The Healthcare Crisis

The healthcare crisis in the US is growing in severity and yet is not the subject of any real public debate. More than 44 million Americans are without health insurance, and almost 65 million will experience a lack of coverage during the year. Emergency rooms are the primary care provider of necessity. All of this despite the fact that, as a nation, we spend more than any other country in the world; 11% more than the next closest country; 90% to 100% more than countries like Germany, Japan, Canada, Australia, and France. Yet the outcomes for our healthcare system are completely second-tier and nearly third-world.

You may be shocked to see exactly how poorly our phenomenally expensive health system is performing. Just to add some further context, note that Sweden (1st in Infant Mortality to the US 41st position) has a per capita income roughly equal to that of Mississippi (the poorest US state) and spends almost exactly half of what the US does per capita on health care.

During our quadrennial presidential personality sweepstakes, neither candidate offered real solutions, really not even a discussion of the issues. We are stuck in a political environment in which neither the Republicans nor the Democrats are offering, and I would argue, are capable of offering real solutions.

Lets make a one basic observation about the situation:

This is not a money problem. As demonstrated by the data on the Comparative Health System Data chart, we clearly are spending enough money in aggregate.

But, this crisis is about money, namely, who gets it and what do they do with it. And, starting from the last serious attempt to tackle the problem during the first year of the Clinton administration, it is very clear that the political system is completely in the pockets of the various interests who have the money now, namely insurance and drug companies, hospitals, and doctors.

It seems obvious to me that we just need to look at any of a number of the top-performing countries for the solution. Then, we need to have the political forces in place to tell some of the current participants that the rules have changed.

Central to any solution will be the participation of all US residents in the system. Healthcare is a basic human right and we should not be treated as “risk” factors in insurance company profit calculations. If everyone is part of the healthcare system, then we can effectively share the individual risks and expenses of healthcare across the whole population. Healthcare should not be an actuarial game to derive profit. It should be a system that delivers a reasonable level of service to everyone in the society.

Two players clearly are at the top of the hit list. First, most assuredly the insurance industry, which adds no value to our health care, but consumes by many estimates 15% to 20% of the resources, must go. Second, the drug companies can be brought into reasonable competition for prices that will bring market forces to bear.

Ironically, given the long history of doctors opposing national or single-payer systems in the US, doctors have now been reduced to the status of wage slaves like the rest of us. Many, if not a solid majority of doctors, will support real reforms to the system.

I close here with two basic notions:

our healthcare problems are not about a lack of money, and
we need to develop political forces that can overcome the control of government (Federal and state) health policies by the current players in the healthcare system.

Given the current Bush administration, I believe the focus of reform must be at the state level. It seems feasible to envision a single-payer system that covers all residents in a state like Massachusetts. We should try it.

