Bear with me, for in the next paragraphs there be more fact than opinion.
First though, statement about nomenclature: I call the healthcare market a market and not a system because that is what it is. I won't call it a "Healthcare System" because that phrase is overused, incorrect, self-aggrandizing and sycophantic. It is an undeserved national self-complement. There is no coherent whole nor palpable structure that underlies the conglomerate hulk that is the modern American health apparatus. No. Rather what we have is an infestation of tiny protected businesses, each connected to the next through an adhocracy of lobbyists, toothless-but-nonetheless-petty regulators, private boards and personal-professional relationships between the practitioners themselves. The word "system" imparts the meaning of orderliness, routine, fit function or of an accepted and methodical means of doing something. In all of these catagories, the American medical establishment lacks. Therefore in this article I will never write the phrase of convenience "American Health System".
Or at least I won't write it til' it be existent.
Anyway, to the facts:
First we must touch on what is the root problem of American healthcare and why some kind of National Healthcare System is needful and desirable. From an economic perspective the cold fact is that the US spends 17.6% of its GDP on healthcare (1). This is up from around 15% in 2004. (2) Obviously costs are rising. Estimates vary slightly among reports and I have come across other, lower, figures in my extensive reading (I apologize for having no social life) but lower only by a few points, ergo a statistical dead heat. In any case some of the exact figures are open to debate, for example we may have spent 12% in 2004 instead of 15%, however the overall trend is one which is steeply upward. This doesn't seem to be open to debate. The current year 17% figure I have seen in several sources, with only one dissenter stating 16.5% , which means it probably rings true, making that figure very troubling indeed.
So costs are rising, so what?
Unsustainability.
The reason rising costs are important is because in our system the people will, directly or indirectly, shoulder all of the cost. The result of all this is that insurance companies will recieve higher bills from healthcare providers (hospitals, doctors), a pre-negotiated percentage of which the ins. company will pay, and as time goes on they will raise their premiums in order to pay their bills, keep their shop open, and of course rake a profit. This is not necessarily bad in itself, however when played out across the whole market it creates a dangerous situation much like a price spiral, where everyone is raising prices because everyone else is doing it. Also part of the problem that Doctors and Hospitals do raise bills on paying customers is because it compensates them for the nonpaying ones, which occurs under many circumstances.
Projections of the total GDP in the future which the US is going to spend on healthcare are nightmarish. 31%, 25% x% by 2025. They are not worth citing at length in my opinion because they are predictions, and a lot can happen to reduce or raise costs in ten years. However it can clearly be said from the trend that given the current situation there will be a big increase in all healthcare bills as the market swells out of control into a bloated American healthcare mess - obese, flabby and disgusting as it paws at the US' collective pocketbook.
Why do the hospitals charge high prices then? Why does a night of hospitalisation cost 2,500$ and up? Why did a visit to the ER at a certain hospital (my previous employer) cost 457$ plus any private fees incurred?
Two simple reasons: 1) FFS (fee for service) and 2) Legal responsibility (little discussed, but I suspect just as important.)
FFS is very simple. Almost everything in the United States is fee for service. You walk into a gas station, buy a tank of gas for your SUV (50$), buy a candy bar (3$), buy sodas for the kids (10$) and a sub sandwhich for lunch (8$). Your total is 71$ plus tax. Wow, an expensive trip! For every service you requested you paid a separate fee. Those fees added up to something monstrous.
Apply this to a hospital visit. You are struck by a car. You go to the emergency room(457$) and see a doctor (300$), they preform some tests (1000$) and think something might be seriously wrong. You spend the night in the hospital (2500$) waiting to see the doctor again (300$ private fee + 108 consultation fee) and get your results (free!) they think you have had some severe trauma to your lung and want you to come back. Your arm is broken, but I don't know what they'd charge you for the plaster of paris. Grand total: 5665$ Forgive me if I miscalculated, but basically you get the point: a lot of rather large things add up quickly.
There you have it.
