Rising health care costs must be curtailed if negative impact on US economy is to be avoided (86). Coverage must be expanded to bring US in line with the rest of developed (OECD) countries (with the exception of Mexico and Turkey (85)). Coverage expansion would be best implemented through a publicly-funded scheme or through the support and promotion of non-profit private insurance plans (see below).
Health care spending is spiraling out of control, due, in no small part to cost inflation and system inefficiency. PricewaterhouseCoopers found that out of $2.2 trillion spent on US healthcare, $1.2 trillion is misspent (36). In decreasing order, the main areas of concern are:
[1] $493B: risky behaviors (i.e. smoking, obesity, alcohol abuse)
[2] $210B: overtesting (to allay liability fears or increase profit)
[3] $210B: inefficient processing claims
[4] $100B: ignoring doctors orders
[5] $88B: inefficient technology use
Methods for controlling costs and reducing money-wasters
Risky behaviors:
healthier school lunches (10)
restrictions on advertising and access to unhealthy food products similar to tobacco and alcohol-related legislation,
better food labeling, such as HFCS % content/warning, GMO, sourcing, pesticide-use, hormone and antibiotics use (28) and more restrictions on use of pesticides, hormone and antibiotics in our food chain (91)
increase public education on substance abuse - tobacco, alcohol, drugs (40)
provide remedial health classes for those who consume or abuse unhealthy/prohibited substances (similar to traffic school) and progressively increase deductibles for those who continue to engage in such behavior
Overtesting:
cap liability/malpractice (39)
impose evidence-based guidelines on health care (37)
Inefficient processing claims & technology use:
standardize claim processing, implement digital health records (38), (89).
enforce/augment implementation penalties for non-compliance with HIPAA.
Ignoring doctors' orders:
emphasize exercise/activity (8)
shift to a more plant-centered diet (9), (90)
provide free public education in schools (in health class) and for the general public (through TV/radio/print advertisement or free seminars) that emphasizes mainstream medicine and its benefits over untested/unproven alternative medicine
Other:
increase Medicare payroll taxes and apply a progressive tax scale to keep pace with future spiraling increase in public health care costs.
Most parties involved in the healthcare reform debate present a false dichotomy: for-profit private vs public single-payer health care insurance plans. Rarely mentioned are additional options: non-profit private (which has all the advantages and none of the disadvantages of the for-profit and public plans) and a partnership between public and private plans (see Medicaid/Medicare model). Non-profit plans have low overhead costs: 5-10% of revenues (72),(73),(74) AND high customer satisfaction (22). In comparison, for-profit plans have high overhead costs of 15-25% of revenues (75), (76), (77), (78), (92), (93), (94) and lower customer satisfaction than non-profits (22). Public healthcare plans have low overhead costs of 5-8% of revenues (42) and higher satisfaction than private plans (95).
To join the rest of the developed world in providing universal healthcare, US should expand Medicaid coverage (80) and fund it by shifting the overall cost from overburdened middle-income to upper-income classes through progressive taxation. Another way to fund this expansion is through taxation of employer-provided health benefits (82). Recent Massachusetts legislative changes that mandate universal care provide a blueprint for this option (83). Compared to the national average of 15%, Massachusetts has the lowest uninsured rates in the union at 8% (84).
As previously outlined, we need a multi-faceted long-term approach to the issues combined with consistent pressure on our lawmakers - conservative Democratic Senators in particular (30), (33).
