As fine as American health care can be in some ways, compared to other nations with similar style economies we suck. Our health care costs are much higher and our outcomes are no better if not worse.

This is the situation as reported by The Commonwealth Fund. To explain what that organization does here is their mission statement.

The Commonwealth Fund, among the first private foundations started by a woman philanthropist—Anna M. Harkness—was established in 1918 with the broad charge to enhance the common good.

The mission of The Commonwealth Fund is to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.

The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. An international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries.


That link will take you to a page on the Fund’s website where you will find an exploration of five possible theories as to why costs in the U.S. are so high in comparison to other industrialized nations.

The presentation consists of a series of charts and graphs and the researcher responsible for the presentation does a voiceover. I will warn you that you may be tempted to laugh because the picture of the researcher, David Squires, accompanying the presentation appears to be that of a thirteen year old boy.

But the proof is in the pudding. I’ll summarize the theories and how they are substantiated or not, but viewing the entire presentation as well as other reports on the site will provide a far more complete picture.

Theory A—-The greater wealth of the U.S. means more will be spent, thus the nearly $8000 per capita cost in 2009.

But the supporting data show that the U.S spends about 18% of GDP on health care and the next highest of the countries examined is around 12%. If our spending was proportionate, it would be almost $3000 less per capita.

Theory B—The U.S. has an older and sicker population so naturally more is spent on medical care.

Wrong, at least so far as an aging population. America has 13% of its people over the age of 65 which is less than all of the other 13 countries examined except for New Zealand. Japan and Germany each have over 20% of their residents in that age bracket.

Smoking and obesity are two factors that highly influence people’s health. Believe it or not the U.S. is also next to the bottom in the percentage of smoking adults, but boy are we fat. Over a third of adults are rated obese, higher than any other of these nations.

(I myself have to plead guilty on the weight issue and recognize several of my health problems may be related to that fact.)

Theory C—We utilize health care more often so of course our costs are higher

But statistics reveal that we rank close to the bottom in number of physician visits. Not only that but we have fewer hospital admissions for shorter stays than most of the benchmark countries.

Theory D—We make more frequent use of more expensive technology.

There is more to this theory than the others so far. For instance we have expensive MRI exams done at a far higher rate than our partners in these studies. Knee replacements are at the top while hip replacements are about average.

Now I would question why these two surgical procedures were cited rather than say bypass surgery. Having undergone that procedure three years ago, I know it is extremely costly. I’ve never had any knee or hip replaced but I have had two extensive knee operations. I’m not well-versed enough in medicine to know which of these is the most technically challenging. I do know I was scared shitless before the bypass and simply concerned over the other two.

Theory E—We pay higher prices for the care we do get.

BINGO! This is true across the board. We pay at least 1/3 more for pretty much the same drugs used elsewhere. MRI and CT imaging fees are higher. Physicians’ fees for comparable procedures are higher. Primary care doctors and orthopedic surgeons have greater incomes than their counterparts elsewhere.

But, you ask, doesn’t our insurance cover these costs so that little comes out of pocket?

Well yes and no. If you are fortunate enough to have coverage, the costs may be of little concern to your pocketbook. But look into it more deeply and you will learn that no one escapes the consequences of these high costs.

Do you have health insurance through your employer? If so be advised, and you probably are already aware, that the premiums for this coverage doubled between 2003 and 2010. The employees’ share of premiums for a family plan increased 63% in that same period.

Are you insured through Medicare or Medicaid? If so it is difficult to ignore the declarations of our politicians that the costs of these two government programs are spiraling out of control and there are threats to virtually eviscerate them to reverse the trend.

Are you insured in a private individual plan? The only good thing about that is if you can afford the backbreaking premiums and still maintain a decent standard of living. But many families using this insurance out of necessity often are forced into hard choices on how to spend their limited income.

Are you not insured at all? Well, there are nearly 50 million of you though the Affordable Care Act aims to bring that number down to near zero. Of course it is being challenged in court and may not survive.

What fools we are and what foolishness it is to resist compulsory coverage.

Every one of the other countries whose health care costs are compared to the U.S. has some form of universal coverage. It may be single payer through the government and tax supported. It may be near universal coverage through employers with the government insuring the rest. It may be a system somewhat akin to ours with private insurers and copays, but with all citizens insured.

In fact, in some nations even tourists are covered under government plans.

Meanwhile we in the United States have approximately 50 million of our citizens who are uninsured. Large numbers of them  turn to hospital emergency rooms when they need to see a doctor.

Two problems with this are that ER care is the most expensive and these patients do not receive the primary care necessary that would mitigate any conditions they have that worsen and send them to the ER.

Since these treatment seeking folks may not be able to afford the care, the costs get absorbed by the hospitals or passed on in higher costs for all which means private ins urance premiums soar or, as a last resort, the taxpayers pick up the tab.

Stop the insanity!

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