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Status of Health Care Reform in the U.S.

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Hi,

It looks like health care reform is really heating up in the U.S. I think it will not pass in its current form, but I don't know what alternatives Congress can come up with.

In my opinion it comes down to this. It is impossible to come up with enough money and resources to care for an obese population. And since obesity accounts for the lions share of illnesses (both chronic and acute), there is just no way to pay for the growing obesity problem.

http://www.examiner.com/x-16850-NY-Triathlon-Examiner~y2009m8d12-The-state-of-wellness-in-the-US-in-2009--headed-in-the-wrong-direction

A case in point. A few days ago I was reading how two recent studies have linked obesity to Alzheimer's disease. On the opposite page there is a fully length ad announcing the new Mac 1/3 pounder with cheese, bacon, and other sorts globbed on it. Remember now, a mere 1/4 pound of red meat a day, increases the chances of dying within 10 years by 30%.

There is just too many jobs in the U.S, and too much money/profits nowadays that are dependent upon an obese population. Both from the product side (Big Macs), and the service side (insurance, health providers, etc.). My solution may be to just move to Canada.

Rich

@richrf,

The drive for health care available to all for all reasons on need not ability to pay is not or could not be implemented overnight.

I understand that health care, in the US, in general is extremely expensive for all,three times more than Europe.Medicine is also three times more expensive than Europe,that in itself could be tackled by legislation.The lobbying system at the moment allows the pharmaceutical companies the freedom to make excessive profits.Private medical establishments are almost as bad,with insurance companies involved in their structure.Its a stitch up for every user of medical needs.

If health was not treated as a political battle field an agreement could be found and it would not require massive tax increases for those who oppose these changes.If you look closely at those who oppose the changes,by tv propaganda,they are the very same ones who lobby governments for the freedom to make these excessive profits.Its not about freedom, its about corporate greed.

@xris,

xris;83302 wrote:

Its not about freedom, its about corporate greed.

Hi xris,

I think it is more about corporate greed. The health (or more properly the sick) industry is HUGE. It makes up over 16% of our GDP. There are millions upon millions of people who have jobs that depend upon the constant flow of dollars, and they are all basically lobbying to keep the money train flowing.

It is an amazing phenomenon. And all aspects of the industry (doctors, pharmaceuticals, hospitals, nurses, etc.) are in unison with their mantra: you will die, if the money flow is cut off in any manner. It is the most incredible thing to observe. And the thing is, most developed countries spend much, much, much less than the U.S. with better life expectancies. Go figure. People love their medicine like they love their burgers in the U.S.

Rich

@richrf,

I think most everyone can empathize with the goal of seeing that all citizens are afforded basic affordable health care and treatment for life threatening diseases. The key is "basic health care" as opposed to unrestricted access to the most expensive, technological and sophisticated care in the world. Rationing health care is implicit in the goal to extend care to all while reducing costs. This especially means rationing in the end of life where a high percentage of US care costs are involved and very expensive treatments with low percentage response rates, minimal life extension and quality of life issues are involved.
The US has no health care rationing system (other than ability to pay) and no method of evaluating such issues.

It is true that health care in the US consumes 16% of the GNP which is about twice that of most other developed nations with national health insurance programs (Canada, U.K., Germany, Switzerland, etc.). It is also true that for spending twice as much; the US lags other countries in terms of longevity, infant mortality and several other measures of overall health indexes. It also true that for many diseases and conditions one can get the best care available in the world in the US.

The problem with the current proposal is that it extends health care coverage to all without any provisions for controlling costs or assessing quality of care or outcomes. It is simply not rational to think that one can add 50 million additional insured to the current system and expect health care costs to magically come down. It is also not rational to think that the additional costs can or should be born by either small business or that small percentage of the population which makes over 250,000$ a year. It is the worst form of political populism to promise benefits for all but taxes for the few or no tax increases.

The other major problem with the current proposal is that it continues to provide physicians with perverse cost incentives by paying for each procedure, visit, or test (fee for service) performed thus making physician compensation dependent on maximum volume with an emphasis on procedures, surgeries and tests and a disincentive for preventive care and patient counseling or education. Tort reform is also necessary as a measure towards less unnecessary testing and procedures. Model health care systems such as the Cleveland Clinic and the Mayo Clinic offer integrated multi-specialty organizations where physicians are well compensated but salaried, preventive care is emphasized and quality of care and treatment outcomes are measured.

The final problem is a cultural problem. The US traditionally is distrustful of big government and of the government's ability to efficiently and effectively manage the economy, the health care system or anything else for that matter. The US has a long tradition of individualism (as opposed to collectivism), of self reliance (as opposed to dependency) and of individual liberty and choice. The majority of the US population is not in favor of larger government or of more government control over larger sectors of the economy. Most Americans prefer the "right to rise" or the "ability to become rich" over cradle to the grave dependency on the government. Americans are not against extending a helping hand to the less fortunate but they are opposed to an entitlement society, the destruction of independence and self reliance, and the loss of market mechanisms as the most efficient and effective way to allocate resources.