Sources and further online reading:
(1) http://www.oecd.org/dataoecd/46/2/38980580.pdf
(2) http://www.olis.oecd.org/olis/2009doc.nsf/LinkTo/NT0 0000B6A/$FILE/JT03259332.PDF
(3) http://www.vegpeople.com/cgi-bin/gossamer/gforum.cgi ?post=67214;search_string=health;#67214
(4) http://en.wikipedia.org/wiki/Emergency_Medical_Treat ment_and_Active_Labor_Act
(5) http://www.irdes.fr/EcoSante/DownLoad/OECDHealthData _FrequentlyRequestedData.xls
(6) http://www.nationmaster.com/graph/hea_obe-health-obe sity
(7) http://www.sciencedaily.com/releases/2008/02/0802071 63807.htm
(8) http://www.hsph.harvard.edu/nutritionsource/staying- active/
(9) http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/advo cacy_933_ENU_HTML.htm
(10) http://www.healthyschoollunches.org
(11) http://www.forbes.com/2007/11/08/obesity-health-econ omics-biz-health-cx_mh_1108obesity.html
(12) http://en.wikipedia.org/wiki/Military_Health_System
(13) http://en.wikipedia.org/wiki/Veterans_Administration
(14) http://www.rti.org/publications/abstract.cfm?pub=126 43
(15) http://en.wikipedia.org/wiki/Health_care_in_the_Unit ed_States
(16) http://www.familiesusa.org/assets/pdfs/FEHB_Issue_Br ief26e9.pdf
(17) http://web.archive.org/web/20040416003232/http://www .cms.hhs.gov/charts/series/sec3-b1.pdf
(18) http://web.archive.org/web/20030718164928/http://cms .hhs.gov/charts/series/sec3-b4.pdf
(19) http://www.kff.org/medicaid/upload/Key%20Medicare%20 and%
20Medicaid%20Statistics.pdf
(20) http://en.wikipedia.org/wiki/State_Children%27s_Heal th_Insurance_Program
(21) http://www.cbo.gov/ftpdocs/80xx/doc8092/05-10-SCHIP. pdf
(22) http://health.usnews.com/sections/health/health-plan s/index.html
(23) http://www.physicianspractice.com/index/fuseaction/a rticles.details/articleID/1197/page/7.htm
(24) http://www.wpasinglepayer.org/HighmarkStorePressRele ase.html
(25) http://conyers.house.gov/index.cfm?
FuseAction=Issues.Home&Issue_id=063b74a4-19b9-b4b1-126b-f67f60e05f8c
(28) http://en.wikipedia.org/wiki/High-fructose_corn_syru p#Health_effects
(29) http://www.nytimes.com/2009/07/22/business/economy/2 2leonhardt.html?_r=1&hp=&pagewanted=print
(30) http://www.nybooks.com/articles/22931
(31) http://www.whitehouse.gov/realitycheck/
(32) http://www.nytimes.com/imagepages/2009/08/10/health/ policy/10facts.graphicA.html
(33) http://en.wikipedia.org/wiki/New_Democrat_Coalition# Current_senators
(34) http://www.pnhp.org/facts/singlepayer_faq.php#ration ing
(35) http://www.pnhp.org/resolution/
(36) http://money.cnn.com/2009/08/10/news/economy/healthc are_money_wasters/?postversion=2009081009
(37) http://www.guideline.gov/
(38) http://money.cnn.com/2009/01/12/technology/stimulus_ health_care/?postversion=2009011204
(39) http://www.dallasnews.com/sharedcontent/dws/bus/colu mnists/jlanders/stories/DN-Landers_21bus.State.Editi on1.9be351.html
(40) http://www.lifeclinic.com/fullpage.aspx?prid=509433&type=1
(41) http://www.aapsonline.org/newsoftheday/00category/my thbusters
(42) http://www.cbo.gov/doc.cfm?index=9924
(43) http://www.cahi.org/cahi_contents/resources/pdf/CAHI _Medicare_Admin_Final_Publication.pdf
(44) http://mediamattersaction.org/factcheck/200905190001
(45) http://mediamattersaction.org/factcheck/200908110007
(46) http://mediamattersaction.org/factcheck/200908080001
(47) http://mediamattersaction.org/search/tag/health_care
(48) http://mediamattersaction.org/factcheck/200908030006
(49) http://factcheck.org/2009/08/obama-wrong-on-aarp-end orsement/
(50) http://factcheck.org/2009/07/false-euthanasia-claims /
(51) http://healthcarefactcheck.com
(52) http://www.aapsonline.org/newsoftheday/00category/my thbusters
(53) http://www.bloomberg.com/apps/news?
