Thoughts on Healthcare in the US

I’ve been thinking a lot about healthcare recently. The furor over “Obamacare” has created much passion on every side of the argument and caused much castigation over “socialized medicine” found in such underdeveloped nations as the UK!

I have many thoughts about this; I grew up under the National Health Service in the UK and am now in my seventh year of residing in the US, with a US family. First off I will give you my personal journey over healthcare (which cannot help but form my opinion, but I also realize I could gather nightmare stories from every healthcare system on the planet) then I will look at wider metrics to determine where the problems lie.

Firstly, the British NHS is anything but a perfect system, however I have to say I have always received excellent healthcare growing up; yes there was typically a little waiting in the Casualty (Emergency Room) if you had strained an ankle or had broken an arm (as I’ve found there also is in the US), but doctors and nurses were kind and there was never any concern over the cost involved. The concern was simply how you can get better. I can say the same for all members of the family. Recently my grandmother, who is in her mid nineties had a mild stroke and was in hospital for about 4 weeks where she received excellent care and for the last few weeks of her stay she received physiotherapy every day.

Moving to the US, I had concerns over the healthcare provided here. Especially as the Christian Ministry I work for does not provide insurance. I am fairly young and healthy and although looked into private insurance when my wife got pregnant, we decided we would have to pay out of pocket $5000+ anyway + the $300 a month for insurance so we decided against insurance, after all my wife was healthy.

Six months into the pregnancy Shari got pre-eclampsia. We went to the ER of the nearest hospital after spending 2 hours there we were transferred by ambulance 5 miles to another hospital. Shari was in hospital for 1 week, costing $30k+. When I paid the bill for the first hospital’s 2 hours it came to $3000. The ambulance a cool $1000; I called up the hospital and went through the line items “Line Item 2” I ask “Blood Test - $500. How can this be? If I go to a profit making lab such as Lab One I can receive the same blood test for under $40” The answer I received was “Well, this is a hospital sir”. I would have thought it would be easier for a hospital to do a blood test – how can they justify costs like this?

Our son was born prematurely and had many medical challenges over his first 3 months of life. So much so that we cannot insure him privately, virtually every medical cost could be attributed to something in the US called a “pre-existing condition”. This is the insurance company’s way of saying – “Oh you are sick – well we’re not going to pay for that”. But there is a type of social net in the US called Medicaid – as it happens, because we earn under a certain income threshold we actually qualify for Medicaid for Josiah and this is how we have paid for a majority of Josiah’s healthcare. But we have a problem, in that we still have out of pocket medical expenses that Medicaid will not pay for (ie KU Med and Los Altos Feeding), we are in a dilemma whether to receive gifts that would pay off some of our debt to the hospital, as if we do it will mean our income will exceed a certain level after which our son would no longer be insured, and we would have to divert the gift aimed at paying off debt to actually paying out of pocket for the highly overpriced health care that Medicaid would have paid for. We are personally between the proverbial rock and a hard place!

This personal story leads me to examine the wider issue of healthcare in the US. The United States of America is the richest nation on the planet. Its GDP is more than 3 times the nearest other OECD – Japan. Its GDP per capita again is nearly at the top of all lists , it certainly has the most billionaires, being a country of several hundred million people however means that there are large amount of poor people who bring the average income down significantly. This being the case one would expect the health of the average US citizen to be good, surely near the top of the world rankings, especially given that spending on healthcare in the US is more than double the median healthcare spending in all other OECD nations – not so.

A recent report "Health Spending in the United States and the Rest of the Industrialized World" (Health Affairs, July/August 2005), Gerald F. Anderson, Peter S. Hussey, Bianca K. Frogner, and Hugh R. Waters of the Bloomberg School of Public Health at Johns Hopkins University - tried to find the root of why spending in the US was so high compared to other industrialized nations, was it because they were socialized with waiting lines and therefore spend less? It found rationing with waiting lines had nothing to do with it "Health spending in the twelve countries with waiting lists averaged $2,366 per capita," the authors say, "while in the seven countries without waiting lists, it averaged $2,696—both much less than U.S. spending of $5,267 per capita. In fact health spending in the US is 53% more than the nearest other OECD nation Switzerland. It is actually 140% more than the OECD median. One would think with such high spending on healthcare that it would be better than all other nations. While it is true that US does boast some of the best and cutting edge research in different specializations when it comes to normal run of the mill statistics it fares very badly.

