With all the shouting going on about America's health care crisis,
many are probably finding it difficult to concentrate, much less
understand the cause of the problems confronting us. I find myself
dismayed at the tone of the discussion (though I understand it---people
are scared) as well as bemused that anyone would presume themselves
sufficiently qualified to know how to best improve our health care
system simply because they've encountered it, when people who've spent
entire careers studying it (and I don't mean politicians) aren't sure
what to do themselves.
Albert Einstein is reputed to have said
that if he had an hour to save the world he'd spend 55 minutes defining
the problem and only 5 minutes solving it. Our health care system is far
more complex than most who are offering solutions admit or recognize,
and unless we focus most of our efforts on defining its problems and
thoroughly understanding their causes, any changes we make are just
likely to make them worse as they are better.
Though I've worked
in the American health care system as a physician since 1992 and have
seven year's worth of experience as an administrative director of
primary care, I don't consider myself qualified to thoroughly evaluate
the viability of most of the suggestions I've heard for improving our
health care system. I do think, however, I can at least contribute to
the discussion by describing some of its troubles, taking reasonable
guesses at their causes, and outlining some general principles that
should be applied in attempting to solve them.
THE PROBLEM OF COST
No
one disputes that health care spending in the U.S. has been rising
dramatically. According to the Centers for Medicare and Medicaid
Services (CMS), health care spending is projected to reach $8,160 per
person per year by the end of 2009 compared to the $356 per person per
year it was in 1970. This increase occurred roughly 2.4% faster than the
increase in GDP over the same period. Though GDP varies from
year-to-year and is therefore an imperfect way to assess a rise in
health care costs in comparison to other expenditures from one year to
the next, we can still conclude from this data that over the last 40
years the percentage of our national income (personal, business, and
governmental) we've spent on health care has been rising.
Despite
what most assume, this may or may not be bad. It all depends on two
things: the reasons why spending on health care has been increasing
relative to our GDP and how much value we've been getting for each
dollar we spend.