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Wasted Wealth and Health Care in the U.S.

October 16, 2006 2:19 PM

The United States is undeniably wealthy -- so why can't we just use that wealth to cover the uninsured? Medical Editor Dr. Tim Johnson blogs:

Johnson_timothy_1 The United States is an undeniably wealthy country -- so why can't the US just spend more to cover the uninsured?

It isn't quite that simple. Given that employers obviously don't want to spend the money to cover America's uninsured, and many people can't afford to cover themselves, the question becomes: whose money and what money are we going to spend?

Many experts say what we really need to do is not spend more money but use the money we already spend in smarter fashion.

Here is a statistic that blows my mind: in 2004, the latest year for this comparison, we Americans spent about $6,100 per person on health care; the average per capita cost in other industrialized countries was about $2,500. In other words we spend more than twice as much, but -- here is the kicker -- we don't do any better in terms of health outcomes (longevity, infant mortality, etc.) and in many cases we do worse. So, the United States is spending a lot of money badly -- on unnecessary treatment, administrative waste, and actual fraud, for example.

If we could reform our health care and spend money more wisely, we could probably cover everybody without spending any more total money -- just use it differently.

But what does it mean to spend money more wisely?

That means all kinds of possibilities. First, we need to make sure we spend money on what is medically necessary and what is proven to work rather than what patients and doctors want simply because it is the latest or the most advertised treatment, or what will make the hospital the most profit.

Second, we need to reduce administrative costs by replacing the very cumbersome paperwork in our current health care with computerized records. Not only will computerized records save money in the long run, but it will go a long way in avoiding unnecessary testing, treatment errors and medication mistakes.

And third, using this same computer system, we need to monitor both costs and quality of treatment to make sure patients are getting what they need in terms of both timely prevention and timely follow-up. These records can automatically tell us when kids need immunization -- and when diabetics need medication changes.

Currently, though, our current health care is fragmented and scattered; most hospital doctors’ patients don't have computerized records. So how can we make this happen?

That question hits on the heart of the matter. There are a lot of things that our health care system needs before things can get better. We need to have better and larger systems of health care that can bargain better with drug companies on our behalf, monitor our doctors for quality, and make sure we get WHAT we need WHEN we need it.

And we are slowly starting to move in that direction. For example, there are large private health plans -- like Kaiser Permanente -- that have computer systems in place to do all this. And the government run Veterans Administration hospital system is doing the same thing -- providing much better and safer care and at a significantly lower cost than most of the private sector -- about $5,000 per person versus $6,500 per person. So we come back to the question of HOW we spend our health care dollars; if we have the political will, and the public demand, we can change health care so it can become better for the patient -- and better for our national pocketbook.

Check out ABC News' week-long series Prescription for Change here.

October 16, 2006 | Permalink | Share | User Comments (27)

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health care in this country really sucks. today you hear of people heading overseas to handle their medical situations. it just cost to darn much. hospital exec's make 3 million or more per year and for what? choosing brand x over brand y is not worth that much. i keep hearing that the uninsured are charged more than the insured and hospitals try every trick to get paid and they collect, if that is so, why do the insured need to be billed tons more to cover the alledged losses of treating uninsured. the medical field are nothing more that legalized crooks who dont pay when they make huge mistakes. when is the last time you heard of a cure of a debilitating disorder or disease? you never will, there is to much money to be made through your pain and suffering.

Posted by: jim l | Oct 31, 2006 11:13:05 AM

While writing my book, I researched the local Department of Health and several other government agencies that get grants from the federal/state governments to help the public out with medical expenses and found the people that run them "inept." i.e. they are clueless to what their program is suppose to offer in terms of healthcare benefits, and it scared me that I had to explain it to them. And what about the pharmaceutical companies that offer drug assistance programs to those in need, but make it impossible for you to find out information about them...hmmmmm. I have seen doctor's salaries decrease in the past 10 years by 40%, which will be decreasing another 4% in a year and another 39% in the next 9 years while insurance providers and drug companies get increases of salaries and say they offer services that make themselves look good...so it seems, but don't provide them, or make it easy for those that need them? The government needs to look into how healthcare money being allocated is spent and the healthcare consumers need to start being their own advocates.....it might take a bunch of people pulling out of their health insurance companies and putting a savings aside, like we would for a "college fund" and negotiating with our healthcare providers in cash, rather than paying a company to do it for us, as well as question some of the programs that are out there and who is running them.....

