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Larry Beinhart’s Body Politic: Of Health, Wealth, and Stealth 

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There is currently a debate on the future of America’s health care.

There are two sides to the debate. On one side there’s sanity, humanity, the numbers, and America’s economic well-being. On the other side there’s the insurance industry.

The insurance industry has allies: money, the Republican Party, members of the Democratic Party who take money from the insurance industry, and the whole host of loons who believe the mythology that anything that private companies do is good and everything that government does is bad.

Reality check. Let’s go to the numbers.

In 2005, the United States spent $6,041 per capita on health care—more than double the median per capita spending ($2,922) of the 30 industrialized countries that form the Organisation for Economic Co-operation and Development (OECD). The US spent 15.3 percent of its gross domestic product (GDP), compared with the OCED median of 9.1 percent of GDP.

That’s worth repeating. In terms of median numbers:

In the US we spend twice as much per person as other modern, industrialized countries. As a country, 40 percent more of our GDP goes to health care spending than in other modern, industrialized countries. Do we get better health care by spending so much more? The answer, by virtually every measure, is no.

Life Expectancy: The US ranks number 46. (CIA World Fact Book)

Infant Mortality Rate: The US ranks number 41. (CIA World Fact Book)

Healthy Life Expectancy: Of 14 OECD nations, the US ranks 14th.

Patients Seeing a Regular Doctor: Of OECD nations, the US ranks last. Only 16 percent of us see a doctor on a regular basis. We have fewer doctors, nurses, and hospital beds than the average of other OECD nations.

Then there are things that we—here in America—don’t usually consider health issues. But they are.

Adult obesity: Obesity means more than merely being overweight. It means so overweight as to affect your health in other ways, like heart disease and diabetes. Of 14 OECD nations, the US ranks 14th—indeed, America has twice the number of obese people as the other countries. Except for England, where we’re only 30 percent more obese than the Brits.

Sixty-five percent of Americans are overweight.

Teenage girls having babies: The rate of teen pregnancy is more than three times higher than the average of other industrial nations. Six times higher than most of them.

There are also social and business costs to the American way of practicing health care. The average health insurance premium for a family of four in 2008, was $12,700. The median income for a family of four was $67,019. If the employer pays, that adds 19 percent to their labor costs. But only 62 percent of people with insurance get it from their employer. The rest have to pay for it themselves. If they’re at the median income level, then they’re spending nearly one fifth of their income on medical insurance. Mind you, if you’re only making $40,000 a year, your premiums don’t go down. It’ll still cost $12,700 to cover a family of four. If it’s you, over 30 percent of your aftertax income will go to health insurance.

That’s insane. It’s so insane that most people can’t or won’t do it. The result is:

Nearly 46 million Americans, or 18 percent of the population under the age of 65, were without health insurance in 2007.

Nearly 90 million people—about one-third of the population below the age of 65—spent a portion of either 2006 or 2007 without health coverage (National Coalition on Health Care).

What happens to the uninsured? Do the unlucky ones simply curl up and die, then get blown away by the wind like fallen leaves? Some do. But most of them, if they get seriously ill, end up in emergency rooms. A hospital, a city, a state, or the federal government picks up the tab. How much is the tab? About $100 billion a year. For that matter, what happens to the insured?

“The cost of obtaining medical care resulted in 62 percent of bankruptcies in 2007—an increase of 49.7 percent from 2001. Patients who filed bankruptcy as the result of health care costs had health insurance.”                   —National Coalition on Health Care

How can we spend so much more and get so much less? We have private health care. Everyone else has government-run healthcare.

That’s in principle. In reality, all systems are mixed. Even in Britain, the most “socialized” system, doctors are ordinarily in private practices and individuals can buy supplemental insurance. Most other countries use insurance companies and employer- or employee-based contributions. In the US, 46 percent of the spending on health care comes from states and the federal government. It is the intent that is notably different.

In Europe, Canada, Australia, Japan, and Singapore, health care is looked on as a right and a social necessity. The question is, how to organize it most efficiently and effectively. In America, it is looked upon as a business. Our question is: How can the people in the health care business take in the most money and spend the least?

The objections to a government run health care program is that it will limit patients’ choice of doctors, ration health care, increase bureaucracy, make people wait for care and have difficulty getting prescription medications, and allow bureaucrats to set prices and determine what conditions are covered.

It is hard to say just how bizarre these objections are, since all of them happen with private health care. Most insurance plans have a list of providers. If you like a doctor, or need a doctor, who is not on the list, you have to pay for care yourself. Certain procedures are usually not covered (that’s rationing health care). Certain people can’t get coverage (that’s rationing health care). There’s often a limit on drug coverage. You can’t get care until you prove you have coverage and the provider determines if your coverage covers the need. Insurance company bureaucrats determine how much they will pay doctors and hospitals for procedures and medication, and what treatments they will pay for.

We’re in the middle of a debate on health care reform.

On one side, there’s the government-run, single-payer system. That’s off the table. In the middle, there’s the current system, with a government option added. That is, you—or your employer—can buy into a Medicaid-type system, instead of a private insurance system.

On the other side, we continue as we are, with the insurance companies, the HMOs, the big hospital chains, and the pharmaceutical industry, all promising to cut costs and reform.

Who’s going to win? Sanity and humanity? Or the insurance companies and big money?

Speaking of...

  • Larry Beinhart breaks down the health care issue as he sees it.

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