Solving the Health Care Crisis in the US – some data

Comparative Health System Data
Health Spending per Capita 2002			Infant Mortality per 1000 Births 2003			Life Expectancy in Years at Birth 2003
1	United States	$4,271	1	Sweden	3.44	1	Andorra	83.49
2	Switzerland	$3,857	2	Iceland	3.53	2	Macau	81.87
3	Norway	$3,182	3	Singapore	3.6	3	San Marino	81.43
4	Denmark	$2,785	4	Finland	3.76	4	Japan	80.93
5	Luxembourg	$2,731	5	Japan	3.84	5	Singapore	80.42
6	Iceland	$2,701	6	Norway	3.9	6	Australia	80.13
7	Germany	$2,697	7	Andorra	4.07	7	Guernsey	80.04
8	France	$2,288	8	Netherlands	4.31	8	Switzerland	79.99
9	Japan	$2,243	9	Austria	4.39	9	Sweden	79.97
10	Netherlands	$2,173	10	France	4.41	10	Hong Kong	79.93
11	Sweden	$2,145	11	Switzerland	4.42	11	Canada	79.83
12	Belgium	$2,137	12	Macau	4.44	12	Iceland	79.8
13	Austria	$2,121	13	Slovenia	4.47	13	Cayman Islands	79.67
14	Canada	$1,939	14	Belgium	4.64	14	Italy	79.4
15	Australia	$1,714	15	Germany	4.65	15	Gibraltar	79.38
16	Finland	$1,704	16	Luxembourg	4.71	16	France	79.28
17	Italy	$1,676	17	Spain	4.85	17	Monaco	79.27
18	United Kingdom	$1,675	18	Australia	4.9	18	Liechtenstein	79.25
19	Israel	$1,607	19	Liechtenstein	4.92	19	Spain	79.23
20	Ireland	$1,569	20	Guernsey	4.92	20	Norway	79.09
21	United Arab Emirates	$1,428	21	Canada	4.95	21	Israel	79.02
22	New Zealand	$1,163	22	Denmark	4.97	22	Jersey	78.93
23	Spain	$1,043	23	Gibraltar	5.4	23	Faroe Islands	78.9
24	Greece	$965	24	Ireland	5.43	24	Greece	78.89
25	Portugal	$859	25	United Kingdom	5.45	25	Aruba	78.83
26	Slovenia	$746	26	Czech Republic	5.46	26	Netherlands	78.74
27	Singapore	$678	27	Jersey	5.52	27	Martinique	78.72
28	Argentina	$654	28	Northern Mariana Islands	5.61	28	Virgin Islands	78.59
29	Uruguay	$621	29	Malta	5.72	29	Malta	78.43
30	Bahamas, The	$612	30	Monaco	5.73	30	Germany	78.42
31	Barbados	$601	31	Hong Kong	5.73	31	Montserrat	78.36
32	Korea, South	$470	32	Italy	5.76	32	New Zealand	78.32
33	Lebanon	$469	33	Portugal	5.84	33	Belgium	78.29
34	Saint Kitts and Nevis	$408	34	San Marino	6.09	34	Guam	78.27
35	Czech Republic	$380	35	New Zealand	6.18	35	Austria	78.17
36	Bahrain	$358	36	Greece	6.25	36	United Kingdom	78.16
37	Hungary	$318	37	Aruba	6.26	37	Saint Pierre and Miquelon	78.11
38	Brazil	$308	38	Man, Isle of	6.3	38	Man, Isle of	77.98
39	Chile	$289	39	Guam	6.58	39	Finland	77.92
40	Slovakia	$285	40	Faroe Islands	6.66	40	Jordan	77.88
41	Costa Rica	$257	41	United States	6.69	41	Luxembourg	77.66
42	Poland	$248	42	Taiwan	6.8	42	Guadeloupe	77.53
43	Panama	$246	43	Croatia	7.06	43	Bermuda	77.41
44	Estonia	$243	44	Cuba	7.27	44	Saint Helena	77.38
45	Mexico	$236	45	Israel	7.55	45	Ireland	77.35
46	South Africa	$230	46	Korea, South	7.58	46	Cyprus	77.27
47	Colombia	$227	47	Martinique	7.62	47	Puerto Rico	77.26
48	Dominica	$208	48	Cyprus	7.71	48	United States	77.14
49	Trinidad and Tobago	$204	49	Montserrat	7.98	49	Denmark	77.1
50	Grenada	$193	50	Saint Pierre and Miquelon	8.18	50	Taiwan	76.87
51.	Lithuania	$183	51	New Caledonia	8.23	51	Cuba	76.8
52	Antigua and Barbuda	$179	52	Reunion	8.31	52	Anguilla	76.7
53	Venezuela	$171	53	Slovakia	8.76	53	French Guiana	76.69
54	Latvia	$166	54	Hungary	8.77	54	Kuwait	76.65
