Can we improve American health care?

An American woman is 10 times more likely to die in childbirth than an Irish woman. The probability that a baby born in America will die before reaching the age of five is 30 percent higher than that for a baby born in Canada or the United Kingdom; 60 percent higher than for a baby born in Belgium.

Uwe Reinhardt, the great economist of the health system, wrote:

U.S. per capita health spending continued to exceed per capita health spending in the other OECD countries, by huge margins, in 2001. After expenditures are converted into purchasing-power parity international dollars (PPP$), Switzerland spent only 68 percent as much on health care per capita in 2001 as the United States.3 Neighboring Canada, with a health care delivery system and medical practice styles fairly similar to those in the United States, spent only 57 percent as much per capita as the United States. PPP-adjusted per capita spending in the median OECD country was only 44 percent of the U.S. level (PPP$2,161).

So we spend a lot more and have worse health outcomes! We should be able to do better. We can do better if we can overcome hysteria and the pressures of vested interests to get a half-way reasonable health bill through Congress.

A key element is to bring the number of uninsured Americans from 50 million to 10 million. The U.S. population is 307 million, so the number of insured Americans is about 257 million. Adding 40 million to that number is about a 16 percent increase in the number of insured.

If we increase the number of insured by 16 percent will we increase national health care expenditures by 16 percent? Well, we could actually do worse than that if we do it badly. If we throw a lot of money at the existing system all at once, it will simply increase prices, as probably happened with Medicare.

On the other hand, the uninsured are not excluded from health services now. They just get them paid for by other means. Since they go for care late, indeed they probably have higher health care costs to the nation than the comparable insured citizens.

Moreover, there are a lot of ways we can reduce health care costs, including improving the use of information technology, simplifying payment schemes, reducing the prescription of services that don;t improve health (such as unnecessary diagnostic tests), and moving toward preventive rather than curative services.

People arguing that we have the best health care in the world and should not tamper with it probably just don't understand the situation. Of course some Americans are in the happy state of world class health care offered to them without cost. Members of Congress and industrial leaders are in this happy class.

I get heavily subsidized care from a great HMO (Kaiser Permanente), so I don't expect to benefit much personally from new legislation. However, as an American I think I have a responsibility to advocate changes in the system that improve national health outcomes and save money.