I have been thinking about this issue alot and actually wrote a paper about it. I thought I would post and see what people thought.
Don't think I'm advocating socialized medicine, I am not. I am advocating a economically efficient health care system based on single-payer insurance and private provisioning of medicine.
My thoughts...
Different policy options are on the table for health care reform ranging from socialization to complete privatization of all health care. Inevitably though, it is the public's burden to assure the publics' health.
My personal opinion based on the readings and other anecdotal analysis is that American's need to first reduce administrative costs associated with health care through the limiting the providers for health care insurance - an optimal organization in my opinion would be a single-payer, nationally regulated cost recovery system: every one pays in, costs are covered via progressive taxes (distributed among businesses and individuals) and equal co-pays. Private health insurance should be allowed, but everyone should be required to participate in the national health system. This of course will not happen until the burdens and costs of health care reach the tipping point and society realizes the necessity of change in order to assure the long term viability of health care in relation to national productivity.
Should we restructure our health care system?
The demands that are being placed on America's current healthcare system are ever growing and although that current healthcare system is functional there are significant questions regarding its long-term viability and optimal utilization of the nation's resources. Healthcare spending, meaning the cost to provide and cover servers, in the United States, accounts for between 12-14% of the U.S. gross domestic product (GDP) or approximately $1 Trillion dollars . The cost per citizen (man, woman, child) to support American health care is around $3,400 dollars per year, compared with around $3,000 dollars per year for near universal coverage in Canada. I assert that the American system for delivering and providing health care should be restructured in order to optimize resources, access to care, and stabilize/cost contain growth for this economic sector. In this paper, I discuss the need to shift healthcare towards health education and primary care, rather than hospital and emergency based care.
The public policy goal of health care restructuring would be to promote the overall general wellness and good health of the population. The question of how to get there remains allusive. Public interest is generally in support of good health, yet also opposes growth of government and government intervention in private markets, except to correct generally recognizable market failures. My primary concern in asserting that health care needs to be restructured revolves around the idea of efficient allocation of resources in the economy. Is it effective and efficient to supply health care through our current model? What are the opportunity costs in the current health care system?
Current State
The cost of providing health care is rising. Since 1965 the cost of health care has grown from 5% of the GDP to 14% of the GDP. According the test health care costs are anticipated to continue a moderate but consistent increase through the foreseeable future, including increasing as a percentage of the total GDP. Private health costs will see growth of between 3 and 6 percent per year, while public spending will grow between 6 and 9 percent per year. These cost increases are nominal if the growth of the GDP mirrors the increases, i.e. the proportions of the costs of health care remain stable in relation to the over growth in the economy. However, GDP historically has only increased by an annualized average of 3.16% since 1972 .
The population is aging, becoming more diverse, and individuals are living longer. The current model of health care for Americans is employer provided health insurance followed by government supplied/supplemented insurance for the elderly and poor. This system, however, still leaves approximately 15 million without health insurance and reliable access to care, save hospital emergency care. In addition the current system focuses on practitioner provided health care and accessing health care sources rather than education and prevention based on health behaviors. With the shift in age demographics, there is a corollary shift in the growth of disease and illness associated with longer life spans - chronic diseases such as heart disease, cancer, and other similar illnesses. In a sense, the burden of disease is increasing as the population ages. The cost of care associated with poor health choices early in life is becoming concurrently more burdensome as well.
According the Centers for Disease Control and Prevention, the most significant influence on an individual's health are their health behaviors followed by their environment and individual genetic resistance to poor health, and lastly access to care. With the primary determinant of good health (wellness) relating to health behaviors, one must address what are the factors that contribute to positive health behaviors thus understanding how to improve both the individual health and collective health of the population.
Society must increase expenditures on public health, public health education, and the identification and promotion of wellness associated behaviors. The current structure of health care does not appropriately promote wellness and wellness related health behaviors. The lack clear wellness related, positive health behavior promoting policies leads to the less than optimal health of the citizenry and concurrently increased and inefficient utilization of economic resources dedicated to health care. The focus of health care is treatment focused rather than prevention focused.
According the CDC studies, one's environment and one's behavior have the most influence on health and wellness. Most employers do not provide benefits that encourage positive health behaviors and many insurance providers do not cover or publicize well any health education, positive health behavior courses.
Health care administration should be downsized - the number and prevalence of health coverage firms leads to redundancy and decreased optimal utilization of health care resources. The cost to administer, not provide, health care in the United States is a around $1,000 dollars per person or one third of the total cost of health care per person; comparatively Canadians pay approximately $307 dollars per person for the administration of health care . For Canadians this represents only about 10% of the average per person expenditures on health care. Similar single provider/limited provider policies exhibit reduced health care administration costs.
Health care in the United States should continue its shift from specialist oriented care to a primary care, prevention-focused model. The cost of providing hospital centered and specialist medical is a tremendous burden. Many of the dollars paid to specialist could provide community based coverage for basic health care for many more people reducing the need for hospital visits and specialist medical care. By creating a system focused on prevention and incenting positive health behaviors, we could improve the utilization of health care resources.
The expense factors related to health care place a tremendous burden on the economic security and stability of the United States. Health care expenditures account for around 14% of total GDP or roughly $1 Trillion dollars. All else being equal, policy changes that restructure the American health care system could save upwards of $300 Billion dollars in the economy. Those savings would represent a tremendous boost in the available resources for continued growth and development, macroscopically. In addition the assumption is that restructuring the health care system would also provide near universal coverage for health care residents, which would potentially improve the general health of the population.
I have taken a very political economy based approach to understanding why or why not health should be restructured. My belief is that the current system is inefficient in delivering, providing, and cost-containing health care. For every dollar spent inefficiently in the health care sector, that is a less amount available for utilization in other arenas - the opportunity cost of health care. Two questions we have not address are what is the optimal percent of GDP that should be spent on health care and in terms of priorities where do health care dollars rest? In restructuring the American health care system, we must determine the best, most politically viable approach - because no matter how rational a solution maybe the interjection of politics brings in an air of irrationality in the process.