In February, 2006, while traveling from Australia to the United States, one of my children became ill with a chest infection. Upon arrival here, my wife took her to the Martha’s Vineyard hospital.
Some hours and $600 later, they emerged with a prescription for antibiotics.
As fate would have it, while traveling from the United States to Australia this February, almost exactly three years later, the same child became ill with a chest infection. After we arrived, I took her to a medical center. About a half-hour later, and at no cost at all, we emerged with a prescription for antibiotics.
It was like, welcome back to the civilized world.
Now, this little anecdote might simply have been another bit of evidence for use in those conversations which inevitably spring up with friends and acquaintances about how dreadful health care is in America.
Except that when I got back here, the first story I found myself doing was on the unfunded liabilities owed by the towns and other Island public entities to their retiring employees.
Those liabilities total close to $89 million, almost all of it related to paying health costs for retired staff. And it quickly became clear that no one here has much of a clue about how they can address the problem, without sending the place broke. And almost every other community in the nation has a similar problem of similar magnitude.
So, I figured maybe I could offer the anecdote as a clue to an answer.
Have you guessed it yet? Yes, it’s universal, single-payer health care, as exists in my homeland and in most of the rest of the advanced world.
Indeed, it would address so many problems. General Motors, for example, is not going bust only, or even primarily because it built bad vehicles. Its problems are in large measure down to the $20 billion cost of paying the health care of former workers. Someone recently referred to GM as a health company that also builds cars.
Sorry, but there is no polite way to put this; the U.S. health system is not worthy of a developed nation. It is beyond inefficient; it is unfair, inhumane and economically insane.
Let’s start with the unfairness of it. In 2001, the Harvard Medical and Law Schools conducted a joint study of the numbers and causes of personal bankruptcy in America.
More than half were due to illness and medical bills. That was some 700,000 cases, affecting some 2 million people, including dependants, every year. And more than three-quarters of those people had medical insurance, at least when they first got sick.
I was staggered when I first learned this. This does not happen in other developed countries.
Sure, some will say that health care is expensive here, but it is good. Well, actually, it’s not. Study after study has shown that health outcomes in the U.S. are not better, compared with countries with universal health care. And for large sectors of the populace, they are actually worse.
Perhaps the ultimate health indicator is life expectancy.
It might surprise you to learn that America — according to the 2009 CIA factbook — ranked 49th in the world for life expectancy. Australia was seventh, yet the USA spends 50 per cent more per capita on health care than does Australia, and significantly more than any other developed nation. Australians live an average of 3.5 years longer.
And, for some groups of Americans, life expectancy is actually declining, according to a couple of reports released last year.
A Harvard study found that between 1983 and 1999, life expectancy had actually declined for women living in some parts of the country; in two places in Virginia, it had fallen almost six years. In many more areas, it had remained static — the first time life expectancy had not improved since the Spanish flu epidemic of 1918.
If you look at the map showing the areas where this decline has happened — across the south and up into Appalachia, it corresponds closely with the area where health insurance rates are lowest.
The other report was from the Congressional Budget Office. It showed the gap between life expectancy of the rich and the poor had widened, along with income inequality, over the past two decades.
From 1980 to 1982, the most affluent could expect to live 2.8 years longer than the poorest. From 1998 to 2000 the number had increased to 4.5 years. While disparities in health care were not the only cause — other things like lifestyle played into it too — analysis suggested it was a significant factor. Yes, the U.S. health care system is actually taking years off people’s lives.
Now, let’s move on to the economics of it.
According to data from the National Coalition on Health Care, in 2008, total health care spending in this country was $2.4 trillion, or $7,900 per person. (And that, of course takes no account of the unpaid hours so many of us spend wrangling with doctors, hospitals and insurance companies over payment). And it was rising at 6.9 per cent per year, or twice the rate of inflation.
The U.S. now spends some 17 per cent of gross domestic product on health.
A table comparing total health spending, per capita, across 19 developed nations (in Western Europe, Japan, Australia and Canada), in 2003, published by the Kaiser Family Foundation, found the U.S. spent more than twice the average. Even if you leave out some of the smaller Euro nations, the U.S. spends some 70 per cent more.
And it’s getting worse, in relative terms, as New York Times columnist and Nobel prize winning economist Paul Krugman noted in a blog post last March.
“Everybody knows that the U.S. spends much more on health care than anyone else, without getting better results,” he wrote.
“Everyone also knows that health spending has outpaced GDP growth everywhere, thanks to medical progress. What I didn’t realize was just how clearly the evidence shows that the rising trend is steepest in the U.S. We have the biggest increase as well as the highest level. We’re #1!”
He included a small table showing comparative growth rates for four nations between 1970 and 2004. In America, health spending as a percentage of GDP had risen from 7 per cent to 15.3 per cent. The numbers are 7 to 9.9 for Canada, 6.2 to 10.6 for Germany and 4.5 to 8.1 for the United Kingdom.
Other figures show that employer health premiums shot up 5 per cent in 2008, or twice the inflation rate. Worker contributions went up 12 per cent.
The annual premium paid by an employer to cover a family of four was $12,700 — rather more than the gross earnings of a full-time, minimum wage worker. Since 1999, premiums have been going up four times faster than wages.
I could go on; the statistical indictments of the economics of the U.S. health system are myriad.
And in spite of all this cost, 46 million Americans — and the number is fast rising — are uninsured.
Now, Barack Obama is talking about health care reform. Here in Massachusetts, we already have seen something of what his reforms might look like.
And while it’s great that in this state they have at least made big improvements in coverage, I personally have recent evidence that it has made not much change in the outrageous cost of the system.
There is only one answer, and I cannot for the life of me understand why hardly anyone in power here is talking about it. You just set up one, federally-controlled health insurer. You don’t even need to think of a new name. Call it Medicare — the new, expanded, universal Medicare.
Those who could afford better could still carry some private insurance to cover things like elective surgery; all these other countries also leave a role for that. Private health coverage accounts for 20 to 40 per cent of health spending in most of them. But the state provides the safety net America so crucially and expensively lacks.
Sure, such a big change would mean people’s taxes would have to go up, but equally surely, their take-home pay would increase. For the amount they would pay to the government would be far less than the amount they now pay to private insurers.
I know the natural inclination of many Americans is to scoff that this is socialism.
So let me just ask this question: Do you resent having to pay $170-odd billion to compensate an insurance company, AIG, for its waste, incompetence, mismanagement and greed?
In fact the waste, incompetence, mismanagement and greed of the private health insurance system is costing you five or six times that much every year.
Do the math. If this country cut health spending to somewhere close to the per capita cost of other advanced countries, it could save well over a trillion dollars a year.
And countless lives. And General-Motors. And 700,000 bankruptcies each year. And the budgets of every little town on Martha’s Vineyard.