Tuesday, February 17, 2009

America's Broken Health Care System

There are over 46 million uninsured Americans, representing about 16% of the population, more than in any other industrialized nation. Of those uninsured, 8.3 million are children, which is about one in ten children under 18. About 25% of people making under $25,000 are uninsured, as opposed to about eight percent of people making over $75,000. Minorities are much more likely to be uninsured than whites. Eighty percent of uninsured people are either working or come from a working family. The overall number of uninsured people is rising due mostly to a falling availability of employer-sponsored coverage.

The uninsured are less likely to obtain preventative care, more likely to receive poor treatment for chronic sickness, and more likely to put off needed medical care making the problem worse.

The reason employer-sponsored coverage is eroding is because insurance premiums are skyrocketing. Since 1999, employment-based premiums have risen 120%, compared to 44% inflation and 29% wage growth. The United States spends about 17% of its GDP on health care, compared to 10.9% in Switzerland, 10.7% in Germany, 9.7% in Canada, and 9.5 in France, all counties that provide health care to all of their citizens. Uninsured Americans incur over $40 billion in costs each year, 85% of which is payed by federal, state, and local governments.

About half of bankruptcies filed every year, somewhere around two million, are due to medical costs. Many of these people have health insurance, but are still forced to pay tens of thousands of dollars out of pocket. Most Americans are one medical semi-catastrophe away from bankruptcy. Part of the problem is that doctors and hospitals are unwilling or unable to negotiate flexible payment options.

Polls show that Americans are deeply unsatisfied with the current health care system and support a single-payer system by about 2:1 margin.

There are more facts and stats like this all over the internet, but the upshot is that the United States has a health care crisis. Health care costs are rising faster than wages and inflation, so less and less people are able to afford health care, so more and more people are forced into Medicaid or no insurance, increasing costs exponentially and decreasing the overall health of the nation.

But, of course, these statistics fail to account for the human side of the health care problem. There are innumerable stories of good people being completely destroyed by what would otherwise have been preventable or treatable illnesses. Besides the toll being uninsured takes on health and in the pocketbook, there is the added emotional pressures of stress, anxiety, and depression.

This is a moral issue foremost. Every other industrialized country offers at least basic medical care to all its citizens, recognizing health care as a right, not a privilege. The United States has more wealth and opportunity than any other nation, but fails to provide for the basic health needs of all its citizens. We have the means to alleviate immense suffering by providing health care to every American and we are at a point where it is irresponsible not to.

There are certain objections to a universal, or single-payer, health care system. The main objection is the cost. Certainly there would be increased taxation to cover the cost of the system, somewhere in the billions of dollars. This cost is offset by no longer paying monthly premiums, fewer developmental losses for children, greater years of workforce participation for healthy adults, increased preventative care, lower demand on ER's, increasing the strength of local economies, and more. As noted above, industrialized nations who provide some level of health care to all its citizens actually pay less as a percent of GDP than the United States.

Another objection is that the United States has the best health care system in the world and that the free market is the best system, not government control which would degrade quality. The United States ranks 23rd in infant mortality and about 20th in overall mortality. The United States ranks between 50th and 100th in immunizations depending on the immunization. Overall the United States is 67th. The free market system we currently employ has costs rising out of control, coverage at an all time low, and the lowest satisfaction among users and doctors of any industrialized country.

Even if there was a slight decrease in perceived quality of care, or some longer waiting periods for non-essential medical care (like getting warts removed), how does that weigh against the benefit of having all Americans insured? This is a matter of values, I guess. I have a relative who has said that he would rather die of cancer as an uninsured than have a universal coverage system. I have a friend who, while not endorsing an American single-payer system, had cancer as a child in England and received top-of-the-line medical care which saved his life and cost his family nothing out of pocket (besides the taxes for the system to begin with), while families in similar situations here in America regularly lose everything they own to fight that battle. Would we rather wait longer for some medical services in order to guarantee coverage for all Americans, or keep the current system and excludes tens of millions?

