Health Care

If we add American health care costs of 16% GDP to the 28.2% GDP in combined tax revenue, we find that our tax and health care revenue combined is 44.2%. It seems reasonable to conclude that by treating drug use as a health issue, and having national health insurance that cuts out the middle man, we will be able to spend about 38% of our GDP for those combined costs instead of 44.2%. Great Britain and many European countries pay for their national health insurance with an even smaller percentage of their GDP than Canada and costs are rising much faster in the States. Canadians spent 7% of their GDP in 1970 on health care, and so did the U.S. Today Canada spends 10% and we spend 16%. What happened after 1970? The Drug War, more injured vets, less preventative care; more de–institutionalized mentally ill and indigent people showing up at taxpayer funded emergency rooms. On top of all that, health insurance companies are taking bigger profits. There are other issues as well. Recently I listened to a talk by Daryl Tol, president and CEO of Florida Hospital DeLand. He said that health care costs $7,500 per person in the U.S. and $2,000 to $4,000 per person in the developed world. Here are some of the reasons that he gave for health care being so expensive:

  • 1. Chronic disease. 75% of the cost of health care is life–style related. (i.e. obesity) We can address this with the changes I suggest in the Urbanism section.
  • 2. End of life battles – we spend a tremendous amount of money in fighting for every last moment of life. We should focus on palliative care and helping the dying face the end with dignity.
  • 3. Routine Care – emergency rooms are the most expensive kind of care we have. It has become our universal health care.
  • 4. We chase reimbursements. Doctors who own MRIs use them 75% more than doctors who do not.
  • 5. Defensive medicine – Doctors do not want to miss something, and they get sued if they miss a diagnosis. They have to test even there is a 0.5% chance of something. To this we can add the high cost of litigation, something I address in my book chapter on Justice.
  • 6. Consumers want the latest health care and they want it now.

Tol pointed out that in exchange for this we have high infant mortality rates, one of the highest death rates, and lower life expectancy. Iowans spend $4,500 and 5% of Medicare recipients die every year. In FL we spend $7,500 and 5% of Medicare recipients die every year. “What's the difference?” He asked. We have more doctors in Florida.

Americans have an average life expectancy of 78.11 years. Because of the way we handle health care, the U.S. has one of the lowest life expectancy rates in the industrialized world. According to the CIA Factbook, life expectancy in Japan is 82.12, Canada, 81.2. On average, all the European countries together have higher life expectancy than Americans. They all have national health insurance, and they pay far less than we do. Is that fair?

Having national health insurance will greatly help the vast majority of Americans. It would have helped the 86.7 million Americans who were without health insurance sometime during 2007 and 2008. It will prevent the daily tragedies that occur because people cannot pay their medical bills. It will prevent having to worry those who are changing insurance companies and worried about falling through the cracks with a pre–existing condition. This happens almost every time someone changes a job. It will help the poor and the middle class meet their monthly expenses and give them a safety net.

We need to allocate health care and do what is the most efficient for the whole population. We should leave off the extraordinary end of life care and the other things that cost a lot but do not improve our quality of life. If someone wants this extraordinary treatment, they can buy a private supplemental insurance, as is done in Europe.

The biggest argument for a single–payer system is the remarkable turnaround story of the Veterans Health Administration (VHA), beginning in the 1990s. A 2004 study showed the VHA was performing better than the nation's highest rated non–VHA hospitals. Today it delivers some of the nation's best health care and it does it for 2/3rd of what Medicare does it for, with a higher satisfaction rating. How did this happen? It was fixed through radical downsizing, decentralization, pay–for–performance contracts, firing of incompetent doctors, increased preventative and primary care, increased outpatient services, and electronic information systems. Being able to call up any patient's complete medical records and integrate this into monitoring systems has caused the biggest improvement. Most doctors and hospitals in the U.S. have not switched to integrated electronic medical record systems, adopted computerized prescription methods, or made the other changes because of they are used to the old, inefficient system.

This resistance to change is endemic throughout our country because incompetence is rewarded. A study done in 1999 showed up to 98,000 people die of medical errors each year in the U.S. – two and a half times more people than die in motor vehicle accidents. The same RAND Institute study reported another 126,000 annual deaths in the U.S. from doctors failing to follow evidence–based protocols for the four most common conditions. No matter how bad an existing system is, there are always people comfortable with it, or profiting in some way. This is where leadership comes in. The system has to change, and the change has to be mandated by enlightened lawmakers with the power to make it happen. Lawmakers doing the bidding of the special interests will zealously guard the status quo.

If the health care reform bill (HR 3200) passes, with the Kucinich amendment allowing individual states to adopt a single payer system if they want, Florida can have a high–quality and lower cost system like our vets have.