id=20601039&sid=aLzfDxfbwhzs
(54) http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.+1:
(55) http://en.wikipedia.org/wiki/American_Recovery_and_R einvestment_Act_of_2009
(56) http://www.unboundmedicine.com/medline/ebm/record/10 220806/abstract/Economic_costs_of_substance_abuse_19 95_
(57) http://www.aapsonline.org/newsoftheday/00321
(58) http://factcheck.org/2009/07/canadian-straw-man/
(59) http://factcheck.org/2009/07/selling-out-the-public- option/
(60) http://www.aapsonline.org/newsoftheday/00327
(61) http://davepetno.com/blog/index.php?itemid=30
(62) http://en.wikipedia.org/wiki/Harvard_Pilgrim_Health_ Care,_Inc.
(63) http://www.va.gov/budget/summary/2009/index.htm
(64) http://www.aapsonline.org/newsletters/sept02.htm
(65) http://www.aapsonline.org/newsoftheday/00291
(66) http://www.tuftshealthplan.com/visitors/visitors.php ?
sec=about_us&content=company_profile
(67) http://www.thehealthplan.com/news/keyfacts.cfm#Backg round
(68) http://education.stateuniversity.com/pages/1923/Drug -Alcohol-Abuse.html
(69) http://www.niaaa.nih.gov/ResearchInformation/Extramu ralResearch/AdvisoryCouncil/prevention.htm
(70) http://en.wikipedia.org/wiki/Kaiser_Permanente
(71) http://www.jdpower.com/corporate/news/releases/press release.aspx?ID=2009053
(72) http://207.153.189.83/EINS/941340523/941340523_2006_ 03D2E03A.PDF
(73) http://207.153.189.83/EINS/042452600/042452600_2007_ 04857E2A.PDF
(74) http://207.153.189.83/EINS/042674079/042674079_2006_ 03C3970F.PDF
(75) http://yahoo.brand.edgar-online.com/displayfilinginf o.aspx?FilingID=6441702-196911-333078&type=sect&dcn=0000893220-09-000405
(76) http://biz.yahoo.com/e/090211/unh10-k.html
(77) http://yahoo.brand.edgar-online.com/DisplayFiling.as px?dcn=0001122304-09-000036
(78) http://yahoo.brand.edgar-online.com/DisplayFiling.as px?dcn=0001193125-09-033022
(79) http://pubdb3.census.gov/macro/032008/health/h01_001 .htm
(80) http://www.kff.org/uninsured/7475.cfm
(81) http://www.ama-assn.org/ama/pub/physician-resources/ solutions-managing-your-practice/coding-billing-insu rance/heal-claims-process/national-health-insurer-re port-card/2008-nhirc.shtml
(82) http://economistsview.typepad.com/economistsview/200 9/05/funding-universal-health-care.html
(83) http://en.wikipedia.org/wiki/Massachusetts_health_ca re_reform
(84) http://www.statehealthfacts.org/comparebar.jsp?typ=2&ind=125&cat=3&sub=39
(85) http://www.oecd.org/dataoecd/5/53/22364122.pdf
(86) http://www.gallup.com/poll/117205/americans-not-feel ing-health-benefits-high-spending.aspx
(87) http://www.oecd.org/document/25/0,3343,en_2649_33929 _37053529_1_1_1_1,00.html
(88) http://www.gao.gov/cgi-bin/getrpt?GAO-02-969T
(89) http://en.wikipedia.org/wiki/Health_Insurance_Portab ility_and_Accountability_Act
(90) http://pcrm.org/news/release080708.html
(91) http://www.ific.org/publications/brochures/pesticide broch.cfm
(92) http://biz.yahoo.com/e/090220/hum10-k.html
(93) http://yahoo.brand.edgar-online.com/DisplayFiling.as px?
cn=0001054833-09-000012
(94) http://biz.yahoo.com/e/090227/hnt10-k.html
(95) http://www.nationaljournal.com/njonline/mp_20090629_ 2600.php