Imagine a nation with a terrible problem - one its leaders refuse to discuss. The problem will needlessly drain trillions of dollars from its economy in the next ten years.
Now imagine that this problem also robs that nation's citizens of life itself, draining years from their lifespans while depriving them of large sums of money. Imagine that it sickens and disables countless others, drives many people into bankrupcty, and kills more than two newborn infants out of every thousand born.
Imagine that fixing this problem would make result in a dramatic decline in publicly-held debt. It wouldn't just "help" the debt problem, mind you - it would cause that debt to plunge.
And now imagine a national "deficit debate" which completely ignores this problem.
Imagine a news media which pretends the problem doesn't exist. Imagine a corporate-funded "Fix the Debt" movement that refuses to mention it, and yet is treated as an objective source of information. Imagine a political consensus in which the debate isn't around how to fix this problem, but how to cut service programs that help people cope with it.
Welcome to the United States of America, January 2013. It's a land where the population is broke, sick, gypped, and mistreated. But the problem's fixable - if we can find the political will.
The problem, of course, is our health care system - although "system" seems like a flattering word for this greed-driven, anarchic three-ring circus. Our health care system - guess we'll need to call it that for lack of an alternativer - is the worst in the developed world. It costs far more, provides much less, and has worse outcomes than any system that's even remotely comparable.
How bad is it?
Our health care spending is 17.6 percent of GDP , compared with an average of 9.6 percent for all developed countries. (All figures are from the compendium of health and economic statistics published by the Organization for Economic Cooperation and Development ( OECD ), unless otherwise indicated.)
Total health spending (from all sources, not just insurance-related) averages $7,960 per person in the United States, versus an average of $3,233 for all developed countries.
If we spent the same on health as the average developed country (as a percentage of GDP ) that would inject more than a trillion dollars per year into other parts of the economy. ( 1.14 trillion, by my rough calculation.)
What are we getting for our money?
- Life expectancy at birth in the United States is 78.2 years, compared with an OECD average of 79.5 years and Japan's life expectancy of 83 years.Our expected lifespan is the shortest of any among the countries we normally think of as "developed." The ones that trail us are newer entrants into the "developed" category -- like Mexico, Turkey, Brazil, Indonesia, and the Eastern European countries.
- Our infant mortality rate is 6.5 deaths per 1,000 live births, as opposed to the OECD average of 4.4 deaths. As with life expectancy, we lag behind all the other long-term "developed" nations.
- We score even more poorly on another metric, "Premature Mortality," which measures the number of years someone loses "before their time" (essentially by calculating how many years it would have taken on average to reach the age of 70).
Our high rates of premature mortality are affected by our high rates of accidents and suicide, too, and from a homicide rate for males that's five times the average. (That's a figure worth citing in the gun control debate.)
The question becomes, Why? Why do we pay so much and get so little for our money?
Part of the answer lies in the fact that, despite the high cost of private-insurance premiums, our health plans don't provide enough coverage. According to survey data, Americans were unable to meet their medical needs because of cost more often than citizens of ten comparable countries ( OECD , Table 6.1.3).
That statistic applied to lower-income Americans, as might be expected. But interestingly, it was also true for higher-income Americans - those that are most likely to have private health insurance. 39 percent of Americans with higher-than-average income had an unmet medical need due to cost in 2010. For the runner-up, Germany, that figure was 27 percent. (It was 12 percent in Switzlerland and 4 percent in Great Britain.)
Higher-income Americans also led the pack in reporting out-of-pocket expenditures of $1,000 or more per year, along with their lower-income peers, with 45 percent in the higher-earner category spending that much or more per year. The figure was 37 percent for runner-up Switzerland. It was 2 percent in Sweden. And in much-reviled "socialist" Great Britain the figure was effectively zero.
These results reinforce the findings of studies on medical bankruptcies by Prof. Elizabeth Warren, which showed that medical costs were a dominant reason for bankruptcy even for people with health insurance. (She was officially sworn in as Senator Warren today - congratulations!)
Where does all the money go? Much of it goes to profit margins for private insurance companies, of course. (They're experts at understanding their margins, which are much higher than most observers believe.) There are also profit margins for a number of health providers, including for-profit hospitals, medical imaging companies, and physician practice management groups.
Underlying much of our explosive cost growth is the phenomenon we described in "Sick Money": Investors like Bain Capital buy up health care companies, load them up with debt, and demand highly aggressive profit margins. Many of them respond to the problem the way the Bain companies did in our piece: through fraud.
But many other providers overtreat, subjecting the population to a barrage of needless (and sometimes invasive) procedures while other basic health needs go unmet.
Here are two more OECD statistics that illustrate the point:
The United States is second only to technology-crazed Japan in the prevalence of high-cost (and high profit) MRI and CT devices for medical imaging, both in hospitals and in free-standing facilities. Many American facilities were financed by physicians who send their patients there, which poses a significant conflict of interest and which both public and private insurers have been attempting to limit. Many others are owned by sales-driven chains. Unsurprisingly, studies suggest there is significant overuse of this equipment in the United States.
And let's not forget drugs. When it comes to per-person pharmaceutical costs the United States is off the charts, spending $947 per person on average. That's nearly twice the OECD average of $487.
And remember: Congress won't even let Medicare negotiate with the drug companies.
Pharmaceutical corporations, for-profit hospital companies, private insurers -- our system is sick. The diagnosis: Corporate greed.
Our "sick secret" can be fixed. In our next piece we'll discuss how to attack it -- and what it will take to shift the debate away from a "consensus" plan to adopt the miserly failures of austerity and toward real solutions that can restore our Federal budget - and us - to health.