Jim Stillman
Nevar
The Obama agenda: healthcare - II
March 19th 2009 16:21
My previous post pointed out a few problems facing the United States and how, as President Obama has stated, we cannot correct long term economic problems without addressing
Why do we spend so much more on healthcare, per capita, than other developed countries? Why do we achieve worse outcomes on several important measures than countries that spend far less? Why do we spend up to twice as much per person as countries that provide universal coverage while leaving as many as 50 million Americans without insurance?
The importance of these questions has grown over the past several decades, since the late 1940’s when Harry Truman tried to create a universal health benefit program that resembled systems in Europe.
Last month, the Paris-based Organization for Economic Cooperation and Development issued the latest in a long series of reports on our wasteful and cruel practices that ought to cause national embarrassment, “Healthcare Reform in the United States."
Documenting the gross "discrepancy" between the enormous amounts that Americans spend on healthcare and the value received for that expenditure, the study found that the United States ranks poorly among OECD countries on measures of life expectancy, infant mortality and reductions in "amenable mortality," meaning deaths "from certain causes that should not occur in the presence of timely and effective healthcare."
But perhaps any discussion of healthcare in the developed world ought to begin with a plain fact noted early in this study: Among the OECD's 30 members -- which include Australia, Austria, Belgium, Canada, the Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, South Korea, Luxembourg, the Netherlands, New Zealand, Norway, Poland, Portugal, the Slovak Republic, Spain, Sweden, Switzerland, and the United Kingdom -- there are only three lacking universal health coverage. The other two happen to be Mexico and Turkey; we are the third!
The report finds that the public share of health expenditure in the United States is much lower than any other OECD country except Mexico; the public expenditure on healthcare is much higher per capita than in most OECD countries. So we pay a lot more in taxes devoted to medical care -- not including insurance premiums, co-payments, fees, and other health costs -– than taxpayers in those 27 countries that have universal coverage. Our public expenditure provides coverage only for the elderly and some of the poor while other countries provide universal coverage while spending less
.
How much less? Nations with comparable standards of living like France, Germany, Sweden, Finland, the United Kingdom, Canada, Norway, and Japan spend roughly between half and two-thirds per capita what we spend annually. They cover everyone and their results are measurably better. And the supposed downsides of universal coverage, such as lack of access to sophisticated medical technologies, are belied in many of these countries. For instance Japan has lower per capita health expenditures than the United States (and universal coverage,) but its citizens have greater access to MRI machines, CT scanners and kidney dialysis equipment than Americans do.
As the study suggests, our inflated, poorly managed health budget results from a variety of horrors, including a greater incidence of obesity and other chronic illness, a powerful pharmaceutical lobby that keeps prices high, and the profit-making imperative of the private insurance companies that dominate American health policy, more than four decades after universal coverage for the elderly and the poor was established.
Note that I do not fault either doctors or attorneys; both are pawns in the schemes of pharmaceutical and insurance companies which benefit from the crises – at the expense of everyone else. Looking forward, the OECD advocates many of the same incremental reforms contemplated by the Obama administration.
But it is difficult to imagine how the United States can afford to provide quality healthcare for all of its citizens in an era of diminished resources -- unless we look to the example of other democratic states around the world. Long ago, they realized that if healthcare is a public good and a human right, the domination of private interests must be curtailed.
OK, our present system has flaws. So what can/should be done?
The next post in this series will suggest an answer.
A hint: such a prototype already exists in the United States.
Why do we spend so much more on healthcare, per capita, than other developed countries? Why do we achieve worse outcomes on several important measures than countries that spend far less? Why do we spend up to twice as much per person as countries that provide universal coverage while leaving as many as 50 million Americans without insurance?
The importance of these questions has grown over the past several decades, since the late 1940’s when Harry Truman tried to create a universal health benefit program that resembled systems in Europe.
Last month, the Paris-based Organization for Economic Cooperation and Development issued the latest in a long series of reports on our wasteful and cruel practices that ought to cause national embarrassment, “Healthcare Reform in the United States."
Documenting the gross "discrepancy" between the enormous amounts that Americans spend on healthcare and the value received for that expenditure, the study found that the United States ranks poorly among OECD countries on measures of life expectancy, infant mortality and reductions in "amenable mortality," meaning deaths "from certain causes that should not occur in the presence of timely and effective healthcare."
But perhaps any discussion of healthcare in the developed world ought to begin with a plain fact noted early in this study: Among the OECD's 30 members -- which include Australia, Austria, Belgium, Canada, the Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, South Korea, Luxembourg, the Netherlands, New Zealand, Norway, Poland, Portugal, the Slovak Republic, Spain, Sweden, Switzerland, and the United Kingdom -- there are only three lacking universal health coverage. The other two happen to be Mexico and Turkey; we are the third!
The report finds that the public share of health expenditure in the United States is much lower than any other OECD country except Mexico; the public expenditure on healthcare is much higher per capita than in most OECD countries. So we pay a lot more in taxes devoted to medical care -- not including insurance premiums, co-payments, fees, and other health costs -– than taxpayers in those 27 countries that have universal coverage. Our public expenditure provides coverage only for the elderly and some of the poor while other countries provide universal coverage while spending less
.
How much less? Nations with comparable standards of living like France, Germany, Sweden, Finland, the United Kingdom, Canada, Norway, and Japan spend roughly between half and two-thirds per capita what we spend annually. They cover everyone and their results are measurably better. And the supposed downsides of universal coverage, such as lack of access to sophisticated medical technologies, are belied in many of these countries. For instance Japan has lower per capita health expenditures than the United States (and universal coverage,) but its citizens have greater access to MRI machines, CT scanners and kidney dialysis equipment than Americans do.
As the study suggests, our inflated, poorly managed health budget results from a variety of horrors, including a greater incidence of obesity and other chronic illness, a powerful pharmaceutical lobby that keeps prices high, and the profit-making imperative of the private insurance companies that dominate American health policy, more than four decades after universal coverage for the elderly and the poor was established.
Note that I do not fault either doctors or attorneys; both are pawns in the schemes of pharmaceutical and insurance companies which benefit from the crises – at the expense of everyone else. Looking forward, the OECD advocates many of the same incremental reforms contemplated by the Obama administration.
But it is difficult to imagine how the United States can afford to provide quality healthcare for all of its citizens in an era of diminished resources -- unless we look to the example of other democratic states around the world. Long ago, they realized that if healthcare is a public good and a human right, the domination of private interests must be curtailed.
OK, our present system has flaws. So what can/should be done?
The next post in this series will suggest an answer.
A hint: such a prototype already exists in the United States.
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