American health care filled with myths

Published 9:48 am Friday, August 28, 2009

Health care reform seems complicated, confusing and expensive. And for most of Americans if reform does not increase coverage and decrease costs, then why reform at all?

After all, in a recent survey 82 percent of Americans expressed satisfaction with their health care.

As it turns out the reasons for reform are actually quite sound, just poorly explained by the Obama administration to date.

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There is an ethical reason. In every industrialized country in the world other than America, no one is denied care, refused insurance or forced into bankruptcy by medical bills as are 70,000 Americans every year. Healthcare, worldwide, is simply a right, not a privilege for the well-off or fully employed.

And there is a very sound fiscal reasons for health care reform. As you may know the CBO projects huge budget deficits ahead for our federal government, nearly $9 trillion dollars over the next decade.

Nearly half of that anticipated deficit is the deficit expense of Medicare and Medicaid. The cost of health care must come down if we are to avoid these incredible deficits in our future.

But our hodgepodge system is loaded with ineffective and inefficient delivery. The most significant indirect cost, that is a cost that does not directly serve patient needs, is the administrative cost of insurers.

In the U.S. we spend about 20 percent of every health care dollar on administrative costs, the highest in the world. France spends 4 percent on administrative costs, Taiwan 1.5 percent, and Canada 6 percent.

Why such a great difference? Primarily because though many nations are capitalist in commerce, they do not see capitalism serving health care successfully.

The profit motive in health care is uniquely American, and results in incredibly high executive compensation in the insurance industry, and huge bureaucracies of workers dedicated to refusing claims, denying coverage and fighting litigation.

Americans end up paying for the denial of health care to encourage the profits the industry seeks.

So we do have reasons for reform, but we also have false perceptions that we need to revise. These include:

1. America has the best health care system in the world. We do not. In terms of outcomes almost all advanced countries have better results than the U.S.

In terms of finances, we force over 700,000 Americans into bankruptcy over health care every year. That corresponding number in Britain, France, Germany and Japan is zero.

2. Care everywhere else is rationed with limited choices and long lines. False. In Germany people can sign up for any of 200 available plans, a broader choice than any American has.

In France you cannot choose a plan but you can choose any provider without any “in-network” limitations. In Japan waiting times are so short most people don’t bother to make advance appointments.

3. Cost controls harm innovation. False. America is good at innovation, but so are other nations.

If you have had hip or knee replacement you have French innovation to thank. If you use Viagra, it wasn’t a result of American research. But we have little or no cost control, where other countries tightly control costs.

In the U.S. a neck MRI can cost $1,500. In Japan the identical scan cost about $100. And the Japanese lab providing it makes a profit.

America cannot face the deficits now in front of us without action, and action is health care reform that ends limited access, ends denials of care, stops bankrupting Americans and stops delivery of inferior care. We can do better, and we deserve better.

Jim Crawford is a contributing columnist for The Tribune and a former educator at Ohio University Southern.