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1) The US spends more than twice as much per person on health care as the average of all other industrialized countries ($7538 vs.$3060 in 2008) BUT we get no better outcomes AND we are the only industrialized country without universal insurance coverage.
2) For example, the five-year survival rates for 17 cancers are virtually the same in the US and Canada even though we spend almost twice as much per person ($7538 vs. $4079 in 2008).
3) And even within our own country, there are enormous differences in expenditures (adjusted for cost of living) with no difference in outcomes. For example, in Medicare spending in 2006: over $14,000 per person in Miami vs. under $6000 per person in Salem, OR.
4) One of the major factors encouraging this high spending without better outcomes is our “fee for service” payment system that basically says to doctors, hospitals, drug and device companies: the more you do or sell, the more you make. In other words our payment system incentivizes health care providers to do more whether or not it makes any difference in outcome.
5) And our media encourage all of us as health care consumers to demand the newest and latest “breakthrough” even though it has usually not been proven to safely make a difference over the long run. Remember Vioxx?
6) Most health care experts estimate that about a third of what we spend on health care – this year that would be over $800 billion out of $2.6 trillion – is “unnecessary.” That includes everything from outright fraud to tests, procedures, drugs, etc. that have not been proven to make a difference. That would be more than enough to completely insure all the uninsured – estimated to cost 300 billion up front.
7) The new health bill – which is far from perfect – is not a “government takeover” because it will actually drive more business to private insurance, which is often inefficient with large overhead. That’s why I do believe we need the government to set fair rules for competition – much like the FAA sets the safety rules and regulations for the airline industry and then lets the industry compete intensely for our business on a level playing field.
8) I think health protection is just as basic and important as police and fire protection. Therefore we should be encouraging/providing basic health insurance to all our citizens just as we do (usually) for fire and police protection. How can you have “life, liberty and the pursuit of happiness” without basic health protection?
9) No industrialized country – including the US – will be able to do everything for everyone at every age that modern medical science might develop; therefore all industrialized countries will have to make hard choices – in other words, do rationing. The only question is whether it will be done rationally – based on objective evidence of cost effectiveness – or done as the U.S. does now – based on whether or not you are wealthy and/or have good health insurance.
10) If we do not bend the rising curve of increased health care costs, this country would go bankrupt in about 8 years. Obviously we won’t/can’t let that happen so when/if we reach that point my best guess is that we will in essence ask the Federal Government to “bail us out” by expanding Medicare to cover everyone. Then, for sure, Medicare will have to undergo major reform to control costs and insure quality. The only way to avoid that scenario is to develop an independent commission to make the hard choices. I have come to the conclusion we cannot count on politicians to do this hard but absolutely necessary work.
The Absolutely Essential Big Four Reforms (in my judgment):
1) Change in payments from “fee for service” to outcomes/results
2) Development of nationwide IT (electronic records/data) standards
3) Support for comparative data research to demonstrate cost and safety effectiveness for various competing tests and treatments.
4) Development of primary care resources – “medical homes” – where everyone can have 24/7 access (at least by phone) for guidance and monitoring about: prevention, screening, treatment choices, etc.
This program aired on October 29, 2010. The audio for this program is not available.
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