By Hollis Wormsby, Jr.
If you look at a chart of medical expenditures per person, per country you will find that the United States spends approximately two and half times as much per person on health care than the countries that follow behind them do on an annual basis. The United States spends approximately $9,300 per person per year on health care. The next leading countries in expenditures per person are Japan at approximately $3,800 per person and the United Kingdom at approximately $3,700 per person. In Japan the national life expectancy is approximately 83 years. In the United Kingdom the national life expectancy is approximately 81 years. In the United States the life expectancy, in spite of extreme expenditures is approximately 78 years, about the same as the country of Panama which expends only about $1,800 per person per year.
Why is that we as a country spend so much and yet get such a limited return on our investment? In my opinion there are two reasons; first that we are one of the only advanced nations that has a for profit health care system; and second that we are one of the only advanced nations that uses a two-payer system in health care. Let’s look at each issue separately.
I was at a conference on health care recently where one of the speakers talked about the impact of a for profit hospital system in a community. He noted that hospitals are designed to compete with each other for patients for profitability, in most communities in urban areas in particular there are more facilities and capacities built than needed. He noted that you might study an area and say that based on the number of heart surgeries to be performed in an average year you would project the need for X number of cardiac surgical units. But because each hospital builds their own facilities to compete with the other hospitals, you might actually wind up with three times X or four times the number of cardiac units that are actually needed. Each of these units cost millions of dollars, the excess does nothing to increase access or quality of care, but maintaining this excess capacity is one of the factors that drives up total health care cost. In addition, even for the service that is rendered, most hospitals are now owned by corporations whose goal is much more to maximize profits than to maximize outcomes for their patients. All of this drives up cost without improving access or quality.
The next problem I see with our health care system is the two-payer system concept, where you pay an insurer to provide the service at a profit of helping you finance access to health care. To get an idea of the impact of this think about the billions of dollars that Blue Cross Blue Shield make in profits to assist in making health care accessible, without actually providing any health care. Eliminating the layered cost of health insurance from the health care equation would drastically reduce the cost.
What is the impact of the high cost of health care in the United States? The impacts are many. First of all, in spite of having by far and away the highest level of expenditure of any developed country, the United States also has one of the lowest levels of access. The United Kingdom and Japan both have universal, nationally financed health care at a fraction of the expense we spend here. Secondly, in this country getting sick can ruin you financially. One the highest causes of personal bankruptcy is people who have encountered excessive medical bills, and having insurance doesn’t always prevent this, as with co-pays and coverage limits a significant illness can still drain every cent you worked hard to save. And finally, under our current health care system, we have senior citizens who have worked their whole lives to pay off a house and save a little money to leave their family, only to encounter a health issue at the end and have Medicare/Medicaid come in and claim it all in reimbursement for service fees.
Our current Health Care(less) system makes a few corporations and their executives extremely wealthy. We have the best system in the world at doing that. We need to work on taking the profit out of health care and putting access and quality of service in. Or at least that’s the way I see it.
(Hollis Wormsby has served as a featured columnist for the Birmingham Times for more than 29 years. He is the former host of Talkback on 98.7 KISS FM and of Real Talk on WAGG AM. If you would like to comment on this column you can email him at email@example.com)