The real problem with American healthcare

There’s a healthcare crisis in America. This is at least one fact that both sides of the aisle can agree upon here. Of course, each side thinks that the crisis is happening for different reasons, and they both have their own solutions. I have a feeling, though, that both of their solutions are going to incompletely solve the problem, because they don’t address the root cause of the problem.

Let’s delve into the specifics.

Costs associated with healthcare are out of control in America. We spend more than every other country in the world on healthcare, and our results are middling at best. How much more do we spend?

per-capita-total-current-health-care-expenditures-us-and-selected-countries-2010-healthcosts

We spend twice as much as many of the countries on that list. Healthcare costs in America run into the trillions of dollars every year. A lot of people point to the high price of drugs. Yes, that does indeed play a role in the high price of healthcare in the US, and it does need to be addressed. Other countries on that list are able to directly negotiate prices with pharmaceutical companies because the government is the insurance provider. Here in the US, pharmaceutical lobbies spend tons of money to get lax standards passed in congress, and private insurance companies are more than happy to charge you higher prices because it makes them more money too. To be sure, it’s an awful system, but it’s only one factor among many that contributes to the overall failure of our healthcare system.

Still some say that there’s too much bureaucracy involved in our healthcare. To some extent that’s certainly true. There are way too many cogs in the healthcare machine, so to speak, and frequently you get situations where the right hand doesn’t talk to the left hand because the system is so convoluted and bloated. There’s redundancy and waste. That’s obviously a contributing factor and should be addressed.

People also argue that we should either reign in or do away with insurance companies altogether, and go back to a simple fee-for- service model that’s left to the providers. This model makes the most sense, but it still has plenty of flaws. Unless you reign in drug prices, this kind of model isn’t really going to save you money at the pharmacy. It also doesn’t address the fact that there are plenty of treatments out there that cost more than the average person can pay (more on this later). Even if you got all of the insurance and government mumbo jumbo out of the way, open heart surgery is still going to be expensive because it’s complicated and risky with a long recovery period. Cancer treatment is still going to expensive. There’s no getting around that. But a model without insurance companies might work for simple primary care visits, and could serve as a patch or a bridge within the system.

All of these problems skirt around the real issue here, the real reason why the price of healthcare continues to skyrocket in this country: the burden of disease is high and keeps getting higher. In short, Americans pay more for healthcare because we’re sicker than almost everyone else. In my state we have an insurer, Moda, that’s in financial trouble because once the ACA went into effect, they very quickly realized that people were much sicker than anyone realized.

And that’s why the ACA is struggling a bit. The very people that the ACA brought into the healthcare fold were the sickest among us—the people who previously had no or sporadic access to healthcare and the people living in poverty. But that’s not exclusive to the lower socioeconomic groups. Americans in general are unhealthier than ever, and that’s an upward trend. What are the most common causes of death here?

2014_Leading_Causes_of_Death_stats

 

The striking thing about that list is that many of those things are preventable. Heart disease is the #1 killer of Americans, and it’s also the most preventable. Diabetes is also preventable (at least Type 2 is) or at least manageable. Respiratory diseases and even some cancers can be prevented, too. The common trend here comes down to ONE simple thing: lifestyle factors.

Unlike your genetic predisposition to something like high cholesterol or cancer, lifestyle factors are completely modifiable. And they play an important role in your overall health and the burden of disease within our healthcare system. In fact, there are four things that have tremendous impact on your health:

1) Sleep

2) Exercise

3) Diet

4) Stress

You’ll notice that all of those things can be addressed quickly and, more importantly, basically for free. You don’t need to spend money to go for a walk outside every day. You don’t need to spend money to eat less every day. Sleeping doesn’t cost anything. And you might also have noticed that all of these things have a profound effect on your immune system. Chronic stress will suppress your immune system. Not enough sleep will screw up your immune system and your metabolism. An imbalanced diet will screw up your immune system. And, for our really “with it” readers, you might also have noticed that all of those things affect each other; exercising and eating properly will help you sleep and they reduce stress.

In short, the problem with healthcare in America is this: IT DOESN’T PROMOTE HEALTH.

And because of that,  too many people get fat and stressed and sick and then burn out the healthcare system, which isn’t designed or able to support hundreds of millions of chronically ill people. Just how much of an influence do those four factors have on health? Well, let’s look at them.

Sleep. We all know that you need sleep. That’s when your body heals, replenishes all of its neurotransmitters, grows, etc. You can’t function properly without the proper amount of sleep. How much sleep you need depends on your age and to some extent the individual, but here’s what the facts have to say. A whopping 45% of Americans say they get poor or insufficient sleep. The same report reveals that 67% of people who report getting “poor” sleep also report having poor or “only fair” health.

