty million) of our citizens have no form of health insurance either because they don’t think they need it or because they can’t afford it and don’t qualify for an existing government plan. Mostly the latter. It’s pretty clear that these one in six are going to get sick and need care at some point. Some of them won’t get care when they desperately need it, some won’t get timely care, and some won’t get the quality of care they need. Hence, the US has the highest mortality rate in live births per thousand of all developed countries and the shortest life expectancy. Is this crazy or what? And to compound the craziness, the care that is provided for this group through city and county hospital emergency rooms is the least efficient and most costly.
There is no evidence available yet that the most recent health care reform legislation (The Affordable Health Care Act) will help, but I have to believe that problems caused by man can be solved by man. I’m pretty sure, though, that name calling won’t help. Let’s keep working on it until we get it right.