Is there anything wrong with American healthcare?

Healthcare reform is the topic d’été in America. In this post I will outline some of what is perceived to be wrong with the American healthcare system.

First, however, I’d like to thank Dana for inviting me to post to her blog. In the interest of full disclosure, I do have conflicts of interest. I am a patient, physician and American citizen who is suffering from and profiting from the current system and has much to gain and/or to lose with healthcare reform. I am not an expert, but I attempt to be an informed patient/physician/citizen.

So what is wrong? Most of the current debate focuses on the broad themes of coverage, cost and quality. In this post, I will focus on coverage and cost. I will save quality for a future post.

Let’s start with coverage. Approximately 15% of Americans are uninsured (figure 1). This equates to approximately 45 million Americans or more than the entire populations of Washington, Oregon, Idaho, Montana, Wyoming, North Dakota, South Dakota, Colorado, Utah, New Mexico, Arizona, Nevada, Hawaii and Alaska combined (2008 US Census Bureau estimates). Further, the number of uninsured continues to grow. In our system, unlike other industrialized nations, most workers rely on employers for access to affordable health insurance. With this employer-based model, accessibility to insurance is rapidly decreasing with rising unemployment (figure 2). So without intervention, at least in the short term, the ranks of the uninsured will grow with the ranks of the unemployed.

Figure 1


Figure 2


Now let’s move to cost. The United States spends more per capita on healthcare than any other industrialized nation (without significant outcome improvements, but that is to be addressed in the quality post) (figure 3). Healthcare spending continues to rise quickly. Current healthcare spending represents nearly 17% of gross domestic product, up from 5% in 1960 and 12% in 1990 (http://www.cms.hhs.gov/NationalHealthExpendData/).

Figure 3


Over the past decade while wages have increased by 34%, healthcare premiums have increased by 119%, more than eliminating any wage advancement (figure 4). In fact, >60% of all personal bankruptcies in 2007 had a healthcare cause (Himmelstein et al. Am J Med. 2009 Jun 4).

Figure 4


In addition to hurting workers, healthcare costs are burdensome to American businesses. Employer contributions to healthcare costs have increased by 117% over the past decade (figure 5). A recent Rand Corp. report examined 38 industries and found an inverse-relationship between industry growth and employee healthcare coverage, not accounted for by other industry factors (Sood N et al. HSR: Health Services Research. Epub June 9 2009). The Business Roundtable (made up of CEOs of America’s largest businesses) are also calling for healthcare reform, noting American businesses pay on average $0.73 more per hour per worker for healthcare benefits than their competitors in other G-5 countries (http://www.businessroundtable.org).

Figure 5


Further, healthcare costs are burdensome on government. Over 45% of all American healthcare costs are footed by government programs (figure 6). Medicare and Medicaid/SCHIP spending will account for 21% of 2010 federal spending, more than either Social Security or defense spending (figure 7). Medicare Part A, while widely popular, is projected to be insolvent by 2017 (http://www.cms.hhs.gov/reportstrustfunds/downloads/tr2009.pdf). Nearly every state in the union is also struggling with Medicaid costs.

Figure 6


Figure 7


So in summary, the ranks of the uninsured are growing and may soon reach 1 in 5 Americans. At the same time that we are losing ground in insurance coverage, healthcare costs are skyrocketing, fast out-pacing wage increases and inflation. Healthcare costs are crippling and unsustainable for workers, employers and government.

I refer you to the following websites (only a few of many) for more information on the problems facing the American healthcare system.

http://healthcarereform.nejm.org
http://www.healthreform.gov
http://www.kff.org
http://www.lewin.com
http://www.rand.org/research_areas/health/
http://www.businessroundtable.org/initiatives/health

Please check back in the coming weeks for posts on how American healthcare got here, the quality of American healthcare, proposed healthcare solutions, the cost of change, the major players, the political dimensions of healthcare reform, what you can do and more. Let the dialogue begin!