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Health Care -- No Time for Baby Steps

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Last week, in what some considered to be the most important legal decision of the new millennium, the supreme court squeezed out a 5-4 decision not to repeal a law that will eventually (unless it will be overturned in the political arena) mandate all American citizens to carry health insurance. This was a victory for individuals who believe that there is a moral obligation to insure a minimal access to health services for every individual.

From a larger perspective it was a Pyrrhic victory.

The inclusive nature of the designated healthcare reforms is an important achievement. However, the real problem of the healthcare system is its structure rather than inclusivity. It is based on a pseudo-capitalist foundation in which there is profit to be made from people's misery and as such it introduces profit-driven players to a system that is designed to represent aid and compassion.

The results? A system which provides selective health services (e.g., depends on the insurance one possesses, depends on administrative authorization for treatments deemed necessary by professionals who are incentivized to reduce cost) at a national cost higher than any other system in the world. For example, in 2008 health-related expenditures in the United States was $7,538 per capita. Sampling other developed countries for comparisons reveals a shocking disparity. The same year, our neighbor to the north, Canada, spent $4,079 per capita providing health services to its entire population with minimal co-pay requirements. Similarly, developed countries such as Germany ($3,737), the UK (3,129), Australia with its efficient combination of public and (affordable) private systems ($3,353), and Japan ($2,729) all provided their residents free (or nearly free) access to health services at a fraction of our national cost. Even compared with the second highest per capita spender, Norway ($5,003), the US spent more than 50% more on health.

With such an expensive system one may expect objective indications of improved health outcomes, right?

Well, I enjoy great expectations like the next person but I guess that this privatized system, which is supposedly better at providing the consumer with superior results at a cost-effective manner, failed us again. A World Health Organization commissioned paper indicates that the efficiency of the American healthcare system (which takes into account expenditures and goal attainment) is ranked 44 in the world with almost all developed countries faring much better (sorry New-Zealand) and even countries such as Saudi Arabia, Oman, and Morocco providing more efficient systems.

Other indications are even more striking- 2007 data indicates that life expectancy (at birth) in the US (78 years) is shorter than countries with much smaller expenditures such as France (81), Canada (81), Italy (82) and Japan (83). Hey, we still beat our old (Russia- 66) and new (China- 74) nemeses. Infant mortality rate doesn't provide any reason to celebrate either with the US (6.9 death per 100 live birth in 2006) faring much worse than our "shoestring" friends such as Canada (5.3), Germany (4.1), Spain (3.5), or Japan (2.8). Think of any developed country- it's likely it has a lower infant mortality...

So where does the darn money go?

It goes to sustain and protect a system in which personal health hardships are translated into profit and sustainability of the actual system and its stakeholders. The systems necessitates a slew of professionals whose sole job is to assess risk, premiums, profitability, marketing, and fear mongering ("look at the poor Canadians who are at the mercy of their government for their health needs" and similar brain washing slogans). These professions will be made superfluous in a single payer mandated system which all other developed countries find acceptable and seem to work better for the benefit of their populations. It also goes to sustain an ever increasing monitory compensation for various providers such as medical doctors, whose salaries have risen well above the average salaries of most professionals in the last few decades. I'm all for fair compensation for these hard working individuals, but even accounting for their lengthy training and responsibilities, observing the trajectory of their salary increases suggest clever if somewhat nefarious agenda of leaders of the private insurance companies to harness the support of this group for their causes. That, however, deserves an independent conversation...

There is no wonder that the individuals who lead this system fight tooth and nail for its survival, but why should you?

As a person who lived in two different countries which provide single payer government run health care (Israel and Canada) and also in the US, I'll share my experiences with these systems in the future to alleviate some of the most notable fear-spreading tactics promoted by interested parties. If the numbers don't convince you of the folly of our system, maybe a personal account will.