Sunday, July 8, 2007

Bar Talk: US health care, or lack thereof

I'm back with another fruitful bar discussion, only this time it came about quite unexpectedly. My bartending friend has actually left her job at the BW, so my dreams of finding stimulating conversation there with the BW's diverse crowd have been dashed. However, it seems that a college-town bar can be conducive to interesting discussions as well, and I found myself in the middle of one a few nights ago. Though, to be honest, I think the place has less to do with it than the fact that I tend to get more thoughtful about things when I've had a bit to drink, but doesn't? Anyways, the topic of the night somehow-- and I really have no recollection of how-- landed on politics. Those that know me well can attest to the fact that I loathe politics, and for all my political philosophy musings, I simply cannot bring myself to have faith in our current political system. But for all my political pessimism, there are some political issues that I can not shy away from. So when the guy I was chatting with mentioned that he has applied to help out in the Edwards campaign, I put away my pessimism and listened. And soon enough our conversation turned to health care, or more accurately, the lack thereof. We both agreed that the current system sucks, and something needs to be done. Everyone has a right to health care, not just the wealthy or those lucky enough to be in the right sort of jobs. But of course, it's all easier said than done...

You may have come across my post a month or so ago about my disgust with Guiliani's attitude towards health care. I used to share his attitude, and many Americans still do, much to my dismay. Namely he thinks that the quality will go down if we mess with the current system, and our quality is the best in the world so we shouldn't tamper with it. To put it roughly, he's unwilling to sacrifice the quality of care that he receives, all the while neglecting the millions of Americans who receive no health care at all, high quality or otherwise. What's the point of having excellent health care if no one can take advantage of it? But of course, there are the naysayers who boo and hiss at the idea of a universal system because it would, they say, never work. Well, let's have a look...

First, I thought it would be helpful to outline what our current system is like. For those not from the US, you may not be familar with our multi-payer / market system. And for those who are from here, it's important to look beyond your personal expereiences with health care and see what is happening in the big picture. I say that because I went a long time thinking our system was just fine precisely because I had great health insurance, well my mom who is a teacher had great insurance, and I've been a free-rider milking it for all it's worth. But my experiences aren't typical, so I thought I'd look for some answers elsewhere.

There's a great article here that gives an outline of our current system, and if you look here you can read up on a study about how our system is failing to meet quality standards. Here are some things I learned that I didn't know before:

  • The US spends more than other countries on health services (after you figure in GDP), but at the same time the US is below the median for it's use of medical services (physician visits, length of stay, etc). Take a look at the US dot. Way to be an outlier guys:
  • 17% of Americans under 65 are completely uninsured (yikes), and the uninsured population is on the rise.
  • Being uninsured is not just a problem for the poor or unemployed. Most (70%) of the uninsured live in families with at least one worker. Also, one third of the non elderly uninsured earn up to twice the amount of the poverty line ($14, 000 ish for a family of 3).
  • My age group (18-24) is the least insured of all other age groups, with a whopping 30% of us going around without insurance.
  • Medical costs, not surprisingly, are on the rise, with the average cost of a day at the hospital costing over 10 ten times what it did 40 years ago.
  • For all three categories of care that are needed (chronic, acute, and preventative), the recommended care (of an appropriate quality) was provided only about 50% of the time.
  • When people don't receive the care they need, they are the ones who pay:
  • The US is behind many other developed countries in life expectancy, infant mortality rates, obesity rates...etc. Granted, there are many factors that contribute to this, but it's important to remember that widespread preventative care can do a lot of good. And, with the proper prevention, many Americans can lead the way in changing their daily habits that contribute to poor health.
  • Other effects of being uninsured: emotional stress or anxiety, job lock (being unable to leave a job solely because you need the insurance), and bankruptcy...among other things.
With over 45 million Americans without insurance, and millions more who are under insured, it's not hard to see that our current system isn't cutting it. In the Case for Universal Health Care, the writers point out that Americans treat health care as a privilege, like owning a car or a DVD player. However, many other countries treat health care like a right that everyone should be able to access, because they see health care more like a public or social good than a commodity to be bought by the highest bidder. After all, who can put a price on health? And even if you could, why shouldn't we make sure everyone has a decent shot at it? Morally speaking, good health is a stepping stone to leading a flourishing life. Like freedom of thought or expression, freedom to maintain an adequate level of health enables people, or gives them a foundation, to live a life that they choose and a life where they can flourish as a human being. If good health is a prerequisite (or some sort of capability, if you're a Sen fan) for living a good life (in whatever form that might be for you), then it should be at the top of the list of things that the people want their government to ensure. Political theorists would probably disagree with this, but I think that the purpose of the government is defeated when it fails to live up to the only reason it's around at all, which is to improve the quality of life that it's members have.

The next question is: what are the costs of reforming the system? Well, it would be expensive (I found an estimate of upwards of $70 billion). And if there's minimal/no cost-sharing (the individual paying something out of pocket), then healthcare might be overused (depending on structure of the solution). Also, employers that provide decent health care now might push employees to take the government provided program, a practice referred to as "crowding out."

And what are the costs if we don't? Well aside for the obvious detrimental effect on people's health, we can expect a loss in productivity from workers, a decreased time-span of years spent working all together, job lock, strain on businesses, and a loss in global competitiveness (because our products carry the cost of privately bought health care).

But there's hope yet, and Dr Kenneth Thorpe, an economist at Emory University, has some positive light to shed the question of health care reform. You can check out his non-partisan study here. The good news is that the government could save over one trillion dollars if it implemented a universal, public financed plan along with cost controls and further measures to improve efficiency.

And once again my goal is high: health care for everyone. Can it be done, I think so. Can it be done in the US, well, I hope so. But before anyone can do anything we must wake up the American population and make them aware of the truth behind our wonderful system. Nothing will change until people see the need. But then again, at the rate that people are loosing their insurance, that time may be coming sooner than you'd think.

RAND nonprofit research findings
Nice overview of the US system
Case for Universal Health Care
Impacts of Health Care Reform: projections of costs and savings, K. Thorpe

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