@prothero,

prothero;83365 wrote:

I think most everyone can empathize with the goal of seeing that all citizens are afforded basic affordable health care and treatment for life threatening diseases. The key is "basic health care" as opposed to unrestricted access to the most expensive, technological and sophisticated care in the world.

Yep, I pretty much agree with everything you said. As it stands now, the proposal is not plausible. What gets me, is that Obama is reasonably sharp about these kind of things. How did he get snookered into endorsing a proposal that really is quite a mess? I don't get it.

Rich

@richrf,

richrf;83281 wrote:

In my opinion it comes down to this. It is impossible to come up with enough money and resources to care for an obese population.

More than 80% of the health care expenditures in the US health care system are devoted to the elderly, who per capita are LESS obese than younger groups, and a disproportionate amount of money is spent on heroic care in the last week of people's lives. Important as obesity is, it is not an accurate statement to quantitatively blame rising healthcare costs solely on obesity.

richrf;83281 wrote:

My solution may be to just move to Canada.

Great idea:

The skinny on obesity in Canada
Welcome to Obesity Canada
Adult obesity in Canada: Measured height and weight
The Obesity Epidemic in Canada(PRB 05-11E)
Overweight and Obesity in Canada: A Population Health Perspective
CTV.ca | Obesity causing problems in Canada's workplaces

@Aedes,

Aedes;83392 wrote:

More than 80% of the health care expenditures in the US health care system are devoted to the elderly, who per capita are LESS obese than younger groups, and a disproportionate amount of money is spent on heroic care in the last week of people's lives.

aedes, what do you think of the Oregon Plan? i remember reading about it and thinking it was good, but how it actually has been working out i have no idea.

@richrf,

As I understand it it's sort of an extension of the Medicaid program that exists in all states. Because healthcare costs have risen far faster than inflation, the program has become far too expensive to fund, and they've had to cut services, charge patients co-pays, and ration care.

@Aedes,

Aedes;83422 wrote:

As I understand it it's sort of an extension of the Medicaid program that exists in all states. Because healthcare costs have risen far faster than inflation, the program has become far too expensive to fund, and they've had to cut services, charge patients co-pays, and ration care.

what i remember is that they faced a lot of opposition because they started out limiting care, rationing it, making three categories etc. this was an attempt to curb the useless spending in the last week of life and unnecessary tests as well as treatments that are destined to fail. there was a list of conditions that would not be covered-the one i recall was babies born with only brain stems (or without brain stems, i forget which) would not be given any treatment to keep them alive as they were incapable of ever living an actual life.

you can see the clamor over this would be huge, but it was really a very good plan in my estimation, the limits on care were ethical in my opinion. i thought it had been trashed long ago but now i see it still exists. but i dont know if it is any better.

i also know california has a state plan that supersedes medicare-it doesnt give quality care either, and those who need it most are put to a lot of inconvenience and difficulties in getting care.

i cant imagine what the number of people now must be in america without health insurance because of unemployment. my son has had no insurance for two years. due to the economic situation i would guess many more people today are driving cars without auto insurance as well. i have to look into buying travel insurance for when i go back there to visit in february because any accident or illness that falls on me while i am out of india could mean i am financially wiped out for ever, and my son will go down with me.

it's really a scary situation for everyone.

@Aedes,

Aedes;83422 wrote:

As I understand it it's sort of an extension of the Medicaid program that exists in all states. Because healthcare costs have risen far faster than inflation, the program has become far too expensive to fund, and they've had to cut services, charge patients co-pays, and ration care.

Cant anything be done to curb the costs of healthcare and drugs.Why is it so much more expensive than the uk?
I can understand the practicalities of creating a national health service but why the opposition in principle?It appears to me the state contributions to health care in america is not much less than the uk but because of costs the effects are less noticable.It appears to me a political problem rather than a practical one.

@richrf,

Drugs are cheaper in other countries because there is a single payor system and therefore a single negotiator for price.

Part of the astronomical health care costs in the US are beurocratic, including the labyrinthine billing system and multiple different insurers.

One thing driving up cost here is the overreliance on diagnostic testing, which is often done for fear of liability. There are studies coming out all the time that show that certain tests won't change management, but people persist in ordering them. Same is true for some expensive therapies.

There is a lot more skepticism about government here than in the UK. For some reason people don't want things nationalized. To be fair, with the size and population of the US the challenge is daunting compared with other countries.

---------- Post added 08-15-2009 at 09:06 AM ----------

salima;83423 wrote:

due to the economic situation i would guess many more people today are driving cars without auto insurance as well.

That I doubt, because it's illegal.

@Aedes,

Aedes;83429 wrote:

That I doubt, because it's illegal.

it's illegal and incredibly foolish but it isnt properly enforced in a preventive way. for instance i am not aware of there being a requirement to show insurance proof when renewing license plates or getting emission tests (do they still do that?) in the state where i used to live.

there have always been people who drive without insurance regardless of the risk, and now that insurance is so high and people are out of work, they are becoming more and more foolish i would guess. i do know one very foolish person who has done this to cut corners on spending, and i wouldnt be surprised if he hasnt also let his house insurance lapse. god help him...i am well aware of the ramifications that he could easily lose his house, his car, his driving license, not to mention be put in jail and and/or be fined heavily.

but of course that is off topic...