Reason two is legal responsibility - which is less insidious but probably no less obvious. Let's say you go to the doctor and tell him you have a pain in your lower left abdomen. Your complaints are generalized and rather hard to pin down. The good doctor believes you probably just have the flu and some muscle aches as a result - just like the last time you came to him with a similar complaint.
Turns out you had full blown xyringious xanthus cocotophyotis! He should have known! You sue the good doctor and win big. For this reason, Doctors in the US often perform huge and unnecessary batteries of tests, procedures and medications on people who don't really need them. Not only "just in case" but also to protect themselves in a court of law, just in case they happen to miss some possible treatment for some possible ailment.
Oh ho! Oh ho! Alas!
So what do we do?
Perhaps take our heads out of our asses and look around us. Europe, Canada and rich Asia have both confronted the twin issues of the uninsured poor and high costs. All of the above parties have done something about it.
We have done nothing, and seem very busy at the moment still doing it and speaking of it's relative benefits.
We need to look at and learn from the outside.
One place to look would be a single payer European system for a start. They spend a Fraction in terms of GDP(3) of what we do (between 10-8%). and cover everyone in the country. Something which we haven't managed to do.
We need to face the fact that with the private market alone we have achieved neither low prices (actually, quite the opposite) nor universal coverage. The outcomes of our health system are comparable to Europe/Japan's or inferior. We may be the only country in the world that over-treats a portion of the population while giving no treatment to others.
So we pay more, get less and deny healthcare to the poor on the basis of market principles. This is not only morally repugnant but highly hypocritical from a country that likes to think of itself as some sort of pinnacle of civilization. Meanwhile we argue and lie among ourselves when the real possibility of reform even remotely becomes obtainable. Other countries surge ahead.
The political parties seem so shy of actually attaching any logic to their right conclusions (Democrats) or any wit to their venom (Republicans) that they seem to be locked at the moment in some idiotic and endless brawl of incoherence. One brainless and dangerous and the other headed in the delusory direction of a Pollyanna's "Hope and Change", I feel myself ashamed to even listen or read any of their collective pabulum. This is an insupportable climate where everyone official seems afraid of saying anything of substance.
It's all "Hope and Change" or "God, Guns and Gays". Where did all the brains go?
I will close this essay saying this:
It seems to me that few people of political wit seem inclined to set pen to paper these days. On the left they too often scupper their own theories with politeness and cute personal/group conceits whereas on the right they wold rather appeal to the worse plebeian forms of jingoist sentiment; or failing that simply prostitute themselves in whorish, shameless manner to the hopefully now ebbing forces of a peculiar type of Christian idolatry. The bankruptcy out there runs deep, so deep that as a result of this American Sickness there is even a debate about wether healthcare should be extended to the 50m poor that go without it every day. How is it this country reckons itself so great when it is so arrogant and ignorant? Is there enough cultural or intellectual power left to even make this internal reform? What if there isn't?
Perhaps that is the answer after all to this American sickness. Our problem isn't that we can't but that we won't. We are enmeshed in a cultural decline as profound as that of old Greece or Rome. We are losing the will to even want to be better.
Note: Thanks to my mother, whose conversation was invaluable for the gleaning of the kernel of idea that was to become this essay.
Works Cited:
(1)-A National Coalition on Heathcare: http://www.nchc.org/facts/cost.shtml See "National Healthcare Spending".
-B The Economist (Newspaper), This is going to hurt: Healthcare reform in America http://www.economist.com/displayStory.cfm?story_id=13900898
(2) -a The Commonwealth Fund, Commission on a High Performance Heath System: Slowing the Growth of US Healthcare expenditures - What are the options?http://www.commonwealthfund.org/usr_doc/Davis_slowinggrowthUShltcareexpenditureswhatareoptions_989.pdf
See Page vii for graph.
-B U.S. National Health Expenditures - U of South Carolina. Report by Samuel L. Baker http://hspm.sph.sc.edu/COURSES/Econ/Classes/nhe06/
(3) Healthcare in Denmark. Official Page. http://www.sum.dk/publikationer/healthcare_in_dk_2008/ren.htm
See graph comparisons of EU nations.
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