One definition of madness: Doing the same thing over and over again and expecting different results. While this statement has been inaccurately attributed to Einstein, it doesn’t take Einstein to know that it could easily define stupidity.
So, as we look at different proposals for changing our health care system, it’s time we looked past the rhetoric and consider the facts.
According to a paper published by JAMA this month, “In 2016, the United States spent nearly twice as much as 10 high-income countries on medical care and performed less well on many population health outcomes.”
This is not new information, but it is time to take it seriously. If we pay more for an inferior product, typically we feel cheated and don’t want to repeat the mistake. That’s easiest when the price and value of product are clear.
The price of health care is very clear. In 2017 it was $10,739 per person in the US and about 18% of our GDP, totaling about $3.5 Trillion. Compare this to about $355 per person in 1970.
The JAMA article states, “In 2016, the US spent 17.8% of its gross domestic product on health care, and spending in the other countries ranged from 9.6% (Australia) to 12.4% (Switzerland).” We have the highest infant mortality rates and the lowest life expectancy. At least by those measures, the myth of American exceptionalism is simply that, a myth
While the US has a lower rate of smokers our rate of obesity exceeds our peer groups by almost 50%. Our administrative costs and physician salaries were twice that of our peer groups. Rx costs are $1443 in the US vs a range of $466 to $939 in other countries.
Innovation is often touted as the US contribution to improved medical care. While that is true, in our global economy other countries are innovating as well. At home, the contributions of the public sector cannot be ignored. Seventeen years of war have resulted in dramatic improvements in trauma care. Research from the National Institutes of Health as well as universities are substantial contributors to our success in many fields of medicine.
The fact that big pharma typically spends more on marketing than R&D has not gone unnoticed. Deloite analytics has cautioned that the dramatic reduction in return on investment requires the industry to take actions such as improvements in collaboration, geography and technology. It is my belief that the industry must understand that our system simply cannot write a blank check for the drugs that eventually come to market. Every ad encouraging us to get tested for HepC, so we can buy the $85,000 medication makes me furious!
There is nothing, absolutely nothing that will stop this increasing cost trend unless we make changes to our system. To do so we must accept the fact that we do not have a better system or better care than our peer nations.
It is argued that people in Canada have to wait a long time for services. I have clients that wait months to get into a specialist. Many of my clients have no primary care physician.
It is time to have a serious discussion about changing the system. The Affordable Care Act attempted to solve the problem by providing universal coverage with a basis in the private insurance system. This legislation has been systematically eviscerated and now has lost its ability to solve the problem.
We must have an honest discussion about our values and not get caught up in inflammatory rhetoric that tries to frighten the public. The current fear phrase is “socialism”. Let’s be clear. Combining Medicare, Medicaid (MediCal in CA) and the VA, we have one of the largest socialized medicine systems in the world.
Why did we create these systems in the first place? Was it our American values that support the belief that basic health care is a right, at least for some populations: i.e. elderly, poor and veterans? What about the rest of us? Why would it not be a right for us all to have at least basic medical care? Let’s think this through.
Would that be provided in a platform such as “Medicare for all”? Clearly the phrase “Medicare for all” means different things to different people. I don’t purport to know the details of each of the proposals. But I do know that the concept of basic health for all our neighbors makes sense to me.
I also know that we simply must consider alternatives because we cannot sustain the system as it stands.
