Sunday, December 3, 2017

US Health Care: Paying too much for too little

On 26 June 2008, in testimony before The President's Council on Bioethics, Dr. Steffie Woolhandler, a primary care physician, stated:

Now, it turns out that medical bankruptcy is, as I said, half of all personal bankruptcies. Millions of people each year are affected by medical bankruptcy, but 76 percent of people who were in medical bankruptcy in our study had health insurance at the onset of the illness that bankrupted them.

So insured people have an issue, too, if they have a prolonged, serious illness. They can't work. They have lots of co-payments, lots of deductibles. They can end up in bankruptcy, as well.
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Dr. Steffie Woolhandler is also an Associate Professor of Medicine at Harvard and co-director of the Harvard Medical School General Internal Medicine Fellowship program.  Her testimony was removed from the government website by the current Presidential Administration, but you can still view an archived copy on the Internet Wayback Machine.

Most Americans don't realize how badly flawed the medical system is in their own country and how many Americans go without adequate medical care as a result.  Even though the US spends more on healthcare, both per-capita, and also as a percentage of its national GDP, than any other developed nation in the world.  According to the OECD, health-care spending in the US was 17.7% of US GDP in 2011 (the chart below is for 2009).  That's far more than any other country, nearly 50% more than was spent by the next highest country on their list. 

Americans spend nearly twice as much as the average developed (rich) country ... but they die 1.7 years earlier.  You find something wrong with that?  Any reasonable person does.

With so much wealth spent on health care ... are Americans healthier than people in Switzerland, Germany, Canada?  In what way could that be measured? Perhaps by life expectancyInfant mortality rates? Prevalence of obesityHeart disease death rates?  

It's not that health care in the US is bad, actually, it is the best available anywhere.  The problem is that the system is so inefficient that Americans pay far more for their health care than is, apparently, necessary.

Nearly half the counties in the US don't have a single ob-gyn providing maternity care (source).   In a for-profit health care system, doctors go where the money is.  In the US, where health care is apportioned by ability to pay, some people get the best care in the world, and immediately.  Millions go without.  Many put off necessary health care they can't afford.  Many die in "waiting lines" for health care they will never get.

What Americans have been doing for generations doesn't seem to be working anymore.  Is there a better way?   A reasonable person has to wonder.