US spending too much, getting too little out of health care

US spending too much, getting too little out of health care

By Stu Alderman for Reno Gazette Journal

I had to laugh at Sam Kumar’s Sunday article regarding “Medicare for All” (“Sanders, Ocasio-Cortez have a math problem,” Dec. 9). It was either that or cry.

On the basis of two loosely defined numbers, Kumar comes to the conclusion that moving our medical system from its current hodgepodge of rich, for-profit insurers and providers to a government-managed single-payer system will bankrupt our country.

Last April, an article in The Economist characterized the United States as “the only large rich country without universal health care” (“America is a health-care outlier in the developed world,” Apr. 26). Cross-checking against almost a dozen other news and information services sites shows that to be true. An article in The Atlantic describes Africa, southeast Asia, the northwest part of South America and the United States as being among the last holdouts not to implement some form of universal health care.

According to Kumar, Americans spent $3.3 trillion on medical expenditures in 2016. Factoring in Medicare expenditures, he correctly calculates that adds up to approximately $2.6 trillion extra that will have to come out of government coffers. He goes on to state that “Medicare for All will result in costs that will far exceed the total federal budget …” Kumar somehow missed an obvious point, which is that the $2.6 trillion saved from insurance premiums will simply be shifted to taxes we pay the government rather than premiums we had been giving to insurance companies.

The latest data available from the Kaiser Family Foundation’s Health System Tracker shows that the United States’ 2017 per capita spending on health care was $10,224. The two next highest cost countries are Switzerland at $8,009 and Germany at $5,728. Position seven is occupied by France at $4,902 and No. 12 is the United Kingdom at $4,246. If we can move to a similar model, Kumar’s estimate of $2.6 trillion may be grossly overstated.

Paradoxically, our health outcomes do not seem improved by the extra money we throw at our medical system. Another Health System Tracker study shows our rate of deaths per 100,000 during the years 2002-2003 to be 110 amenable (that is, preventable) to health care and likewise our rate for the years, 2006-2007 to be 96. Now, please contrast the United States numbers against the much lower mortality rates for all the rest of the countries, including France at 65 and 56, and the UK at 103 and 83.

Each European country manages its own socialized health care system. In the case of France, the locals with whom I’ve spoken are quite happy with their care. France negotiates drug prices for the entire nation of 67 million and gets excellent rates. I’ve several times purchased medicines at retail in France for less than my copay in the U.S. Our AMA, acting like a doctor’s union, severely limits the number of doctors admitted to medical schools, driving the price of care up while making the availability doctors limited.  The French government subsidizes the education of doctors and adjusts the volume of doctors being graduated to assure enough doctors are available for timely service while adjusting the upper limit so that doctors are assured of making a good living.

In the last paragraph of Kumar’s Medicare analysis, he castigates the VA about patients dying while on waiting lists and other justly heinous practices. Speaking to local veterans, it appears the Reno VA does an exemplary job and demonstrates what a well-run medical facility looks like. Rather that casting the VA in general as just a bad organization, a better plan might be to promote how the VA in Reno, or other top-notch VAs, are run, and push that model as to what the rest of the nation’s VAs need to strive toward.

In summary, the U.S. medical system is rife with too many deep-pocket operators who spend way too much money in Congress to keep their highly profitable status quo. Somehow we citizens need to communicate to our elected representatives that they will not be re-elected unless they start seriously moving the United States into a first-world medical system with low rates and good outcomes.

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