We Need To Spend more on Healthcare!
Many commentators vilify the US for the fact that infant mortality in the US is higher than in many European countries. This sounds horrible until you look at the details and realize that many European countries only count infant deaths if the infant lives one month and then dies. Deaths in the first month aren't always included. Meanwhile in the US, all live births that end up dying count towards our statistics. Furthermore, we are much more aggressive with preterm births. The fact that our patient population is much sicker and we include all deaths in the statistics explains the gap in infant mortality.
While we'd love to think that the grass truly is greener across the border, lets take a closer look. In Canada you wait weeks, months, even years for procedures not deemed emergent like hip replacements. A set amount is allocated at the start of the year for each procedure and when the money runs out, so does any hope of you getting your procedure done that year. We aren't talking about breast implants and botox. I'm referring to procedures like knee and hip replacements so that grandma can walk again instead of spending another six months in a wheelchair popping narcotics to relieve the pain. Sounds like a great healthcare system.
How much would you pay to spend one more year with your loved one? What is the value of knowing that if you get sick, you have the best medical care in the world right down the block? What is that peace of mind worth to you? Our country bemoans the cost of healthcare while sitting around a table eating KFC and McDonald's. Am I the only one who finds this just a little disingenuous. I maintain that our healthcare system is the best in the world and that it is a bargain. In fact, we should be paying more for the healthcare we get. I'd like to go over the biggest complaints against our healthcare system and hopefully explain why I feel so differently from the majority.
Widely held belief #1: Our healthcare system does not provide quality. In fact there are many countries that provide better care. The "I wish I lived in France or Canada complaint!"
The widely quoted studies that claim US healthcare quality isn't up to snuff do not take into account genetic and behavioural differences. For example, the incidence of coronary artery disease in the Japanese population is much less than that in the US. Do you think this is because we don't have good cardiac care or because we like eating at McDonald's?
Many commentators vilify the US for the fact that infant mortality in the US is higher than in many European countries. This sounds horrible until you look at the details and realize that many European countries only count infant deaths if the infant lives one month and then dies. Deaths in the first month aren't always included. Meanwhile in the US, all live births that end up dying count towards our statistics. Furthermore, we are much more aggressive with preterm births. The fact that our patient population is much sicker and we include all deaths in the statistics explains the gap in infant mortality.
While we'd love to think that the grass truly is greener across the border, lets take a closer look. In Canada you wait weeks, months, even years for procedures not deemed emergent like hip replacements. A set amount is allocated at the start of the year for each procedure and when the money runs out, so does any hope of you getting your procedure done that year. We aren't talking about breast implants and botox. I'm referring to procedures like knee and hip replacements so that grandma can walk again instead of spending another six months in a wheelchair popping narcotics to relieve the pain. Sounds like a great healthcare system.
Lets forget the fuzzy math and the unavoidable delays inherent in any system that rations healthcare. Ask yourself what you would do if your mom, dad, son, or daughter developed a serious medical condition. Would you take them to Canada, France, or Great Britain or would you take them to the top notch hospitals all across this country. Just to make the point further, one of the Canadian Parliament members who is a huge proponent of the Canadian healthcare system came to the US to get care when she developed cancer. People from all over the world fly into Boston and Baltimore in the hopes of having their disease treated. They don't fly to Paris for the healthcare.
Widely Held Belief #2: Even if we deliver good quality healthcare, it costs too much! This is the "I want to eat my cake and have it too!" complaint.
Healthcare does cost a lot of money but so does going oversees and killing Iraqis, so does giving subsidies to farmers, bankers, and auto workers, so does paying for your local NFL team to build a new stadium. Before saying that healthcare costs too much lets compare it to other expenses both at a national level and at a personal level. For every dollar in federal taxes, 41 cents was spent on war, preparing for future war, or paying off old wars (interest on the military portion of the national debt). 19 cents of the federal tax dollar was spent on healthcare. So, we spend twice as much money killing people as we do on helping our own citizens get the healthcare they need.
Oregon is one of the few states that has medical coverage for all its citizens. They have published their fee schedule that details reimbursement for all covered procedures. It makes for interesting reading. Lets go through it and try to compare how much Oregonians pay for various medical procedures and try to compare that to what else they could buy with the same amount of money.
Open chest heart massage: $110.67 or you could buy two tickets to watch the Portland Trailblazers (section 209, rows:a-h). Of course you'll have to pay extra for the parking and the food you eat at the game. So, a night out to watch a pretty bad NBA team vs open heart massage. Which one do you think costs too much?
Insertion of a pacemaker: $351.10. You could buy a Playstation 3 for $399. Of course you'll have to pay extra for any games you want to buy. So, the insertion of a device to keep your heart beating costs less than a Playstation 3 but we MUST be spending too much on healthcare, right?
Bone Marrow Transplant: $92.16. Or, you could spend one night at a Holiday Inn Express (20 miles outside Boston). This price doesn't include tax or any of those little drinks in the mini-bar.
Antibiotics for severe infections like pneumonia (zosyn): $5.57 per dose. Can you even get a meal at McDonald's for that much anymore?
Cesarean delivery: $1221.99 or about the same as a year's supply of diapers. This is a close call. What do you think should cost more?
The amounts quoted above might not jive with the amounts many of you see when you get you bill from the hospital. This is because a significant amount of money is skimmed off the top by insurance companies. Have you ever wondered why the tallest, newest buildings in many cities are owned by health insurance companies? While doctors, nurses, pharmacists, and drug companies offer something to the patient, I am at a loss for the value added role for insurance companies. The costs I listed above are what the hospital is actually reimbursed. A significant amount of a patient's total bill goes towards overhead and is lost due to inefficiency. This will be covered in another post where I discuss my dislike of insurance companies.
One other reason for the large healthcare costs in the US is due to the fact that we are the innovators for the rest of the world. The reason HIV drugs are available in Africa is because we spent the research dollars to develop them here for our citizens. The same can be said for ~ 90% of the medical breakthroughs over the last few decades. We develop the technologies and techniques that the rest of the world uses. Doctors and scientists from all over the world come here to learn and to help us further medical care. Innovation comes with cost.
My final point will probably be the most controversial one. Healthcare costs in the US are going up because we aren't taking care of ourselves. That's right, I am blaming the patient. We don't exercise, we eat too much, we drink too much, and we smoke. And then when we are 100lbs overweight and addicted to nicotine, we act surprised when we have a heart attack. When we get the hospital bill we get mad. We rant and rage and go on CNN and complain about how healthcare costs are ruining America. We now have the technology that allows you to live despite a lifetime of overindulgence but don't' expect that to be free. Everyday, you can scarf down your bag of Cheetos, chug a few cans of Budweiser, eat the box of Krispy Cream doughnuts, and take a long deep breath full of that great Marlboro air, and still live to see your grandkids have kids. Isn't America great? By the way, when you have that massive heart attack and go to the hospital to get your arteries opened up, the hospital will be paid $600 to place a stent in your heart. That is about the same as a person spends on cigarettes over a 4 month span. Do you still think we need to reduce health care costs?
I think everyone deserves quality health care despite their ability to pay for it. However, I think that a single payer system isn't the solution. And certainly, any healthcare reform that seeks to curtail healthcare spending is not going to result in better patient care. I'll discuss a few ideas in my next post but I would love to get your thoughts on healthcare spending.