If the argument is that we have to keep government out of health care, then it is assumed that it is acceptable to have about one in six people in the country without insurance, with disproportional representation by poor and minorities. The free market system simply will never cover everyone. There are no other alternatives. Charities and churches cannot and will never have the capacity to insure the poor.

If, on the other hand, we see health care as a moral issue, where we seek for equality for all Americans, including in our ability to be healthy, then the government must get involved. Government cannot solve all our problems, or even most of them, but it can be useful, and in the case of health care, essential.

The Book of Mormon teaches us to care for the sick:
27 And they did impart of their substance, every man according to that which he had, to the poor, and the needy, and the sick, and the afflicted; and they did not wear costly apparel, yet they were neat and comely.
• • •
30 And thus, in their prosperous circumstances, they did not send away any who were naked, or that were hungry, or that were athirst, or that were sick, or that had not been nourished; and they did not set their hearts upon riches; therefore they were liberal to all, both old and young, both bond and free, both male and female, whether out of the church or in the church, having no respect to persons as to those who stood in need.
Alma 1: 27, 30. And:
37 For behold, ye do love money, and your substance, and your fine apparel, and the adorning of your churches, more than ye love the poor and the needy, the sick and the afflicted.
• • •
39 Why do ye adorn yourselves with that which hath no life, and yet suffer the hungry, and the needy, and the naked, and the sick and the afflicted to pass by you, and notice them not?
Mormon 8: 37, 39. I am not saying that government-based universal health care is the only way to keep the commandment to tend to the sick, but it is a way and it does reach the most possible people.

I think we should want to provide adequate medical care to every American. The system we have right now is broken and does not have the potential to do so, so it is time for change. One proposal is President Obama's, which is not a single-payer system, but does have the potential to reach every American, and it worthy of our support.

Again, we can argue the costs and benefits, and hopefully will, but if we shift the focus to the families and individuals, and emphasize the right of all people to medical care, we come closer to the type of just and equal America that we can acheive.


jamieschip said...

I feel very strongly about this issue and hope that the country can support Obama in his healthcare reform. It's a start in the right direction, that's for sure. Thanks for posting this, baby.

peter said...

So, this response is really long, probably too long, but I'm going to post it anyways. :) Kristy

I agree with the fact that the health care system is broken, I agree that all children should have healthcare and that every adult should have reasonable access to health care. I know that government programs provide an important service to hard-working people who just can’t make ends meet because things are so expensive. I’ve been there and I know. I don’t know what the best model for fixing the system is, but unless some of the following concerns are addressed, I don’t believe that the single-payer system will do the trick.