Exercise. It’s recommended that you move around for at least one hour every day. Yet most Americans lead very sedentary lives. The average American watches 5 hours of TV per day (7 if you’re over 65). In case you were wondering, here’s how our television watching compares to those in other countries:

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If you’re like me, this doesn’t really surprise you. But it does reinforce the fact that Americans are exceptionally sedentary. And what about exercise specifically? The CDC reports that only 20% of Americans over 18 meet the recommendations for aerobic and weight-bearing physical activity; that statistic jumps to just below 50% if you remove the weight-bearing exercise.

Diet. Again, there probably won’t be any surprises here. Take a look at this info from the USDA:

USDAchart1

As you can see, Americans eat too much fat, salt, and sugar and not nearly enough lean meat and vegetables. The average American consumes 3,770 calories per day, which is about 53% more than is recommended. The average American also eats more processed foods than ever before:

dietpiechart-ck

Stress. Stress is hard to quantify, but we can certainly try. Let’s think about some of the things that cause us stress. Work is one thing. We do work more than people in other countries:

150709130137-chart-americans-work-long-hours-780x439

Money or financial things also cause people stress. 63% of Americans have less than $1,000 in their savings accounts. 21% don’t even have a savings account at all. Good luck replacing the refrigerator or repairing the car. This also partially why you’ll never be able to just get rid of insurance companies (as much as we’d all like to). This survey from the American Psychological Association shows that while overall stress levels have decreased since the first survey in 2007, they’re still way above what the survey defines as a healthy amount of stress.What’s more, how Americans manage stress is also horrible: we eat, watch TV, drink, or smoke.

So what does all of this mean? Well, for one thing it means we’re fat. 62% of adults are overweight, and 27% are obese. What does that mean? It means more heart disease. It means more strokes. It means more diabetes. These are all things that happened to be in the top ten causes of death, by the way. It also means things like more arthritis. If you’re diabetic, which about 10 million people in America are, it means chronic wounds, visual problems, kidney failure, etc. That number is expected to jump to 44 million people by 2020, with spending on JUST DIABETES related problems expected to climb to $336 BILLION dollars a year.

And none of this is taking into account all of the effects that hypertension associated with these things have on individuals. Or the fact that 16 million Americans have asthma. And I’ve left out the effects that diet has on oral health, as well. The dental situation in America is out of control, but that’s almost another post. The bottom line is that these things profoundly affect the health of America and the burden on our healthcare system, and they’re all modifiable.

Of course, we don’t do that in this country. For philosophical reasons we let everyone engage in whatever self-destructive and detrimental behavior they want, then we balk at the price tag when the bill comes and can’t understand what went wrong.

But it obviously doesn’t have to be that way. Yes,  waste exists and we should try to eliminate it. But prevent the disease in the first place and you prevent the spending. There are lots of ways this could be done. I personally favor taxes on soda and fast food. I don’t care about “It’s my right to drink 7 Pepsi’s a day,” arguments. We tax alcohol and cigarettes, two other substances that raise the disease burden on the healthcare system. We could do the same thing with soda and fast food.

I also think we could do a better job providing incentives to people (as if not dying a slow, fat diabetes death isn’t enough in the first place). If you’re classified as overweight or obese, why not grant people tax breaks if they lose weight? Everyone loves saving money. I’d also be a proponent of publicly funded gyms that anyone can access for free. Start a public awareness campaign about diet and exercise. We did the same thing with smoking and teen pregnancy and the rates went down. Perhaps all that “This is your brain on drugs” money would have been better spent on “This is your body on sugar” commercials.

But until the way we conceptualize health and the role of healthcare systems changes, the price tag attached to healthcare won’t change. If we don’t address the root causes of disease we’ll never be able to stem the tide of rising healthcare costs. If we don’t promote and encourage health, we’ll never be healthy.

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9 thoughts on “The real problem with American healthcare

  1. Great write up Ryan. Your discussion of just the massive expense at hospitals was a huge expose, and the longest article in Time Magazine history. http://www.uta.edu/faculty/story/2311/Misc/2013,2,26,MedicalCostsDemandAndGreed.pdf

    I agree with you that the problem is so much larger than just the type of health care we go with. However, I know in Canada the one advantage of a single payer government run health care is that the government therefore dictates the costs. They aren’t going to let hospitals charge $1 for every Tylenol that’s handed out, they regulate prices because they know how much they actually costs. As a result of course, doctors don’t make as much in Canada, although they still live quite comfortably. I do think that a Single Payer health care system does work better only when an investment into preventative health care is done as well. The money you save from single payer usually gives you plenty of left over for education which is pretty low cost.

