Wednesday, November 4, 2009
When I attended T.R. Reid’s lecture on American health care reform two weeks ago, I expected to be part of a larger student crowd, engulfed in an intellectual mosh-pit of impassioned students both for and against reforming the health care system. Instead, I noticed that the majority of the auditorium was filled with stern-faced men and women more than 55 years old. KU students were scattered throughout the back of the crowd, displaced and overshadowed by the very real concerns of those whose health care has become part of their everyday lives.
Most students are not very concerned with health care reform, let alone health care in general. We are typically young, healthy, carefree and reckless. We are not concerned with chronic disease, medical bills or even our own mortality. Why should we care about changing a system we’re not using?
Students need to understand why there is a movement to reform our health care system if they are to make an educated decision about the reform itself. Instead of persuading you to support or oppose this round of American health care reform, I will present a semi-scientific method to better understand the situation, in the form of three questions that informed students should ask themselves.
What is the problem?
America does not have the best health care system in the world. When the World Health Organization last ranked 191 heath systems in 2000, the U.S. came in 37th, between Slovenia and Costa Rica. The U.S. spends more than 15 percent of its GDP on health care, the greatest amount in the world. Most countries spend below 10 percent, and Germany and France only spend about 10 to 11 percent. High medical bills are the number one reason Americans are declaring bankruptcy.
Our system has overlooked more than 35 million Americans who do not have health insurance. Paradoxically, for those with good insurance and high incomes, American hospitals and doctors provide some of the best health care in the world. This difference between good health care and a good health care system is crucial in understanding reform.
What are the alternatives?
To say that other universal health care systems around the world are simply “socialized” medicine is both a gross oversimplification as well as factually inaccurate. Although the United Kingdom has a universal health care system instituted by government-run hospitals and insurance companies, many more, such as Japan, have private hospitals and insurance companies. Japan spends only about 8 percent of its GDP on its universal health care system, and Japanese use their services much more than Americans.
A reformed system could be socialized or privatized, and Americans need to look around the world for alternatives to our current system.
What is important?
Every health care system has its weaknesses, so the public must decide what should be valued in each system. The U.S. spends an enormous amount of money and doesn’t offer a standard level health care to everyone. Other countries with universal health care coverage may have waiting lists, poor hospitals and decreased physician salaries, but which is the greater price to pay, especially when that price is both dollars and lives?
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Comments
Folmsbee: Questions for health care reform
Sai, as our usually impressive science guy, the one who actually looks at the statistics more often than our other columnists, I must say that I am not impressed.
You didn't look into the reasons why the WHO study ranked the US 37th in the world. The ranking system itself includes factors that have little to nothing to do with the quality of care:
25% - Life expectancy: What factors other than quality of healthcare cause premature deaths? Car crashes, homicide, genetic predisposition, nutrition, etc. How is this an effective method of ranking healthcare between countries? If we remove accidental deaths from the equation, the US climbs to the top.
12.5% - Responsiveness: This is a measure of a national healthcare system's speed of service, choice of doctors, and amenities, such as having quality linens.
25% - Financial fairness - This is taken as the discrepancy between households of the percentage of household income spent on healthcare. A country with a government run healthcare system that spends equally on all of its citizens will by its very nature (and not quality of care) score high on this ranking, while a free market system will inherently score lower. It only makes sense that families with higher income will spend a smaller fraction of their overall income on healthcare than families with low income. This is just an arbitrary judgment call having nothing to do with the quality of care in a country, but everything to do with whether or not a country's healthcare system is run by the government.
37.5% - Health distribution (25) and responsiveness distribution (12.5) - These measure the quality of a nation's healthcare system in a manner that does not actually tally results. A country with a majority of the population receiving "excellent" healthcare and a minority receiving "good' healthcare would rank lower than a country in which the entire population receives "poor" healthcare.
Folmsbee: Questions for health care reform
You go on to mention that there are 35 million uninsured Americans. I actually read an article that breaks this number down recently to make things a little bit more clear:
The Census Bureau's Current Population Survey gave the number of uninsured Americans at any given moment in 2007 to be 45.7 million, nearly one sixth of the US population. This number has been touted frequently as the number of uninsured Americans and is the one I will use:
Slicing down the CPS data gives us these numbers:
-6.4 million were enrolled in Medicaid or SCHIP but likely misreported their status (based off of evidence from a 2005 study.) -4.3 million were eligible for Medicaid or SCHIP but had not enrolled -9.3 million were non citizens -10.1 million belonged to families earning more than 300% of the federal poverty level (at some point not having health insurance becomes a choice. Some believe it is at 250% of the FPL, but this study gave 300%) -5 million were childless adults aged 18-34 (these individuals are usually uninsured by choice or because the cost of covering mandated conditions prices them out of the market. Ending mandated coverage practice or allowing the purchase of insurance plans over state lines could do a lot to fix this problem.)
Removing these individuals from the equation gives us 10.6 million Americans who are ineligible for government coverage and earn below 300% of the federal poverty level.
A 2003 CBO report observed that "between 1/2 and 2/3 of the people who experienced a period of time without insurance in 1998 had coverage during other portions of the year.
Finally, we must discriminate between having health insurance and having access to healthcare itself. Based on data from the 2005 Medical Expenditure Panel Survey, "the uninsured receive 50-60% of the amount of services received by those who are insured." While this is not 100%, it is certainly not a lack of access to care.
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