Problems with the current government health programs:
1. No way to internalize cost. A great number of people on government programs have no idea the true cost of the health care services they utilize. A patient will ask for a specific treatment or name brand medicine. Peter will point out that it is a costly procedure or medicine and not medically indicated. The patient will return with, “It’s okay, Medicaid/Medicare will pay for it.” These patients have no way to internalize the cost…it means nothing to them because they don’t pay it. People place more value on things that cost them something. In college the better students were ones who were paying for their own education instead of their parents paying for it. It would be far better for people to have to pay a nominal fee or percentage of the actual cost (based on income or some other indicator) in order to feel some fiscal responsibility and understand the cost than have medical care free of charge. It could be argued that they would pay that in taxes, but we all know that the current tax code gives low-income Americans basically all of their tax money back plus several credits so they are making money at tax time and therefore the cost is not internalized in this way. I’d even suggest some form of community service if money is still an impediment.
2. A sense of entitlement. This goes along with the last problem, but is has its own unique facet. All Americans feel that they should get premium health care the way they want and when they want. For example are the people who overdose on drugs, spend two weeks in the very expensive ICU on the taxpayers dime and continue using as soon as they go home. The same could be said of smokers, drinkers and the morbidly obese. They don’t take care of themselves, they don’t want to pay, but they expect the million dollar treatment. Health care is a right, but how much health care is a right and when do we draw the line? Other single-payer systems have algorithms to determine if someone will receive a specific treatment based on age and lifestyle. Are Americans ready for that?
3. Inefficiency. Using the Veteran’s Affairs (VA) clinics and hospitals as models for government sponsored health care would indicate that it won’t work. The VA is notorious for its inefficiencies and wait times. And the wait times are not just for getting warts removed…it includes fairly serious surgeries and preventative screenings. With high levels of bureaucracy and physicians on a fairly low salary with no incentive to hurry, things take time. Maybe the physician problem could be mitigated by efficiency incentives but the bureaucracy problem is a problem of scale (and seems inherent to any government program) and not easily remedied.
4. Physician reimbursement. Medicare and Medicaid already low-ball payments to physicians, they are the government and they can do that. Many doctors who see primarily patients from these programs have a hard time keeping their doors open because what they are paid barely/does not cover their operating costs. This year the government was looking at raising compensation levels based on inflation. (The measure was also a band aid to stop a scheduled 20% decrease in physician compensation.) Inflation was 2.4% but the government has decided to raise compensation levels to 1.1% with an additional 1.3% compensation if they reach government set increase-in-productivity goals. In plain words, they will pay the doctors the same as last year for seeing more patients. Would any professional field embrace this payment plan?

That being said, I read President Obama’s health care plan and it has a couple of good points, but the bulk of the information was vague rhetoric. I’d be interested more in an explicit explanation of what he wants to accomplish and how.

To finish, I have some suggestions and points to make.
1. Malpractice is a big cost in medicine. I do not deny that there are legitimate cases for malpractice suits, but I contest that there is a fairly high percentage of suits where the plaintiff is looking for a jackpot style jury verdict. Many physicians run tests and do things to be covered in case of a lawsuit that are not truly necessary. I would suggest that mediation and malpractice caps on payouts be considered and that all suits should be reviewed by an impartial medical board before going to trial to determine if the case has merit as true medical malpractice or is just someone playing the system or upset by a bad outcome.
2. Insurance companies could be run as not-for-profit businesses. Everyone who works for them would get paid, but the company would be more concerned about the people they insure rather than making the shareholders happy.
3. Is this universal health care system supposed to be something that only the “rich” pay for and how much more are they expected to fork out? I am not opposed to helping out those in need, but the highest tax bracket is already taxed at 35% and forecast to go to almost 40% next year with Obama taking office. If universal health care is such a good idea then everyone should be willing to pay more taxes for the benefit, not just have the wealthy support everyone else.
4. Reasons that healthcare premiums are going up include the cost of drug coverage, but also include the fact that care costs are high for the numerous people who drink, smoke, do drugs, and are obese. These are costs that could be avoided…maybe tax credits or discounts for people who meet healthy living criteria.
5. Caring for the poor and needy is an important, Christ-like attribute, but so is self-sufficiency. We should promote self reliance when at all possible and not encourage a welfare state. The government could save money by cracking down on the abuses of the welfare system: people on disability who really don’t need to be there and are just lazy, the generational welfare recipient for whom it is a way of life and who doesn’t see a need for anything else. Current programs do not reward productivity or encourage saving.

Obviously I have a unique perspective that comes from being a doctor’s wife and, I admit, a unique bias. I hope, however, that as we (as a nation) tackle the healthcare reform monstrosity, that these concerns and questions will be hashed over and good solutions found that are not just based on ideology and power brokering.

Jacob S. said...

Those are all very good points, Kristy. Thanks for commenting. Of course there are many difficult issues and decisions to deal with, and I certainly don't have the answers. But I don't think a single-payer system, if that is indeed where we are headed, necessarily means that everyone gets any procedure or medication they want, no matter the cost, and I think if you want to purchase increased private insurance coverage that should be available. And for your sake, I'll support keeping doctor's salaries high, they deserve it.