Took some notes at the latest Stone Arch Discussion Group meeting. Dr. Steven Miles from the University of Minnesota brought his expertise regarding various forms of universal healthcare. My notes are as follows, and anyone else who attended should feel free to chime in.
The Left in America has always demanded reform of the healthcare system, but only recently has business finally determined that it can't afford not to have healthcare reform as well...
Took some notes at the latest Stone Arch Discussion Group meeting. Dr. Steven Miles from the University of Minnesota brought his expertise regarding various forms of universal healthcare. My notes are as follows, and anyone else who attended should feel free to chime in.
The Left in America has always demanded reform of the healthcare system, but only recently has business finally determined that it can't afford not to have healthcare reform as well. In fact, Spain, Greece, New Zealand, the United Kingdom and France all have more efficient means of delivering healthcare.
The United States of America (US) spends almost $4,000 per year per person on healthcare, yet we receive lower life expectancy and the US has the highest rates of deaths among boys under five and women 15 to 59. For all other groups our life expectancy is competitive, yet our spending is way out of line with our results.
The World Health Organization, using a wide variety of objective measures, rates the US at 37th place in providing healthcare to its citizens. The US is better in some categories than in others, but overall ranks 37. The suggestion from data provided by the World Health Organization suggests that we get little bang for the buck because we put relatively little focus on primary care. Other countries that perform better emphasize more primary care.
An example of the US inability to deal efficiently is a comparison to Canada. By measuring breast and prostate cancer survivability according to income, Canadian rates are constant while US rates descend corresponding to income. The US claims that other healthcare programs ration healthcare, the above example, of the US poor dying at higher rates, doesn't hold water. In fact, we don't have any more healthcare workers than other countries, nor we do we have any appreciably more doctors visits. In fact, compared to the Japanese rate of visiting the doctor, we rarely see the doctor relative to what we could be doing. Whereas the Japanese record many visits to primary care physicians, Americans in the lower 35% income bracket generally don't have a personal physician, resulting in fewer visits.
Another measure of rationing is hospital stay. For minor heart attacks the US has the lowest number of days in hospital in the industrialized world. Furthermore, technology is not at a premium either. When looking at MRI use and other technologically advanced procedures, our usage is very rare compared to countries like Japan.
The US is in fact the Country that rations healthcare.
The US is also not using the technology available in the best possible manner. For example, Sweden uses far less technology, and far less invasive techniques for post-heart attack care, yet the US has an identical rate of death to follow-up heart attacks. Another example is Britain, where again, far more cancerous tumors are found using less invasive, and less expensive, techniques than the US.
The US can't blame poor health for its poor healthcare performance. It turns out that, relative to other industrialized countries that rate above us, we neither drink nor smoke more than the competition. In fact, we're light smokers and non-drinkers.
The end result is that a US citizen spends $700 per year out of pocket. That is $300 more per head than the next nearest country, without any objective increase in quality of care.
The evidence indicates that decreasing barriers to primary care is the best way to lower costs and increase health outcomes.
We can't look to an aging population as being a problem any larger than other countries either. In fact, age is not a factor in determining our high healthcare costs because as people get older, their Intensive Care Unit and Emergency Room visits decrease. These are among the most expensive of medical visits, so age should have a positive impact rather than a negative impact. We can't blame malpractice suits either. The total malpractice bill represents 2.2% of the total healthcare budget. Tort reform will not fix our medical expense crisis.
The lessons learned from countries that spend less money and deliver the same or better results indicate that the US should be looking at a universal system that includes, price discipline, low administration costs, equitable access to healthcare, and rationalizes healthcare.
There are a number of different alternatives to our current US healthcare system. Drug coverage would not have to be included if prices were controlled. We can include private insurances that allow people options for perks like private rooms. This is akin to the German healthcare system. The Australians offer progressive tax-based financing for regulated competing insurance companies. There is also the UK's National Health Insurance system.
Going forward stringing together existing entitlement programs is problematic because it creates cracks in the system. Rather we should be looking at systems like the German system where a baseline plan is required for all citizens, and private insurance supplements with amenities. Minnesota Care is interesting because a poll was taken to ascertain what priorities are greatest. Responders indicated that primary and secondary care was more important than catastrophic care. This is similar to the German plan, and to what works in other countries.
The hope in reforming our healthcare system relies on two new factors. First, now that men are living longer and still control much of the political agenda, healthcare reform is on the table. Furthermore, growing numbers of people are uninsured and this is now a cross-party issue.
Ultimately, in the political debate we must remember that people from most walks are concerned about reform, including evangelicals. Furthermore, we have finite resources. We ought to start with price controls and easier primary care entry points. We have to have an open debate about paying for people on the downside. Specifically, do we pay for people to be on life support? These are big issues that need to be settled by public debate.
I'm going to try and get some of the evidentiary slides loaded another time. For now I think Doctor Miles has given us something to chew on.
Jeremy Wieland
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