American Health Care System: Still Broken

Oh, did you think we reformed health care? No, we just changed insurance rules. The American health care system still needs some serious fixing, says a new report issued by the Center for the Study of the Presidency and Congress. CSPC's commission on health policy, co-chaired by former assistant surgeon general Dr. Susan Blumenthal and Mayo Clinic emeritus president and CEO Dr. Denis Cortese offers this grim summary of what John Thune calls the best health care system in the world:

America’s health care system is in crisis. Despite spending 17.3% of its GDP on health in 2009, far more than any other industrialized nation, the U.S. health care system is inefficient, inequitable, and ineffective for many people. Moreover, health care costs are escalating in America and there is significant variability in how care is delivered. In 2009, national health spending grew 5.7%, up from 4.4% in 2008. Of U.S. health expenditures, 30-50% is wasted on the overuse, underuse, and misuse of medical and administrative services. Patients receive the recommended treatment just 55% of the time, and America ranks only 49th on life expectancy worldwide. Significant health disparities exist for different segments of the U.S. population. Furthermore, 46 million Americans are currently without health insurance, and the numbers continue to grow. In 2007, over 60% of bankruptcies in the United States were linked to an inability to pay medical bills. The bottom line: Americans are paying far too much on health care for far too little health in return [A 21st Century Roadmap for Advancing America's Health: The Path from Peril to Progress, A Report of the Commission on U.S. Federal Leadership in Health and Medicine: Charting Future Directions, Washington, D.C., May 2010].

That paragraph alone comes with eight citations. Go ahead, check the data yourself.

But don't just sit there complaining (John, Tim, Steph): do something! Blumenthal, Cortese, et al. recommend four major areas of action:

1. "Re-engineering America’s health care system" with (among other things) results-based payment, comparative effectiveness research, and lots and lots of health information technology (actually, March's reform law takes a fair swing at health IT, right alongside the 2009 stimulus).
   
2. "Strengthening the public health infrastructure to underscore the power of prevention and community health"... in other words, more federal support for prevention, nutrition, and exercise.
   
3. "Promoting global health and health diplomacy."
4. "Securing sustained funding for scientific and medical research" (more federal money for R. Blake Curd to complain about).
   

Of course, the commission misses the obvious solution adopted by most of the 48 countries where people live longer than we do: a strong universal public health insurance program that makes a trip to the doctor less likely to bankrupt or kill you.

Oh, wait: they do address universal coverage on page 14! They worry that real universal coverage would increase demand for doctors by 4% and leave us short another 31,000 doctors by 2025. But that isn't a game-stopper: the report urges the feds to offer more incentives to make it affordable for medical students to go into primary care. Where there's a will....