Writers on the Range: Health care reform a chronic national malady
November 21, 2013
The error-prone website for the Affordable Care Act website is causing considerable glee to critics who like to believe that the federal government can do nothing right, or at least not as efficiently as the private sector.
If fixes are not forthcoming, the rollout glitches and botched assurances might eventually do what the Tea Party's attempt to shut down the federal government didn't — crash the whole Obamacare program. But if that happens, where will we be?
I've done a little research, and the numbers show that Americans would be stuck with the industrialized world's most expensive health care. A Bloomberg study rated the United States as 46th in the world for efficiency, which puts us behind Romania and Iran. And in 2012, the International Federation of Health Plans, a global insurance trade organization representing insurers in 25 countries, compared the costs of various medical procedures in Canada, Spain, Switzerland, South Africa, Argentina, France, Chile and the United States. The results were shocking.
Across the board, the graphs look like the "hockey stick" graph that Al Gore used to illustrate global climate change. In this case, however, every other country's bar looks like a one-story hut — until you come to the United States.
Our bar appears as a skyscraper. For example, the cost of a routine office visit ranges from a low of $10 in Argentina to $38 in Chile, but it's a whopping $176 in this country. An angiogram runs from $35 in Canada to $264 in France, but it's up to an astronomical $2,400 here. The cost for a day in the hospital runs from $429 in Argentina to $1,472 in Australia; in the United States it ranges from an average of $4,287 to $12,537.
There is a broader range here because of the diversity of different providers and insurers, many of which charge as much they can get away with. The same lesson applies to drugs; we pay far more than other countries.
We currently spend 20 percent of our Gross Domestic Product on health care, about double what most other countries spend. For a time, the explanation for this huge disparity was thought to be that Americans use more health services, but studies have proven that isn't the case. The truth is that our health care prices are ridiculously inflated, leading to profits in the industry of about 20 percent — similar to the profits expected in the financial sector. Alone among industrialized countries, we have a for-profit health insurance industry mediating these services and jacking up the prices even more.
There are opportunity costs to this extravagance, as a Princeton economist notes: "The money we spend on health care is money we don't spend educating our children, or investing in infrastructure, scientific research and defense spending." Frank McArdle, a consultant to the Business Roundtable, says that the old system was "cramping our economic growth."
The plan that Gov. Mitt Romney instituted in Massachusetts was based on one originally proposed by President Nixon and supported by the conservative Heritage Foundation. It proposed that all households be required to obtain private insurance as a necessary measure to drive down galloping costs. This was also supported by Newt Gingrich and other Republican luminaries as an alternative to expanding Medicare or creating any kind of government-regulated public option, where the overhead would be 5 percent (like Medicare) versus the 30 percent overhead in the private sector.
Now, Tea Party adherents and many Republicans are doing everything possible to oppose what was in essence the conservative, private-sector solution to our health care crisis. So what exactly is their solution? It appears that they really don't have, or even want, a solution, no matter how much of a drain our dysfunctional system is on the rest of the economy, no matter how many Americans die prematurely because they cannot afford preventive care, no matter how disgraceful it is that the health care system of the world's richest nation ranks behind those of Romania and Iran.
Meanwhile, we are slated to spend billions of dollars upgrading our nuclear arsenal, while continuing to account for almost half of the world's total military spending. Yet no one ever accuses the military of being a "socialist" enterprise, even though it is funded 100 percent by tax dollars.
This leads me to a disturbing conclusion about our nation: We will devote any amount of federal effort and treasure to the purpose of killing people, but the effort to bring the healing of our people up to current world standards is just too cumbersome and oppressive to support.
Travis Kelly is a contributor to Writers on the Range a service of High Country News (hcn.org). He writes from Grand Junction, Colorado.
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