    I also think that part of the sudden jolt on the burden for insurance companies is that boat loads of people who never saw the doctor because they couldn’t having a pre-existing condition and thus couldn’t afford to go to the doctor, wait until something gets a lot worse. A child that is fully covered for health care all the way through and then is covered into adulthood, will see the doctor before something gets too bad thus reducing the health care costs needed to make him or her better. Because regardless of whether people have health care or not right now…we do still end up absorbing those costs, and usually much higher than we would if that person had been able to see a doctor on a more regular basis. Because eventually their health problems will get to the point where they have to go to the doctor, and if that person can’t pay the bill in an emergency situation, then eventually hospitals will write it off and just raise prices even higher to recoup the money they didn’t get from the patients who couldn’t pay. So I do think better access to health care promotes better prevention. Hell just being able to talk to a doctor you can get all that education you’ve been passing out here. A lot of people literally don’t get it.

    But yes, America doesn’t get as many holidays as workers in other countries, doesn’t get as much parental leave which is also beneficial for child development. They can breastfeed longer, they can form better attachments with parents, because even in the womb studies show that kids can feel the stress of poverty.

    I am not sure what the answer is…but we’re doing just about everything wrong here in this country.

    1. I’d love to see a single payer healthcare system for precisely the reasons you outlined. It seems like other countries have a much better handle on the “prevention” aspect of things. I don’t really know what would cause people in the US to really come around. I suspect that as long as people think that free markets literally solve every problem on the planet, that will never happen.

    1. Thanks! Public health is something near and dear to my heart. Stopping a problem before it starts seems much more logical than trying to come up with a bunch of contingency plans for an outcome.

  2. Fantastic post Ryan. Just awesome!

    1. Sleep: Not as much as I’d like.
    2. Exercise: Not as much as I need!
    3. Diet: More than I probably should. Although my processed foods are
    very low.
    4. Stress: More than I’d like to put up with.

    The system is broken from the top to the bottom. Waste, fraud, price gouging, and inflated prices for insurance vs. cash payers. I know my local Dr. will charge $65 for a cash office visit and $95 for an insured visit. What kind of B.S. is that? Just because you have insurance they decide to gouge a little? Then they are more likely to run tests, take x-rays, etc. if you are insured. Just to oil the frigging machine.

    This is just the tip of the iceburg. There is no telling how much $$ is being piled onto the system just because you are insured.

    My wife had an emergency event a while back with what turned out to be an abcessed appendix. She spent the first week in the H, they ran cat scans and x-rays daily. They couldn’t figure out the problem. Finally they went in for an exploratory to try and figure it out, lo and behold it was the appendix. 2 weeks in the H for an appendix. Well over $100,000 dollars worth of bills (closer to $120,000). No insurance due to a dropped ball at the office where she worked. They had her down as part time instead of full time. FYI part time insurance is worthless, you are better off with none. She had been trying like hell to get them to fix it for at least 3 weeks, then bam! The situation hit. She had to file bankruptcy. Fortunately our situation allowed for me to not have to go along for the bankruptcy ride. Still it was a very trying time.

    I swear on all I know to be good and true, every fucking Dr. that even walked by in the hall billed us from 2-400 dollars every single time they walked by. Some walked in, said good morning, asked how she felt, and walked out. This was the basis for their billing. How does that work? Is that even ethical?

    If I can see this much from my very limited exposure there is no telling how high, or how deep this all goes. It is an absurdity. So we have 2 systems completely broken, political and medical. And too many hands in the pot from both sides, no one wants to fix it.

    1. First, I’m sorry you had to go through that.

      Second, I couldn’t agree more. What insurance companies can get away with is ridiculous. Where I work, oftentimes the insurance companies will just decide they won’t pay for something. The skimpiest of reasons, and then just, no we won’t pay that for that. How is that a working business model? How are they allowed to get away with that?

      Because our elected officials won’t hold them accountable. Because it’s a for profit venture, the easiest way to make money is to pay as little as possible while charging people the most possible.

      I almost look at what insurance won’t cover and then how much they charge for that they do cover and I have to wonder what’s the point in having it at all?

      1. I know when I read the homeowners policy it is more a matter of what they won’t cover, which is a great deal, than what they will cover. I’m convinced insurance is one of the biggest scams in history. Next to religion of course.

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