In an earlier entry, I promised that right after the 2008 U.S. presidential election I would address an important subject, the U.S. health care system. Well, I’m a man of my word. My plan is to devote a number of entries to the subject, despite frequent warnings from my webmaster to make every entry a complete piece; there is just too much to discuss to fit into a reasonable length single entry. So the grand plan is to first provide an overview of the subject in this entry. Future entries will focus on the details.
Is health care a right or a privilege?
Before we get into the details,, it is necessary first to address a very basic moral/ethical/legal question: Is quality health care for all a right or is it merely a privilege? So, is access to quality health care just a commodity that one is free to buy on the open market just like a BMW or a ski parka or a condo in Aspen, Colorado? Or, is it a basic right? This is not just an academic question. There is considerable opposition to implementing a universal health care system in the U.S. For some, the opposition is a mixture of philosophy and interpretation of the law- that there is no basis in law (constitutional or otherwise) to spend tax money to assure health care coverage for people who have not “earned” it. It’s sort of survival of the fittest where America is seen as the land of opportunity. If people just work hard enough, they can make a success of themselves by making enough money to buy good health care coverage (and whatever other commodities they want); otherwise, too bad. The other side takes the position that whether or not there is a legal basis for universal health care coverage, the U.S. is a wealthy nation that can afford to do the right thing, i.e., provide universal health care coverage. I have greatly oversimplified the two opposing positions; it’s not just the “good guys against the bad guys.”
I am not going to take sides in this debate. I would point out, however, that many studies have shown that not having high quality access to health care for all, costs both those with and those without health care coverage dearly. For example, did you know that almost 1 of every 3 dollars spent on health care premiums actually goes to cover health care costs for the uninsured. So, as it turns out, unless we as a society are ready to deny all access to the health care system for those who do not have health care coverage (including life-threatening emergencies) or cash “up front,” it is far cheaper in the long run to assure health care coverage for all than to exclude anyone.
For the purposes of this discussion, I will assume that high quality health care coverage is a worthy goal for our society, regardless if one favors this approach on philosophic grounds or merely economic ones.
Is there really a health care crisis in the U.S.?
These days the term “crisis” gets tossed about quite a bit and I think it is way over used. It seems to me that for something to be a “crisis” means that the situation whatever it might involve is such that unless something is done about it in short order, the results are likely to be disastrous. In my opinion, the current U.S. health care system is a mess, and some would say it’s already a disaster. But, does that mean we have a crisis? I would prefer to think about our health care problems as more like a chronic disease that if left untreated (or treated poorly) will just get worse and worse for quite some time until things are so bad that something revolutionary happens- that would be a crisis. I don’t think we should to wait for the revolution (one never knows how a revolution will turn out), but rather, develop a comprehensive effective treatment for this “disease” now.
Despite its problems, doesn’t the U.S. have the best health care system in the world?
Myth: the U.S. has the best health care system in the world. Fact: among the world’s most highly developed countries, the U.S. ranks mostly last in the quality of its health care. Whether it is longevity, infant mortality rates, chronic disease outcomes, or whatever, the U.S. generally falls far short of what many other countries have been able to achieve. The U.S. does have some of the best medical care and research facilities in the world, but that hasn’t resulted in great medical care for many of its people. Some of the reasons for poor performance are related to socioeconomic status but even if one makes allowances for that, the U.S. falls far short- just having lots of money does not assure that a person will get high quality health care in the U.S.
Adding insult to injury: health care costs
So, the quality of U.S. health care is not up to its potential. Yet, on a per capita basis, the U.S. spends far more than any other country in the world on health care, more than $7000 per person per year. In fact, the U.S. spends about twice what the next closest country spends- 2-3 trillion dollars per year.
How come U.S. health care isn’t very good and costs so much?
It is not totally clear exactly why U.S. health care cost so much and isn’t so hot, but most experts point to one fundamental problem- access. Many people in the U.S. do not have easy access to the health care system; even if medical care in the U.S. were uniformly outstanding, if people can’t get the care, it doesn’t matter how state-or-the-art it might be. It is estimated that between 40-50 million people in the U.S. do not have health care coverage (by coverage, I mean commercial insurance or a governmental plan such as Medicare or Medicaid). Another 40-50 million more may have some form of coverage but which is not considered optimal (e.g., no drug prescription plan, very high deductibles and c0-pays, no preventive care coverage). Many experts have concluded that if the U.S. were to have universal coverage of high quality, medical care outcomes in the U.S. would be the best in the world.
But, with medical care costs so high and climbing every day, the question is whether or not it is possible to actually achieve high quality universal coverage in the U.S. without “breaking the bank?” I am confident we can can achieve those twin goals. In upcoming entries I will do my best to provide an easy to read road map showing where the U.S. needs to go (high quality health care access for all, at a price its citizens can afford) and how to get there . As I will emphasize, the U.S. cannot “fix” its health care system without improving high quality access and it cannot improve high quality access without controlling costs. No workable plan can disregard either component.
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