What’s next for U.S. health care?

MATTHEW EDLUND M.D.
Contributing Columnist
health@lbknews.com

Many pundits have announced the American economic collapse is so severe that the next months of political maneuvering will be all about the economy, not health care. Yet health care now represents a sixth of American GDP. You can’t fix the economy without trying to fix health care.
Last month GM announced sales were down 45 percent. The major American car companies may soon all be bankrupt. There is much to blame for this development, including pushing SUVs to spearhead growth, exemplified by GM’s decision in the ’90s to destroy its electric car division and put the money “saved” into the Hummer. However, high health care costs were also a major cause of the auto industry’s present near death. Detroit executives constantly pointed out Toyotas and Nissans had huge cost advantages because their workers were mainly insured by national health care systems.
And what do we get for our health care dollars? A system about twice as expensive, person by person, as most of the industrialized world. In survival, we rank about 40th, out there with Cuba, which pays perhaps 3 cents on the dollar per citizen. Our infant mortality rank of 29 gives out death rates double that of Singapore or Scandinavia, though our costs are double theirs. From a business standpoint of national cost competitiveness, U.S. health care is a disaster.

Political obstacles to change
These dismal results mask enormous profits for insurance companies and drug and device makers. Health insurance executives put 30 percent of their money into “administration.” Most national health insurance schemes take 5 percent to 8 percent for such costs, with Medicare coming in at around 3 percent.
What do you get for your health insurance dollars? Hours on the phone, told your already pre-approved procedure will not be paid. Letters explaining that your drug bill is 1,000 percent higher than when you signed up, as a necessary drug was “slipped” from the approved list without your knowledge. Many weeks of writing and calling “consumer representatives” only to learn that because you received antidepressants 18 years ago, you are ineligible for any coverage due to your “high health risk.”
Health insurance executives speak with the swagger and arrogance of our financial and investment banking titans, explaining that only they have the knowledge and experience to know “what works” in health care. They don’t.
The dirty secret of the pharmaceutical industry is that the lion’s share of their profits comes from the United States. Other governments refuse extortionate tactics that see 10-year-old drugs double or triple in price. Only the Bush administration could make laws forbidding Medicare from negotiating pharmaceutical prices, handing monopoly-pricing power directly to Big Pharma.
Yet the costs of “high” medical technology represent some of the greatest waste of health care dollars. Nothing succeeds like excess. American physicians have long recognized they get paid far more for procedures than cognitive services. Why should dermatologists make several multiples of what general physicians make? The danger of their work? Their frequent early morning emergencies?
Most national health systems would never allow such scandals to start let alone continue for decades. Just as we need to fix our financial markets, our housing debacle and our chronic budget deficits, we need to fix health care.

The way forward
Though the army of medical-industrial lobbyists will effectively block legislation in Congressional subcommittees, some sectors can be bought off. Allowing insurance companies to run new national insurance schemes makes little economic sense but may be required politically. Drug and device makers may accept guarantees of continuing business. Physicians, generally a spent force politically, may be enticed by obtaining small pieces of the 20 percent to 25 percent of administrative waste built into the system.
However, the real gains remain in fostering public health. Here, the advantage lies in programs that immediately benefit the national economy while aiding long-term public health.
The first place to look is infrastructure. New mass transit can put idled construction workers back to work, help save financially strapped cities, decrease dependence on foreign oil from countries that want us dead and help get people walking again. With diabetes rates doubling, we need people to transport themselves. Autotransport through walking and biking can save American health care hundreds of billions.
Next, we must revisit our food policy, a.k.a. the “farm bill.” With people scrimping on food costs, they quickly find that government-subsidized fast food, which ultimately costs us hugely in health care costs, is far cheaper than healthy fruits, grains or vegetables. When you have only $3 a day for food, there’s not much choice. What is now necessary is to cut our government subsidies to high fructose corn syrup and other fast food chemicals.
To save money and ourselves we need to recognize the issue is health, not health care. A healthy population is also a creative, economically productive one. Health, not health care, is the necessary priority, as politics will make difficult quick reform of our intensely expensive and massively dysfunctional medical industrial system.
Dr. Matthew Edlund practices sleep medicine and psychiatry in Sarasota. His new book, “Designed To Last,” is available online. He can be reached at 365-4308 and via his Web site at doctoredlund.com.