Healthcare Woes

The U.S. spends more per capita on healthcare than any other developed nation in the world, yet our people are less healthy on average than most of those nations (data from OECD, the World Health Organization and the World Bank).  Here is one view of the spending data:

The U.S. in healthcare, as in so many things, is somewhat of an enigma.  At the top level, our healthcare must surely be more sophisticated than any other in the world.  Our medical research is more extensive and more richly funded than any other nation’s, as shown by the following chart:

Biomedical research and development expenditures classified by country in 2012 in billions of U.S. dollars:[2]
Country	Total	Public	Industry
United States	119.3	48.9	70.4
Canada	5.3	3.3	2.0
Europe	81.8	28.1	53.6
Asia-Oceania	62.0	19.3	42.7
Total	268.4

Our medical technology, surgical procedures and disease treatment are probably the best in the world, though that is my own wildly subjective assessment.  (I couldn’t find any convincing data – too broad a topic)

But our population is not as healthy as that of many other nations and does not score as well when health indicators are evaluated (see World Health Organization data, not included here). How can that be?

Before we look at the reasons for our low scores on health, let’s look at why our healthcare is so expensive.  I can think of several reasons:

1. The fear of lawsuits and litigation causes doctors to order more tests and undertake more procedures.
2. Our doctors and health executives are compensated significantly higher than those of other developed nations.
3. Our complex insurance structure adds significantly to the costs.
4. Our market-driven healthcare promotes newer and more expensive drugs and procedures.
5. We have more advanced (and thus expensive) treatments, technology and capabilities for the most serious diseases, injuries, etc.

I can’t measure the relative impact of these factors, and I have not done a rigorous search for data, but I believe this is a reasonable set of factors that would be hard to dispute.

Please note that only one of these factors actually contributes to better health outcomes (number 5).  This would explain why our very costly healthcare does not produce the best health in the world.

As to why we have lower scores in health indicators, one merely has to invoke the usual contradictions in U.S. society – the widening income gap, the number of uninsured people, poor access to healthcare in impoverished areas, our large prison population, our drug problems, our problems with obesity and our focus on treatment of disease rather than wellness and disease prevention.

As in most things, the U.S. is both a place of wonder and a place of stubborn disappointment.  The freedom that many of us have in managing our healthcare, and the incredible array of options for treatment are probably unique in the world.  But a sizable part of our population has the type of access to healthcare that one would find in a much poorer, under-developed nation.

So what is the future for U.S. healthcare?  I am certain that one day in the not-too-distant future we will shake our heads at the thought that we did not provide basic healthcare for all of our citizens or make it possible to obtain insurance if they had a pre-existing disease or condition.

But the future of healthcare is daunting.  The combination of several factors will require us to make difficult decisions:

1. People are living longer and the care needed to maintain quality of life and life itself is growing ever more capable and expensive.
2. As medical technology, drugs and treatment become more sophisticated and capable (which of course leads to number 1!), the costs and effort required increase.
3. If healthcare is provided at ‘no cost’ to everyone and access is easy and pervasive, then there may be an ever-increasing demand that overwhelms the system.

These factors may cause healthcare costs and effort to skyrocket.  There are already predictions of people born today living to 150.  If one assumes that the healthcare costs during this lifespan will increase at least linearly, and possibly exponentially over the last 50-80 years, then the healthcare system will certainly be unable to sustain itself.  We will become a world that focuses most of its energy and resources on maintaining life, rather than enhancing or enriching it.

There are also the questions of how to curb the appetite or need for healthcare.  Even with a focus on wellness and preventive medicine, human beings will ignore good advice and engage in risky behaviors that jeopardize and even ruin their health.  Should the obese have an added health tax?  Should the elderly be discouraged from endless rounds of physical therapy and other quality of life treatments by some sort of surcharge?  Should a smoker or drug-user be denied care or forced to pay extra to receive it?  Should sexually transmitted diseases be taxed to encourage less promiscuous behavior?  These may seem like draconian or big brother tactics, but a desperate need to rein in costs may eventually trump the hesitancy to apply such limits.

We are facing a brave new world of longevity/life expectancy, medical breakthroughs and treatments, and social awareness.  These will create a perfect storm of expense challenges and ethical dilemmas.  If our civilization manages to emerge from the political and socioeconomic crises and the menace of global warming relatively unscathed, then global health will be the final hurdle on the path toward a world that is more equitable, peaceful and enjoyable for all its denizens.