Sunday, June 14, 2009

Rebuilding Healthcare Without the Middlemen

Rebuilding Healthcare Without the Middlemen


By Derrick Z. Jackson

The Boston Globe

June 13, 2009


President Obama says that if healthcare is not reformed

this year, "we're not going to get it done." His

Council of Economic Advisers warns that healthcare

expenditures, currently 18 percent of gross domestic

product, will nearly double to 34 percent by 2040

unless costs are contained. The number of uninsured

people in the United States would expand from its

current 46 million to 72 million by 2040. "The American

healthcare system is on an unsustainable path," the

council said. "Expenditures as a share of GDP are

already substantially higher than in other developed

countries . . . This growth threatens to have a devastating impact."


Even if Congress responds to Obama's alarm, it is

doubtful reform will put us on par with other developed

countries. Obama has already taken a single-payer

system off the table, despite repeatedly acknowledging

the clear benefits of eliminating the administrative

costs of middlemen insurance companies. In a May town

hall in New Mexico, he said to applause, "If I were

starting a system from scratch, then I think that the

idea of moving towards a single-payer system could very

well make sense. That's the kind of system you have in

most industrialized countries around the world."


Alas, he says, we are so entrenched in employer-based,

insurance-company healthcare, all he can promise is

"vast improvement." He told the New Mexico audience,

"We don't want a huge disruption as we go into

healthcare reform where suddenly we're trying to

reinvent one-sixth of the economy."


Insurance companies and pharmaceuticals, the nation's

top two lobbying industries, have Capitol Hill on

lockdown. They have spent $2.8 billion since 1998 on

lobbying and $76 million in the 2008 elections in

campaign contributions, according to the Center for

Responsive Politics. Faster than you can say Obama,

contributions historically weighted heavily toward

Republicans are swinging to the Democrats.


Part of the reason obviously is that the health

industry feels the heat of American outrage on costs. A

coalition of insurance and pharmaceutical companies,

hospitals, and the American Medical Association this

week issued a plan to voluntarily knock costs down

between $1 trillion to $1.7 trillion over the next 10 years.


But that was short of a goal set by Obama of $2

trillion. It underscores how hard it will be for Obama

to get any goal line approaching universal healthcare,

with our embarrassingly bloated middleman costs. The

United States, according to the Organization for

Economic Cooperation and Development, spends $6,714 per

capita on healthcare, double the spending in countries

like Sweden, the United Kingdom, France, Germany,

Australia, and Japan. Second highest is Switzerland at

$4,520, and only two other nations, Norway and

Luxembourg, cross the $4,000 per-capita mark. Our per-

capita spending on prescription and nonprescription

drugs is $843, compared with $639 in Canada, $500 in

Germany, and $303 in New Zealand.


We might say our for-profit system is worth it if, for

all those health costs, Americans indeed boasted the

best health in the world. But it can be argued that our

system is literally costing each American two, three,

and four years of life. The United States is the only

industrialized nation with life expectancy under 78

years. Australia, Canada, France, Iceland, Japan,

Norway, Spain, Sweden, and Switzerland all have life

expectancies between 80.3 and 82 years.


Even more striking, in the early 1960s the United

States was ahead of, or virtually tied with, Japan,

Spain, Italy, Luxembourg, Germany, France, Finland, and

Austria in life expectancy. Today, we are a year-and-a-

half or more behind them all.


Will reform reclaim those years, at a time when we are

compounding costs with preventable diseases, such as

the highest obesity rates in the developed world?

Reform will have to be as dramatic as the first heart

transplant, as radical as taxing junk food, and as

meaningful as making physical fitness as important as test scores.


As long as Obama and Capitol Hill say we cannot start

from scratch on healthcare, we will forever be scratching the surface.


Derrick Z. Jackson can be reached at

c Copyright 2009 The New York Times Company




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