Health Care Reform: The Math

This series of posts features my thoughts about health care, organized into some simple categorizations. It is this data, these experiences, and these moral arguments that inform my opinion about health care reform. It is, of course, incomplete compared to everything in my head, and I welcome your questions and comments.

I. Money

In the United States, we spent $2.4 trillion, or $7900 per person, on health care in 2007. This is 17% of our GDP [1]. Health insurance premiums increased by 5% last year -- twice the rate of inflation. Our neighbors to the north (Canada) spend half what we do per capita, yet have the opportunity to consult with doctors nearly 60% more than we do (an average of 6.0 visits vs 3.8 visits per year) [2].

II. Demographics

In exchange for the highest per-capita investment in health care, we end up with suboptimal health outcomes. We have the 33rd or 46th lowest infant mortality rates in the world (depending on if you use the UN or CIA factbook statistics), getting beat out by countries like Cuba and Israel [3]. We have the 30th or 38th longest life expectancy, getting beat out by Cuba, Greece, and Jordan [4]. In the WHO assessment of health care systems by country, the United States ranked 37th out of the 191 countries evaluated, behind Saudi Arabia [5]!


What are we getting for all that spending, then?

For those who have access to healthcare, we get some of the best care in the world -- the United States has a lot of resources that aren't available in places like Cuba, after all. But those who lack the access to healthcare, well, they may as well be living in a country that doesn't have any of those resources, because they won't get a chance to see them until there's such a dire emergency that the medical bills just can't be avoided any longer.

Here's the dark side of what we're getting: we're getting a whole lot of money wasted on administration -- six times the amount per capita than is spent in our peer Western European countries, all of which achieve superior health outcomes to us. We're getting CEOs rewarded with nine-figure bonuses when they merge two large health insurance companies into one mega-company. We get our insured health care decided based on profit, not on what's actually best for the patient, and all health care rationed based on people's assets rather than their needs. We get 68% of medical-bill-related bankruptcies being folks who had health insurance when their medical condition began [1].

Surely there's got to be a better way. We could spend all that money more wisely and provide better healthcare for more people.

Next: The Ethics and Morality