55	Jamaica	$157	55	French Polynesia	8.95	55	Costa Rica	76.43
56	Turkey	$153	56	Chile	9.12	56	Portugal	76.35
57	Saint Lucia	$151	57	Poland	9.17	57	Chile	76.35
58	Maldives	$150	58	Virgin Islands	9.21	58	Northern Mariana Islands	76.16
59	El Salvador	$143	59	Bermuda	9.28	59	Libya	76.07
60	Namibia	$142	60	Puerto Rico	9.3	60	British Virgin Islands	76.06
61	Peru	$141	61	Guadeloupe	9.3	61	Uruguay	75.87
62	Jordan	$139	62	Cayman Islands	9.89	62	Jamaica	75.85
63	Iran	$128	63	American Samoa	10.09	63	American Samoa	75.75
64	Botswana	$127	64	Nauru	10.52	64	Slovenia	75.51
65	Gabon	$122	65	Costa Rica	10.87	65	Argentina	75.48
66	Mauritius	$120	66	Kuwait	10.87	66	French Polynesia	75.45
67	Syria	$116	67	Netherlands Antilles	11.06	67	Netherlands Antilles	75.38
68	Thailand	$112	68	Barbados	11.71	68	Korea, South	75.36
69	Tunisia	$108	69	Estonia	12.32	69	Czech Republic	75.18
70	Burma	$97	70	Macedonia, The Former Yugoslav Republic of	12.54	70	United Arab Emirates	74.75
71	Dominican Republic	$95	71	French Guiana	13.22	71	Macedonia, The Former Yugoslav Republic of	74.49
72	Paraguay	$86	72	Jamaica	13.71	72	Slovakia	74.43
73	Fiji	$86	73	Tonga	13.72	73	Tunisia	74.4
74	Romania	$86	74	Fiji	13.72	74	Paraguay	74.4
75	Belarus	$85	75	Brunei	13.95	75	Croatia	74.37
76	Belize	$82	76	Belarus	14.12	76	Brunei	74.3
77	Malaysia	$81	77	Bulgaria	14.18	77	Dominica	74.12
78	Guatemala	$78	78	Uruguay	14.25	78	Turks and Caicos Islands	74
79	Honduras	$74	79	Lithuania	14.34	79	Serbia and Montenegro	73.97
80	Bolivia	$69	80	Grenada	14.63	80	Poland	73.91
81	Kazakhstan	$62	81	Saint Lucia	14.8	81	Venezuela	73.81
82	Bulgaria	$62	82	Latvia	14.96	82	Bahrain	73.72
83	Ecuador	$59	83	Sri Lanka	15.65	83	New Caledonia	73.52
84	Nicaragua	$54	84	Saint Kitts and Nevis	15.83	84	Reunion	73.43
85	Guyana	$51	85	Dominica	15.94	85	Qatar	73.14
86	Swaziland	$46	86	United Arab Emirates	16.12	86	Saint Vincent and the Grenadines	73.08
87	China	$40	87	Saint Vincent and the Grenadines	16.15	87	Saint Lucia	73.08
88	Congo, Democratic Republic of the	$40	88	Palau	16.21	88	West Bank	72.68
89	Cape Verde	$37	89	Mauritius	16.65	89	Sri Lanka	72.62
90	Philippines	$37	90	Seychelles	16.86	90	Oman	72.58
91	Zimbabwe	$36	91	Bahamas, The	17.08	91	Albania	72.37
92	Albania	$36	92	Argentina	17.2	92	Panama	72.32
93	Bhutan	$36	93	Greenland	17.28	93	Mexico	72.3
94	Kenya	$31	94	Serbia and Montenegro	17.36	94	Bosnia and Herzegovina	72.29
95	Nigeria	$30	95	Turks and Caicos Islands	17.46	95	China	72.22
96	Turkmenistan	$30	96	Romania	18.88	96	Hungary	72.17
97	Sri Lanka	$29	97	Bahrain	19.18	97	Solomon Islands	72.1
98	Ukraine	$28	98	British Virgin Islands	19.55	98	Lebanon	72.07
99	Cote d’Ivoire	$28	99	Panama	19.57	99	Ecuador	71.89
100	Papua New Guinea	$25	100	Jordan	19.61	100	Barbados	71.84

Data for Spending: World Bank. 2002. World Development Indicators 2002. CD-ROM. Washington, DC

Data for Infant Mortality: CIA World Factbook, December 2003

Data for Life Expectancy: CIA World Factbook, December 2003

All data courtesy of http://www.nationmaster.com/index.php (09/29/04)

Solving the Health Care Crisis in the US – some data

Share this: