One of the major issues in the current U.S. presidential race is health care. The cost of health care in the U.S. has risen past what is affordable for a large number of Americans. Both candidates for U.S. President are pushing for a restructuring of the health insurance system. They only differ in how to restructure it.
Whether we create a new national health insurance or provide incentives to private insurance, does tackling the problem via health insurance really make sense?
According to the National Coalition on Health Care:
In 2007, total national health expenditures were expected to rise 6.9 percent — two times the rate of inflation. Total spending was $2.3 TRILLION in 2007, or $7600 per person. Total health care spending represented 16 percent of the gross domestic product (GDP).
U.S. health care spending is expected to increase at similar levels for the next decade reaching $4.2 TRILLION in 2016, or 20 percent of GDP.
According to the U.S. Department of Health and Human Services, from 1960 to 2005, the national health expenditure has risen from less than 6% of the gross domestic product to more than 16% of the gross domestic product.
The rise in cost is not simply a matter of inflation. There are systemic problems with the cost of health care. Sadly, we have, yet, to see the full blown cost result of this hyper-inflation of health care cost. The national health expenditure will escalate exponentially when the baby-boomer generation hits the age when they will need care for chronic illnesses associated with aging.
Implementing a new national health insurance system will not diminish the hyper-inflation of health care cost. It will only temporarily spread the current national health expenditure. As health care cost continues to rise, the cost of the health insurance will rise, pushing the cost of health insurance, once again, to where it's out of the reach of a large number of Americans.
Proposing a new national health insurance system is like saying, "We are doing some stupid things in our health care system that's causing the cost to rise at an uncontrollable rate; and we will throw a lot more money at the problem so that we can continue to do those stupid things but for more people."
A solution that does not solve the problem of health care cost hyper-inflation is simply stupid.
The rise in health care cost can be partitioned into five problem areas:
1) Defensive medicine to avoid mal-practice payout.
2) Enormous duplication of data entry of patient medical information.
3) Lack of free market forces for controlling the cost of prescription medication
4) Lack of incentive in health system to keep people healthy instead of healing them when they get sick.
5) Unhealthy lifestyle of a large number of Americans
The main reason defensive medicine is contributing to health care cost hyper-inflation is the lack of national legal standards to define what is acceptable medical procedure. The legal counsel for the plaintiff will always define acceptable medical procedures to be the most advanced and often experimental procedures that may have unproven effectiveness. Too often, the jury (uninformed about medical procedure) will agree with the plaintiff. These rulings push doctors to practice defensive medicine which includes these every expensive and often unnecessary procedures.
It would be more cost effective, than a new national health insurance system, to establish a permanent national medical board for defining the legal standard for acceptable medical procedures.
The duplication of data entry of medical information is due to a lack of a national standard for electronic storage and transmission of medical information as well as a lack of legislation to protect patient privacy regarding the electronic transmission of patient medical records. President Bush and various members of congress have been talking about this problem but have yet to come up with a framework for such legislation. Just do it already!
The lack of free market forces in prescription medication is a direct result of outdated patent system. This patent system protects the patent holders with very little regard for the consumer. The duration of the patent protection period is much too long. There needs to be a shortening of the patent protection period. However, to protect the interest of the patent holder, the countdown to the expiration date should begin when the first product based on the patent enters the market.
There is a lack of incentive in health system to keep people healthy instead of healing them when they get sick because our health care is based on a payment for medical procedure system. We need to move to a HMO-like payment scheme for our health care irregardless of whether we choose to be part of an HMO or to be a regular patient of a medical practice.
The average American lifestyle is literally killing us. Too many of us consume an unhealthy diet loaded with sugar and fat. Too many of us smoke tobacco products with no intention of quitting. To many of us do not even attempt to exercise once a week much less the recommended daily exercise.
These unhealthy lifestyles are resulting in chronic illnesses like coronary diseases (strokes and heat attacks), pulmonary diseases, diabetes, hypertension not to mention the need for joint (hip, knee) replacements.
Nowhere is the quote from the Pogo cartoon more applicable than in the American lifestyle:
"Yep, Son, we have met the enemy and he is us."
We need to stop subsidizing the corn from which most of our sweeteners are made. It would not only cut out a large portion of our unhealthy diet, it would also resolve the international complaints against the U.S. for unfair trade practices.
We should also allow the insurance companies to consider unhealthy behaviors like unhealthy weight and smoking in setting health insurance premiums.
We may even want to consider limiting commuter traffic to increase the likelihood of using public transportation and walking from the transportation stop to our destination.
I might even suggest raising the retirement age to keep the aging population active.
The best medicine and the most cost efficient medicine is to stay healthy.
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2 comments:
You make many excellent and insightful points. In fact, I agree with all of 1-5. However, you fail to account for the significantly contributing impact of the millions of uninsured and under-insured Americans on our growing national health care expenses. Lack of sufficient health insurance drives people to:
1) forgo the preventative care you rightly emphasize, which allows their conditions to develop/progress
2) seek care for non emergent illnesses in emergency departments, where they know they will be accepted and seen, and
3) skip payments that are unrealistically high due to their individual lack of bargaining power relative to the insurance companies who [essentially] purchase in bulk.
Each of these actions puts enormous strain on the health care system. The system, in turn, passes a portion of it's unmet expenses on to us--the lucky insured.
To provide a tangible and all-too-common example of my point: A young woman seeks a pregnancy test, but does not have insurance to cover a visit to a GP or ANP; woman goes to the ER where her test will be "free" (again, because she is unable to pay, but at least there they will see her); woman's ER visit contributes to ER overcrowding and consumes specially trained physician, RN, and laboratory time. In this example case, none of these resources are able to be directly compensated. Instead, we all pay just a little bit more next year to make up for the many similar pregnancy tests--and heart attacks, for that matter--that occurred under like circumstances.
Add to this scenario the frightening possibility that (given current economic struggles) fewer employers are able to provide more costly health insurance benefits to their employees. Suddenly this becomes (even more clearly) not just a problem of the lazy, jobless poor (said tongue-in-cheek, of course). It is a scenario in which any one of us could find ourselves culpable.
Now, suppose that woman--and the millions like her--do have access to health insurance. The cascade of costs to the system that ultimately get passed on to the consumer stops much sooner, does it not?
Thank you for bringing up this incredibly important topic.
Julie, RN.
Thank you for visiting my blog page and posting a comment. I always welcome responses to my blog entries.
I totally agree with you about the problem of the unsured and under-insured and all the points that you made.
However, I truly believe that the number of uninsured and under-insured would drop when the cost of private insurance drops; the insurance premiums would drop when the cost of medical care drops. Market competition always drives down prices to what the business cost can afford.
Once the number of uninsured and under-insured drops, it would be affordable for the U.S. Government to move them into Medicaid and Medicare.
Thanks again for your comments.
p.s., I'm always thankful for all you nurses serving in our nation's health system. Too often it's a thankless job. I thank you for having the heart to be there for us when we are sick or injured.
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