Healthcare — the Fundamental Choices

One of our fundamental choices about health care has moral and practical dimensions.  The other is purely practical.

Let’s first address the practical issue.  Our  appruoach to health care puts our businesses at a serious and growing competitive disadvantage.  US corporations currently spend $12,591 on average for coverage of a family of four, up 54% since 2005.

Our national health care spending, which was 5% of GDP fifty years ago, is now 17 % of GDP.  It has more than tripled.  Meanwhile, Germany’s spending is two thirds of ours and is growing much less rapidly.

We spend half again as much or more on health care as other advanced economies.  And the gap is growing.  Germany now spends 11% of GDP on health care, only increased from 9% half a century ago.  Japan spends 10%,  Britain 9%.

It’s no coincidence that our health care system is fundamentally different from our competitors’.

Our business leaders say their competitiveness is hobbled by corporate taxes, but while our health care spending has more than tripled in the last half century, corporate taxes that were then 4% of GDP are now half that at about 2%.

It’s true we have industrialized nations’ highest corporate tax rate but many of our great multinational corporations pay little or none.  It’s also true that our high tax rate hurts smaller domestic corporations but that’s much less important than our health care system’s costs.

To remain competitive, we must restructure our health care system.  

The choice with both moral and practical dimensions is whether everyone will have health care, or only those who can pay?  

If only those get health care who can pay, the others will suffer and die.  If we favor this approach we should consider, are we okay with that fact?

If everyone will get health care, there must be some rationing.   If we favor this approach, do we recognize that fact?

It’s misleading to think of health care as a human right.  Nations choose what rights their citizens will have and embody them in laws.  Those laws can and do change.

Our current legal system specifies that, with an exception I’ll get to in a minute, those of us who cannot pay for health care do not get it.  Why is that, and could it change?

It is an article of faith with us that we are rugged individuals who take responsibility for ourselves.  We resist anything we think could make us less responsible.

Another of our articles of faith is that competing organizations motivated by profit always get the best results.

But that could be about to change.  The Medicare for All act has 108 sponsors as of May 13, 2017: https://www.congress.gov/bill/115th-congress/house-bill/676

We would get better results from a unified approach to health care.  We do not, after all, provide for our defense with autonomous, competing armies.  We know that kind of service can only be supplied effectively by our central government.  And we know our government has encouraged, not stifled innovation in that field.

Here are links to what I’ve written before about some important aspects of our approach to health care but if you’re out of time, just skip past them to the conclusion — a single payer system works best.

In http://martinsidwell.com/socially-acceptable-healthcare/ I pointed out that we do currently provide not health care but at least medical treatment to all via the Emergency Medical Treatment and Active Labor Act (EMTALA) passed under President Reagan.  That approach means: “We have in the USA universal access to medical treatment via the most costly system possible.”

Data I posted at:  https://usaturnaround.wordpress.com/2011/09/21/healthcare-from-85000-feet/ show that:  “US health care delivers poorer results at higher cost because it is based on the flawed assumption that market based systems always deliver the best results. While in most cases they do, for health care they do not. The incentives are perverse”.

Exploring our Federal deficit at: https://usaturnaround.wordpress.com/2011/07/11/drivers-of-the-deficit/ I noted that: “more important even than getting rising Federal healthcare spending under control is to get rising health care cost under control.  As noted in previous posts, we spend double what other advanced economies do on healthcare without getting better results.”

Examining national spending and results at: https://usaturnaround.wordpress.com/2011/04/19/overall-us-healthcare/ I pointed out some contributors to our abnormally high costs:  “our obesity rate, the highest of all OECD countries and more than twice as high as the 15% OECD average …  The percentage of our adult population considered obese rose from 13% in 1965 to […] 34% in 2007.  Obesity-related medical spending in the USA doubled […] between 1998 and 2008.”  

Focusing at: https://usaturnaround.wordpress.com/2011/04/17/medicare-and-medicaid/ on Medicare and Medicaid I pointed out that: “The primary cause of increased Medicaid spending is that it now services 16% of all Americans, up from 2% at its inception [while] Medicare now serves 15% of the population, up from 10% in 1966 and the percentage will continue to increase as our population ages … The key fact about Medicare is that an aging population, unhealthy lifestyles and technology advances are driving its costs up 8% annually, much higher than Medicaid.”

The conclusion?  Our need to remain competitive means we must restructure our health care.  Our competitors did that long ago.  They all established a unified system for all their people, they all have much lower costs than ours, and they all get the same or better results.

Our current approach to health care is not exceptional in a good way.

When the government acts as the one health care buyer it has the market power to negotiate the lowest price that is profitable for suppliers.

A competitive health care market benefits consumers only for procedures like breast enhancement where they have enough time to make an informed choice.

To remain competitive we must change our health care system.  We must either stop providing care to many millions more of those who can’t afford it or establish a single buyer to negotiate the lowest profitable price for providing care to the largest pool of consumers, which is both the currently healthy and the sick.

4 comments on “Healthcare — the Fundamental Choices

  1. A friend responded: “Curious how you would tackle obesity. Seems to me people should pay for their own choices. Why should I pay for someone to eat poorly and not exercise? Unless there is some direct correlation between a person’s choices and their pocket book, I don’t see Americans taking responsibility for their health.

    “Type 2 is *rampant* in the US. People are literally having their feet amputated rather than change their diet. Think about that for a moment: people would rather have body parts amputated than eat healthy. That’s astonishing.

    “I’m not sure how you deal with that. They simply won’t make choices that are healthy.”

    I replied: “Obesity is a very serious problem in America. I’m always amazed by how many of the workers in doctor’s offices and hospitals are obese. I don’t know what changed, why the rate is now so high, and I don’t know the remedy.

    “I also don’t know the cause or the remedy for our opioid epidemic.

    “I do know that since the food abusers aren’t deterred by amputation and the drug abusers by death from overdose they are not going to change by being denied or having to pay more for health care.

    “The closest I can come to an answer is what I didn’t elaborate on, rationing.

    :If you need a lung transplant now, for example, and you are overweight, you won’t get one. I haven’t thought through the details but I’m sure others have of what care should be provided and what denied to those whose health problems are self-induced.”

    Someone I don’t know asked: “Why do we call it “Type2”? Why the euphemism? Why isn’t it called “Self-Induced-Diabetes”?”

    I repied: ” That approach might well help over the long term. It’s not enough to recognize our behaviors that harm us, we must also believe that changing them will make us happier.”

    My more considered response to the excellent question at the top of this comment is, I hope establishment of universal health care with relentless encouragement to see a doctor annually would slowly, slowly alert everyone to their unhealthy behaviors and how they could change them.

    The long campaign against tobacco usage has been effective but the roots of the obesity and opioid crises are deeper. Cigarette smoking was enticingly advertised. It’s not practical to take the same approach with fast food and soda. Widespread opioid use seems rooted in feelings of helplessness related to our present economic system.

    Even if we could eliminate the causes of these unhealthy behaviors, though, it would still be beneficial to get more people talking with doctors, being told the potential results of their unhealthy behaviors, and offered help to so they could change them with confidence that they would be happier by doing so.

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