Health Care: Cost VS Outcome

Catching up on my reading after the chaos of overseeing the move of the retail store for which I manage, and the normal holiday hustle and bustle.

The January edition of National Geographic features many interesting articles concerning the future of health care.  Advances in technology and an acceptance by Western Medicine to treat patients as individuals, should result in future health care services which are long on technology and long on specific diagnosis tailored for each patient.  Imagine the days when the doctor made house calls, knew you as a person not just a chart, but now would be able to bring with her a tool kit filled with the most up to date technology.  Individualized treatments, rather than the "take this pill, it works most of the time on most people" approach.

What struck me about this particular edition, however, was the chart in the beginning which detailed the relationship between life expectancy rates and health care spending, from 1980 to 2015, along with the article towards the end of the magazine about maternal mortality rates.

First, the cost vs outcome chart.  It depicts the life expectancy rates for 36 of the world's most affluent countries along with their 1980 per person health expenditure.  At the time, the United States was a bit above the average for these nations in life expectancy while spending more per person than all but one. 

Thirty-five years later, the US is last among these nations, over 2 years per person, on average, below the bottom of the chart, while spending over $2500 per person more then the second highest spending country, over $4000 more person than most of them.  In other words, we are spending far more for poorer results.

Of course, the facts are one thing.  Why is a whole different subject.

Some analysts point to unequal access and poor preventive care as part of the explanation.  When sick people are reluctant to see a medical professional, either because of cost, or proximity of a health care facility, then when they finally are treated, it is because the problem has become serious and will result in a higher cost, either at the emergency room or after being admitted to a hospital by the doctor.  Regardless, the malady has worsened, more extensive treatments are required.

In addition to this interpretation, I also think that even for those with health insurance, it can sometimes be difficult to navigate the rules, so seeing the appropriate health professional doesn't occur.  Questions about referrals, co-pays, in network or out-of-network doctors, even which hospital to go to in an emergency can delay or prevent proper care from being sought.  Not to mention, the almost yearly exercise by your employer to provide health care insurance without spending a fortune or passing along higher premiums, create another obstacle to knowing where to go for health care. 

I had an experience this year where I received a bill from a testing facility after my yearly physical.  The bill was for the blood test which checks for possible prostate cancer.  Apparently, this test was not covered by my insurance as of 2018 (it was the previous years) unless the doctor indicates that it was necessary due to a prior condition.  Since I had a prostate biopsy just a few years ago, my doctor resubmitted the test with a different "code" and it was covered by my insurance.  Had I not called, and just paid the bill, I wouldn't have known to make sure future prostate blood tests are coded correctly, or worse, perhaps requested that the test not be performed in the future. 

I am sure most people have had such an experience as well.

There is no doubt that the United States health care system is among the best in the world.  People from outside America routinely come here for the most advanced care and treatments.  I have no doubt that as the technological advances occur, we will all benefit.

Unfortunately, I also have no doubt that those with the most money will benefit the most.  The fact is, health care is treated just like any other commodity in America.  Have a six figure income, and work for the biggest corporations, and you will have access to the best care anywhere.  Be a small business owner, or work for a small business, and your access will be very good.  Work for a company that does not provide health care insurance, or provides very poor coverage, and your access will be very limited, if you can afford it at all.  So, while the rich from other countries flock to the United States to pay for the best health care in the world, millions of working class Americans will struggle to balance paying for health care or foregoing a doctor visit until the situation is serious.

When at my most sarcastic, I see the access issue as one of a refusal for those with the most to wait their turn in line.  You know who I am talking about.  People for whom the rules don't apply.  People who believe that their money and influence guarantees them to be first, never having to wait for anything.
I think that is behind some of the claims that people in other countries have to wait for doctor appointments or surgeries, etc.  The fact is, when most people call a doctor, it is difficult to get an appointment same day unless it is an emergency, and even then, sometimes one must go to a hospital.
We all wait for things, at the supermarket check-out lines, at entertainment venue entrances, for food delivery.  But some people thing they are above waiting; they are the ones with special parking, reservations when no one can get one, personal assistants who wait for them. 

It is not a coincidence that almost all of the affluent countries in the world have some form of universal health coverage provided by public or private insurers, and that their cost vs outcomes are better than ours.  It is obvious that some form of universal health care will not only extend our lives, but cost us less, both as individuals and as a nation.  If we were a sports team, and our team came in last five straight years, but did not change their system because they were afraid of being like everyone else, or afraid of a loss of individuality, or worse, were owned by someone who just didn't care what we thought as long as he made large sums of money, we would demand change, loud and vociferously.

The crazy thing is, most Americans are demanding change, but many are scared of the obvious answer because of a few powerful groups and individuals who prefer the status-quo where they get rich and we get sick and die so they use the "S" word with pictures of Venezuela in the background.

Speaking of dying, the article on maternal mortality rates was startling.  Are you aware the United States is one of only two developed nations (along with Serbia) to see a rise in maternity mortality rates since 1990?  More women are dying as a result of childbirth in our country than 25 years ago!

Our mortality rate was below such countries as Slovenia, Croatia, and Montenegro among other more recognizable names, in 1990, and is now below Malta, Cyprus, Macedonia, and Belarus, among others which you might struggle to identify on a world map.  A rise in pregnancy related medical conditions, the age of women giving birth, along with a lack of standardized protocols across hospitals are all mentioned as causes.

How about our medieval perception of birth control and contraception?  We allow a minority of righteous individuals to stand in the way of common sense sex education and universal access (without stigma and high cost) to preventive birth control measures, and then are surprised when our female children are becoming mothers too soon, and do so without strong support systems. 

Sadly, we are our own worst enemy when it comes to health care outcomes vs cost.  We fail to see that we all do better as a group when it comes to these big social issues.  That spreading the costs out, even among those who are sick less than average, enables those that are sick more than average to be treated.
That you could spend 60 years in that first group and the last 5 in the second.  That social nets keep our grandparents and parents from living in our homes, or dying in the streets.  That the vast majority of us will need the help of our government for health care and income when we can no longer work, yet we decry the "nanny" state forgetting that only the rich had nannies; we all had our parents wiping our butts, paying for our food and shelter, and, in some cases, staking us to $300 million. 

Precision medicine which will monitor our health, alert us to issues both present and future and provide individualized treatments designed just for us is the future.  I only hope that once it arrives, we will have determined that inequality is our enemy, unequal access to health care is bad for Americans, and that together we can solve our problems much more efficiently than any one one of us, regardless of his perceived regal residence.