Monday, January 28, 2008
The health care market is killing us
Steve Huff
Recent columns
From the RoundTable blog
The U.S. health care system -- is it broken? Here's the shakedown:
Democrats blame Republicans for bowing to Big Medicine. Republicans accuse Democrats of promoting socialized medicine. Citizens blame legislators for playing politics with their health. Big Medicine blames Americans for craving expensive treatment. Doctors blame lawyers for whipping up lawsuits. Lawyers sue doctors for skimping on health care. Insurers penalize doctors for prescribing too much care. Patients complain they are pawns in this out-of-control health care game.
Meanwhile, the United States has fallen to dead last among 19 industrialized countries for quality of health care.
The study "Measuring the health of a nation: Updating an earlier analysis" was compiled by the prestigious, nonpartisan Commonwealth Fund and appears in the current issue of Health Affairs. It analyzes data from patients, doctors and national statistics to measure a broad array of outcomes.
The U.S. falters in nearly every category, from access to equity to efficiency. The most glaring deficiency is lack of health coverage for all citizens. That sets us apart from every other country.
Some people, our president included, have asserted that we already enjoy universal coverage: If you are sick and don't have insurance, you can go to the emergency room. He also has boasted that the U.S. health care system is the best in the world. Given this remarkable lack of insight, we look to the next administration.
The Republican candidates are in lock step: Reduce taxes to make insurance affordable; promote competition among providers; shift costs from employers to individuals; do not require universal coverage.
The Democratic alternative, as the Republicans frame it, is socialized medicine.
That option scares me, too. I've worked with the Veterans Administration. Inefficiency, red tape and rationing of care rule the day. It smacks of Great Britain, where a program is in place to reduce delays in treatment to 18 weeks. The Brits ranked second to last in the Commonwealth Fund study.
Who was first? France.
There, employees and their families are covered by a state-run system. Non-employees buy in separately. If you fall below a certain income, coverage is free. There are co-pays. Private plans compete for supplemental coverage. This is not socialism.
Still, the French system is criticized for waste and abuse. At 9.8 percent of their GDP, it is expensive. Contrary to the implications of Michael Moore's documentary "Sicko," foreign systems are far from perfect.
They're a lot better than ours, though, and a lot cheaper. In 2005, American health care devoured 16 percent of our GDP, or $6,700 per person. We spent the most and got the least.
The term Hillary-care has been bandied about as a synonym for socialized medicine. If you review her plan and those of her Democratic rivals, none recommends socialized medicine. In varying degrees, they combine public and private money to improve quality, reduce waste and cover all Americans.
Since the crash and burn of Hillary's original proposals 15 years ago, conservatives have presided over American health care. Their free market model, meant to improve costs and quality through competition, has sent costs through the roof and quality to the basement.
The Commonwealth Fund calculates that if U.S. outcomes were similar to those in France, more than 100,000 American lives per year would be saved. That number far exceeds the combined deaths in 2007 from automobile accidents, murders and Iraq war fatalities, both civilian and military.
By my interpretation, the Republican candidates believe the system needs some tweaking. Do not be fooled by words like "transform" and "complete overhaul." The Republican fine print spells business as usual.
I am bone tired of telling patients they need a test or treatment or referral that they cannot afford. I also am sick of the hegemony of Big Medicine over lawmakers, clinicians and patients.
In November 2002 -- five years ago -- the National Academy of Science published an analysis of the state of our health care system. The conclusion: "The health care delivery system is incapable of meeting the present, let alone the future, needs of the American public." It pleaded for change.
It was ignored.
Pitting profit against health is killing us. After so many years of neglect, the prognosis is grim. The cure is drastic, but one point is clear: The current prescription has flat run out.
Huff, a family physician from Patrick County, is a Roanoke Times columnist.
