Congress is on the verge of passing landmark legislation ensuring that most Americans have access to basic health care. Estimates are that this legislation will reduce our nation's deficit, but there can be no doubt that universal coverage will be expensive. Many people are asking whether we, the richest nation in history, can afford to provide health care to our citizens.
But this is the wrong question. To understand why, consider a typical operation like hip replacement. In the U.S., the total hospital and physician costs for a hip replacement average about $32,000. In Germany, the same costs average $8,500, in France $8,200, and in the Netherlands $7,600. Or consider a medication like Lipitor, used to treat high serum cholesterol. Americans pay up to 10 times as much for this medication as those in other developed nations.
This pattern is repeated for almost all medical expenditures, and as a result we pay two or three times more per capita for our overall health care than that paid by most European nations. So rather than asking if we can afford health care, isn't it more appropriate to ask why it costs so much in the U.S.?
Most of the answers can be found in T.R. Reid's recent book, "The Healing of America." Reid traveled to other nations to learn why their health systems function better than ours yet still cost less.
What he found could be summarized in three key points. First, in many of these countries the insurance companies, whether public or private, provide basic health care on a not-for-profit basis. They earn their profits on supplemental policies.
Secondly, there is a uniform fee schedule for all medical services. Patients have freedom to see whom they want and thereby combine their bargaining power to keep prices low and quality high; think of it as the public option plan on steroids.
For doctors and other providers this means lower salaries than their U.S. counterparts, but frivolous lawsuits are a rarity and their medical education is virtually free. For hospitals it meant tighter budgets.
And for patients it meant fewer frills and better outcomes. Of course, what's more important if a loved one is in a car accident: quick access to a trauma center or valet parking at the hospital?
Thirdly, and most importantly, in all these countries health care is treated as a basic need rather than as a commodity. By worrying less about maximizing revenue and more about maximizing access to care, costs are kept down.
Here in the United States our health care system has evolved into what could best be called a medical-industrial complex, and it's hard to imagine how we could even begin to introduce some of these features. Moreover, the tone of discussion borders on lunacy. When certain parties and politicians equate guaranteed health care with death camps, it's hard to be optimistic about our nation's future.
But unless we want to spend ever-increasing amounts of our income on health care, we have no choice but to make changes. It is also important to recognize that the impetus to implement improvements like these must come from the patients. It won't come from the providers and certainly not from the insurance companies; quite frankly it's not in their financial interest to do so. But we all will benefit from a fair and streamlined system that allows physicians to do what they do best and allows the public to be as healthy as possible.
Randall L. Plant, M.D., F.A.C.S. is a physician in Anchorage.
By RANDALL L. PLANT, M.D.