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Health Policy in Medicine: Inside the Beltway
Exotic, Dangerous and Expensive: US Health Care and the Need for Reform
by Eugene Rich, MD, FACP
January 4, 2010
The 2009 Holiday Season has been complicated by national financial woes, meteorological misadventures, and health care politics. Advocates for reform emphasize the shame of tens of millions of uninsured citizens and the need to establish long-term cost control. Those against reform stoke diverse voter fears, from concerns about tax dollars subsidizing undocumented worker benefits, to threats that bureaucrats will callously deny life-sustaining treatments. While the Senate passed its version of health care reform Christmas Eve, January 2010 will see a continuation of the national “Civics lesson” that is the health care reform debate. The House and Senate must negotiate numerous points of disagreement before the final reform legislation can proceed to the White House for signature.
During this debate the public has become increasingly anxious. While polling continues to show that a solid majority (54%) of Americans want health care reform now (http://www.kff.org/kaiserpolls/upload/8036.pdf), and that 49% have recently put off care because of cost (http://www.kff.org/kaiserpolls/upload/8036.pdf), no reform proposal earns broad electoral support (http://www.pollingreport.com/health.htm). In our form of government, it far too easy to criticize any effort at reform, and far too hard politically to point out that US health care has become exotic, expensive, and dangerous.
The US health care “system” is the most byzantine approach devised by humankind to redistribute money to deliver care; it is superb at creating high paying jobs (for claims adjusters, technicians, nurses, doctors, and administrators) and capital investments (in new drugs, technology, machines, and facilities). But US health care is terrible at improving the health of its citizens. This is not just true for the appallingly large numbers who have no financial access to regular health care (over 10% of US citizens) but it is true for almost everyone else as well. Primary medical care is sadly antiquated (when available at all); hi-tech specialized care is poorly integrated with numerous redundancies and associated errors. Highly effective interventions are often not delivered; proven therapies take almost 20 years to become routine practice. Yet novel technology can be adopted with enthusiasm, resulting not just in more wasteful spending but harms current (e.g. drug side-effects, unhelpful surgery) and future (e.g. the impending epidemic of CT-scan induced cancers).
No other industrialized country has developed a health care system as strange as ours. Countries that have used our current approach of mixed public, employment-based, and private insurance (e.g., Germany), have at the same time employed strong tools of social policy to control avarice and ensure discipline. They do this not by ceding control to insurers or placing heavy financial or intellectual burdens on the ailing or the disadvantaged; instead they pass responsibility to the doctors, administrators, public officials and policymakers. Other countries applying the Senate’s proposed strategy of requiring all citizens to purchase health insurance have at the same time tightly regulated insurance benefits, premiums, profits, physician fees, and health care facility investments. Few industrialized countries have truly “socialized” their health care (contrary to the misinformation regularly spread by opponents of reform). But using the types of strategies under consideration in Congress, most developed nations have achieved universal financial access to care, higher public satisfaction, better delivery of highly effective treatments, and much lower cost.
Americans are afraid of health care reform, having been told by the advocates of the status quo that they will lose something of value to them and their loved ones. Sadly, what they need to fear are those politicians seeking to preserve our current system, an unwieldy, exotic, dangerous, and expensive mess that fails many in the present, and blights the future for all. Whatever your hopes and fears for 2010, I am wishing us all a happy new year of health care reform!
Eugene C. Rich MD FACP
Scholar in Residence
Association of American Medical Colleges
Professor of Medicine, Creighton University School of Medicine
Faculty Associate, Center for Health Policy and Ethics
email: richec@creighton.edu
More information about Dr. Rich can be found at http://chpe.creighton.edu/people/profiles/rich.htm
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