@Aedes,

Aedes;83392 wrote:

More than 80% of the health care expenditures in the US health care system are devoted to the elderly, who per capita are LESS obese than younger groups, and a disproportionate amount of money is spent on heroic care in the last week of people's lives. Important as obesity is, it is not an accurate statement to quantitatively blame rising healthcare costs solely on obesity.

The problem with your analysis is that it does not take into account that:

1)The elderly get less obesity as they get older because they are ill and

2) Their illnesses are caused by lifestyle choices particularly obesity when they were much younger.

http://www.aan.com/press/index.cfm?fuseaction=release.view&release=354

San Diego - People who are overweight or obese in their 40s have a greater risk of developing Alzheimer's disease later in life, according to research that will be presented at the American Academy of Neurology 58th Annual Meeting in San Diego, Calif., April 1 - 8, 2006.

Wiley InterScience :: Session Cookies

There is an age-related increase in total body fat and visceral adiposity until age 65 years that often is accompanied by diabetes or impaired glucose tolerance. The prevalence of type 2 diabetes increases progressively with age, peaking at 16.5% in men and 12.8% in women at age 75-84 years. Over age 65, diabetes or glucose intolerance was present in 30%-40% of Framingham Study subjects. There has been an alarming increase, of epidemic proportions, in both obesity and diabetes in the general population.

USATODAY.com - Health spending soars for obesity

Overall, employers and privately insured families spent $36.5 billion on obesity-linked illnesses in 2002, up from an inflation-adjusted $3.6 billion in 1987. That's up from 2% of total health care spending on obesity in 1987 to 11.6% in 2002, the latest year for which data are available. Private health insurance spending on illnesses related to obesity has increased more than tenfold since 1987, according to the first research to quantify the trend.

As for Canada and the U.S., Canadians have a longer life expectancy at substantially less cost:

http://www.thecanadianencyclopedia.com/index.cfm?PgNm=TCE&Params=M1ARTM0012163

The report, accompanied by maps depicting longevity rates in every part of the country, shows that in 1996 Canadians' average life expectancy at birth was 78.6 years (up from 73 years in 1970), with men living, on average, for 75.7 years and women for 81.4 years. Among industrialized nations, Canada ranks third in life expectancy behind Switzerland and Japan, and well ahead of the United States, which ranks eleventh. While there are sharp discrepancies in some regions, the report also shows the life expectancy for nearly 99 per cent of Canadians to be within 2.8 years of the national average.

http://www.kff.org/insurance/snapshot/images/figure-1.gif

Rich

---------- Post added 08-15-2009 at 10:26 AM ----------

xris;83424 wrote:

Cant anything be done to curb the costs of healthcare and drugs.Why is it so much more expensive than the uk?
I can understand the practicalities of creating a national health service but why the opposition in principle?It appears to me the state contributions to health care in america is not much less than the uk but because of costs the effects are less noticaeble. It appears to me a political problem rather than a practical one.

Hi there xris,

I think it is less a political problem than a social one. The medical industry has scared everyone into thinking that they need all these tests, drugs, regular checkups in order to continue to live. The differences in expenditures in the U.S. vs. other developed countries is huge with no discernible benefit. We have a very greedy medical/insurance system in the U.S., which is obese in terms of desire for money, as we are overweight.

Healthcare Economist U.S. spends $700 billion on unnecessary medical tests

""

Rich

@richrf,

Its costing you more and your getting less,it seems you need an autocratic government,led by you know who.Only severe restrictions on the medical profession, is your only hope.Is it too simple for the government to negotiate with the drug producers for price control in the US?When your government is paying out more per head of population than the UK it can only be administration.The majority of the british admire our health system even if we moan about certain parts of it,i have no problems,its fantastic.

@xris,

xris;83448 wrote:

Its costing you more and your getting less,it seems you need an autocratic government,led by you know who.Only severe restrictions on the medical profession, is your only hope.Is it too simple for the government to negotiate with the drug producers for price control in the US?When your government is paying out more per head of population than the UK it can only be administration.The majority of the british admire our health system even if we moan about certain parts of it,i have no problems,its fantastic.

The problem is this xris. Doctors, hospitals, nurses, etc. need to keep generating money in order to keep the system growing. It is more a source of jobs than it is a source of health care - as opposed to sick care, which it is.

The moment there is a hint of price or more importantly service controls (a massive amount of money is being spent on unneeded services, and everyone knows it), then the physicians and hospitals begin scaring the patients that they will not be getting the services that they need to stay alive.

The whole system is a job and profits generator, as opposed to a health generator. Controlling costs is actually pretty easy. If a person is obese or a smoker you just raise their premiums to pay for their future health expenses. That is how it should work. But it doesn't, because really, the medical system has no incentive to drive down costs (revenues and profits). People have to be given incentives to change their lifestyles. There are some plans in the U.S. that are now beginning to link premiums to lifestyles, otherwise they will be bankrupt.

Rich

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