Monday, September 21, 2009

Health Care if I needed any more reasons!

Here are opening paragraphs describing the Harvard study obn death rates among uninsured Americans.

Nearly 45,000 annual deaths are associated with lack of health insurance, according to a new study published online today by the American Journal of Public Health. That figure is about two and a half times higher than an estimate from the Institute of Medicine (IOM) in 2002.

The study, conducted at Harvard Medical School and Cambridge Health Alliance, found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.

“The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors, and baseline health,” said lead author Andrew Wilper, M.D., who currently teaches at the University of Washington School of Medicine. “We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease — but only if patients can get into our offices and afford their medications.”

This number is roughly equivalent to the number of people killed in automobile accidents in the U.S. each year. Over a ten year period, we are talking about almost 500,000 largely preventable deaths. This fact alone should be enough to demonstrate the failure of our current private enterprise based health care and insurance system.

Monday, September 14, 2009

Health Care Reform

We are at a historic moment for the financing of the American health care system. In the 44 years since the establishment of Medicaid and Medicare, we have never been closer to fundamental reform that can have systemic impacts on the financing and quality of American health care. In this discussion, it is important to keep certain facts in mind:

  • Among developed, industrialized countries (Organization for Economic Cooperation and Development) the United States spends vastly more than any other country.
  • 16% of GDP which is almost double the OECD average.
  • Highest per capita with $7290 which is two-and-half times the OECD average. (Adjusted for differences in purchasing power)
  • Despite this large difference in effort, 45 million Americans are not covered by health insurance
  • Health outcomes (life expectancy and infant mortality) are far from the best.
  • There are fewer doctors per capita than in most other developed countries.
  • Most other countries spend substantially less than the U.S. and provide health care with at least equal and in some cases better health outcomes.

As a nation we have been clear that a market mechanism—while obviously superior in terms of the economic production—was not an effective or just method of allocating resources the fields of education, national defense, police and fire protection, and criminal justice. However our free market ideology has led us down a path in which market mechanisms and private ownership have been the determining structures of our health care system. After 40 years, I think we can conclude that this has only added cost without benefit to a health care system. We need to move away from a failed ideology and move toward an approach that every other industrialized country has found both efficient and effective.

However, simply changing the financial and institutional structures of the health care system will not solve the more fundamental problem: the deteriorating health of American citizens. When Medicare was established, 13 percent of adult Americans were obese; today 32 percent are. Fully two-third of all adult Americans are overweight or obese. In 2008 $147 billion in health care costs were spent on health issues related to obesity. This is 9 percent of all expenditures. There is nothing to suggest that these trends will not continue.

It is well established that Americans consume substantially more of the world’s resources than our share of world population. While this over consumption has provided us with a comfortable and easy life style, it is now becoming apparent that this very over consumption—whether of oil or of food—carries costs that we simply cannot afford. Sooner than later we need to reform our health system in ways that effectively incentivize health and wellness rather than treating chronic diseases caused by our life style. If we do not address both issues, it is hard to see how an unhealthy and bankrupt America can provide the political leadership the world desperately needs.