The World Health Organization stopped ranking health systems in 2000 due to complexity of the task – at that time the US ranked 37th in the world. Hardly something to shout about. The WHO however does track many other metrics in the nations of the earth and for fun I looked to compare the “broken NHS” of the UK with the metrics of the US. In every metric that I looked at, infant mortality, adult mortality, life expectancy, maternal mortality the UK had better results, meaning people lived longer, kids had a better chance of survival at birth and people were healthier for longer. This surprises me, especially given that health spending is per capita almost double in the US what it is in the UK. Added to this is the fact “the U.S. has fewer per capita hospital beds, physicians, nurses, and CT scanners than the OECD median” Something is broken in the US Healthcare system and needs fixing.

Before we move on to talk about specifics, a brief word about “socialized healthcare”. This has come to be a demonized term among the political right (of whom on many issues I would count myself). Anything which smacks of socialism is a potential risk of communism and suddenly we are thrown back to McCarthyism. However I don’t hear of big calls amongst the Republicans (it always strikes me as funny that the Republican color is red – in England it is the socialists who are red!) for privatization of the police force, of the mail service, of the library service. Why is there a socialized Police force in the US? Why don’t we privatize? Well the argument is that we could never entertain the notion of a private army, it would lead to corruption and a mafia state, with some areas getting better protection than others, the rich would be protected, amongst the poor there would be anarchy – a privatized protection racket no less. I have to say I have similar feelings about the healthcare system in the US. When your loved ones need vital life saving treatment and you face a monopoly you will pay anything. I believe nearly every other industrialized nation has a form of socialized medicine and that does not mean they are necessarily a socialist nation.

That said, what Obama is currently recommending in his Healthcare reform is not socialized medicine, and in fact until the root problem is dealt with, increased spending on a broken system will never solve the problem. Increased spending in fact it will only harm business owners who will have to pick up the tab. So what are the problems?

1) Health Providers Costs – until these are addressed things will never work. Health should never be viewed in purely capitalist terms. In my opinion it can never be a free market. The question “How much is your loved one worth?” should never be a motivating factor for profit – it has become so. Health care professionals are the highest paid earners in the US by a long shot; who regulates what they receive? Is the answer to whether the anesthesiologist gets a million a year – he needs to be paid a lot because otherwise he could kill you if you don’t pay him. This sounds similar to being held to ransom. A New Zealand friend recently told me of a well respected surgeon in New Zealand who earned $400k per annum in his homeland had accepted a job at a hospital in Houston with a salary of $2.5million per annum. This doesn’t really feel like a free market to me, it feels more and more like a protection racket; the question is who pays for this greed?

2) Pharmaceuticals – The cost of healthcare is clearly out of proportion to what it should be. Certain groups however exacerbate this for profit. For me the pharmaceutical lobby in Washington is one of these powerful groups that clings onto the status quo and is looking to increase the dividends of all of its shareholders. Who will break its stranglehold?

3) HMOs – Interestingly the insurance companies were introduced into the US system at exactly the same time that a famed legal case called Roe v Wade was passing through the courts. I believe in much the same way it has made profitability and greed the metric of success in the healthcare system not the health of the patient. Many in the US balk at the so called “death panels” in socialized medicine. I am not aware of any death panels in the UK, however I hear on a regular basis of insurance companies turning away sick people because they do not qualify. If this is not a “death panel” I do not know what is. If the metric of your success is financial profitability over the health of the patient, then the health of the patient will always suffer. As we live in a world of scarce resources tough decisions will always have to be made by someone, there are therefore “death squads” in every healthcare system. The question is who would you rather making those decisions? An elected official who is looking to garner votes because of his success with the people or with an unseen insurance official who is trying to please shareholders. I know who I would prefer to make the decision.

All of these problems contribute to the big mountain that must be tackled – medical costs are too high in the US. I actually appreciate certain elements of the bill that Obama proposed to congress, however without getting to the root of the cost problem and putting the patient’s health above profit the problem of the US healthcare system will never be solved.