Posted by: Michelle | Nov 1, 2006 10:55:16 AM

My husband age 43 has Charcot Marie Tooth disease and Rheumatoid Arthritis. He was hospitalized in December for a collapsed colon and in January for a stroke. He lost his job since he has not been at work and along with it went our health insurance. In September we filed bankruptcy with $50,000 of medical bills. With the December and January hospital stays he was insured but we still owe almost $20,000.00 ($10,000 was deductible and the rest uncovered). My employers do not offer insurance. (I have 2 jobs) I make less than $30,000 per year but I make too much to be covered under any state plan. COBRA is $810.00 per month - that's almost one of my bi-monthly pays. Medicaid will not cover my husband because I make too much AND they will not consider us a 4 person household because I have 2 kids from a previous marriage and since they are not HIS biological children, they don't count. He pays for everything for them, raises them, disciplines them, does their homework with them but they are not HIS according to Medicaid. For him to get Medicare he has to be disabled for 2 years. He applied for disability in January but there is a five month waiting period for which you receive no compensation so the earliest we will get money is June and he can't get Medicare until 2 years from June. Insurance Agents tell me not to even try to get him a policy. If I change jobs and get insurance then all his conditions will be pre-existing and won't be covered anyway. Arthritis has eaten away at his elbow joint and he is in alot of pain but we can't get that fixed. He has a hernia where his stomach protrudes through the abdominal wall. Social Security wants documents from all his doctors to prove his disability. The doctors are reluctant to fill them out until he comes in for an office visit so they can talk to him and they want him to go for testing but we don't have the $90 to $120 for the visit and forget paying for the tests. So we may get turned down for disability and then we can't get Medicare either. We see nothing but a deep dark hole that we keep descending down. My second job is preparing bankruptcies for lawyers. I see alot of medical bills that are outrageous and the credit card bills are usually where people have charged their medical bills or medicine on or they have used their credit cards to pay for their regular household bills and used their cash to pay for the medical bills and prescriptions. Of course there are always abusers of credit cards and people who don't plan for a loss of income but most of what I see are people struggling just to get what they need. I have been doing bankruptcies for about 17 years now so I know what I am talking about. We don't need to lay blame, we just need to figure out where to go from here so people aren't devastated by medical conditions. When someone is struck with a disability they have to change everything about their life. We had to move from our 2 story home to a one story, we had to get an automobile to accomodate the mobility cart, we had to get a ramp installed, we had to change where we go so we can get the cart in there and even my job as a spouse needs to change because I lost my insurance. Then there's the total debt from the medical bills. Then you have hospital social workers tell you that you need to use coupons and manage your money better so that you can afford insurance. Saving fifty cents off cereal isn't going to balance out to pay $810 a month for just me and my husband in COBRA insurance payments!! I do use coupons and buy anything I can at a discount but it still won't pay the insurance. So we are without. My husband isn't getting the care he needs. His condition is deteriorating and it's hopeless. I beg of our government to find a new way to handle the health care system so everyone can afford to be taken care of and get the help they need. I'm not against paying for it but it has to be at a reasonable price.

Posted by: Diane Hetrick | Mar 1, 2007 11:45:05 AM

Gov't is incapable of delivering a solution; and we consumers are unwilling to change our unhealthy habits and will not accept health care that does not bring about 100% discomfort-free recovery (we'll sue if we don't get this). We spend billions on AIDS research - a preventable disease if people would only exercise self-control and common sense - which could instead be used to cover a few thousand uninsured children. We want pharmacy companies to spend billions to find a cure-all for cancers, heart diseases, and other ailments we bring upon ourselves with poor eating and lifestyles; and we want them to give us this medicine for free or low cost even though most of their billion-dollar research efforts will fail. In essence, we want our healthcare to beat death, and the industry/politicians are more than happy to oblige.

I'm resigned to paying more for health insurance than my mortgage. I only hope my family will financially break even and we'll embrace healthy lifestyles that will ensure we never have to use our insurance because I know a serious illness - with or without health insurance - poses a good risk of breaking our bank account.

Posted by: Gabriel Jim | Mar 14, 2007 9:40:04 PM

My mind is like a bunch of nothing. I've just been letting everything wash over me lately. Oh well. Such is life.

Posted by: monarchy | Sep 24, 2007 9:48:36 PM

Hey -- if you want to see how bad the medical - insurance colossus has gotten, try getting into an automobile accident with all four of your family members. A driver crossed the center line and hit us head on. My wife suffered the most severe injuries.

It has been a nightmare. I have been getting weekly notices from the medical insurance provider that they are not going pay any of the claims unless they see that the auto insurer paid out their portion of the medical coverage. The total med coverage on the auto policy is $20,000. We spent that within the first hour or two of this incident (four of us were admitted to the emergency room via ambulance, my wife and youngest daughter had emergency surgery).

Each week brings its special challnge from the hospital, the nursing home, or the insurance company. We just don't know which one it is going to be. Sometimes it is all 3 on the same day.

Just simplify the system folks. Too much of the time, you don't understand what you are being billed for and then you can never quite reconcile the hospital or physician's version of the bill with what the health insurance folks say the bill should be.

Before this incident, I thought the biggest problem was the uninsured. Now I realize it is the whole medical/health provider community that is the problem. Too often, the docs and the insurers just don't give a darn about the patient. The system is grossly inefficient. Americans spend
WAY too much for what, in the end, is usually insufficient coverage. How many times have you ever had a medical insurance claim that was processed properly and in a timely fashion and in a manner in which you understood? Probably not many. Should we not demand more? Don't we deserve better?

Posted by: mark | Feb 22, 2008 4:31:01 PM

Preemies under a certain weight typically have very poor outcomes. With modern imaging technology it is often determined that some have no brain or very limited brain function. Many have GI tract problems that is for the most part incompatible with life. These patients are like a gift to the hospitals and medical providers. They will never recover and will never be able to tell of the horrors of the procedures preformed upon them. The hospitals and medical providers can maintain a heartbeat thereby qualifying this patient as living and can continue to provide treatments. Treatments and medications and hospitalization cost the insurance companies millions of dollars (sometimes for a single patient). The hospitals and the doctors and the medical providers all know the probable outcome will be death yet they are greedy and will maintain that heartbeat for as long as possible. Without intervention this patient would have died at birth or soon after. With intervention this patient will die sometime later, perhaps weeks or even months later. The outcome is the same. Without intervention is a difficult decision and millions of dollars less costly. With intervention is a difficult decision and cost mega millions of dollars. The outcome is substantially the same for both decisions for the patient. But with intervention the hospitals and the doctors and the many medical providers make a lot of money. Would this money be better used for a heart bypass or hip replacement on a patient who will recover and have a better quality of life because of it? I think so. Suggestion...go to a level IIIc NICU and do your own unbiased investigation.
The level I and the level II and the lower acuity level III NICU's have good outcomes. These are not wasted dollars. It is the higher acuity NICU's that are the cash cows for the providers and are where substantive savings can be realized without changing the outcome for the patients.

Posted by: concerned | Nov 13, 2008 10:51:38 AM

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