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The result of the American system is that the people of the United States are forty-second in life expectancy, behind both Chile and Cuba. They are seventy-second in quality of healthy, behind every other country in the developed world.

US healthcare is a highly responsive system that doesn't really work

There is very general agreement that the cost healthcare is bankrupting the United States. The cost of providing medical care averages to a little over $8,600 for each woman, man, and child in the country, and is currently increasing at a rate of 6.3 per cent a year. The $2.5 trillion spent in 2010 is projected to become $5.0 trillion by 2022.

In return for their vast investment in healthcare, Americans have the most responsive medical system in the world. Nowhere in the world do ambulances come faster in emergencies, and nowhere in the world is it easier to make an appointment to see a doctor--that is, if you have the health insurance coverage the most doctors require of all their patients. Americans who do not have health coverage, some 51 million in all, must pay hefty fees out of pocket to see doctors for the simplest conditions. They may have to pay hundreds or even thousands of dollars for a single doctor's visits and tests, or wait for hours in emergency rooms or free clinics to be seen for simple conditions.

Obamacare won't cut it. Real healthcare reform is a necessity for the survival of the American people and the American economy. Obamacare is extending coverage to several thousand applicants to the federal health insurance risk pool this year and potentially 90 per cent of the American population by 2014 (assuming that it is not repealed), but the underlying economics of American healthcare will not have changed. Real healthcare reform seems to require seems to require some changes that are not yet on the horizon, and that cannot be forced by legislation. 

Why Obamacare won't cut it?

1. Treat people, not numbers


Every year, the definitions of diabetes, high blood pressure, and high cholesterol are tightened lower and lower so that more and more people have to be put on expensive medications. Diabetes, high blood pressure, and high cholesterol are important to control, but it's also important to note that these health conditions are symptoms, not diseases. American healthcare invests hundreds of billions of dollars in lowering numbers for these symptoms, but almost nothing in preventing their effects. Real healthcare reform requires the medical profession to admit that a pill that lowers the annual risk of having a heart attack from, say, 1.0% to 0.9%,  may not be the best way to spend a billion dollars a year.

2. Preserve life, don't avoid death

Over 30 per cent of all medical costs in the United States are incurred during the last 30 days of life. Keeping a patient on a ventilator for a single day, for example, can cost as much as $10,000. No patient should be subjected to a "death panel" that could rule arbitrarily when a case is hopeless. Every family, if at all possible, should have a chance to say goodbye to loved ones. Simply encouraging everyone to have a living will specifying wishes regarding end of life care, however, could save hundreds of billions of dollars each and every year.

3. Put prevention first

Almost everyone in the United States will eventually be treated for high blood pressure. Nearly two thirds of all Americans will be treated for high cholesterol. Nearly two-thirds of Americans are obese.

All of these conditions respond to healthy diet. The dollars spent providing medications to the poor might be better spend providing healthy food for the poor, fruit juice instead of soft drinks, fish instead of hot dogs, vegetables instead of chips. Fast foods and junk foods are preferred by many low-income Americans because of the simple reason that they are filling and cheap. America might be able to avoid many medical costs by providing more of the foods that are healthy, but expensive.

4. Encourage exercise for its own sake

When people find out that going to the gym every day results in gaining weight, not losing it, they tend to drop out of exercise programs. For most people, it's simply not possible to work off the pounds. And since America defines health in terms of what Americans weigh on the scales, people don't stick to their exercise resolutions.

The real value of exercise, other than simply feeling good, is that it provides a reserve for meeting stress. Two overweight people who both have high cholesterol and high blood pressure may both have a heart attack, but the one who has a history of exercise is more likely to survive the heart attack and get out of the hospital sooner. If walking around the block every day is enough to enable someone to get well after two days in the hospital instead of ten, then walking can save tens of thousands of dollars in future health costs. Exercise should be promoted for its own sake, not for its effects on weight.

5. Stop subsidizing the production of crops that are turned into junk foods

In 1971, a Secretary of Agriculture named Earl Butz conceived a plan to help Richard Nixon win the Corn Belt states in the next presidential election. He designed a system of subsidies for the farmers who grew corn. More and more corn required more and more fertilizers, fuel, and tractors, and growing corn became an even more important part of the American economy.

Something had to be done with all the corn that was produced, and in the 1970's food manufacturers perfected the processes requiring high-fructose corn syrup, the super-sweet form of corn sugar that now constitutes about 20 per cent of all the calories consumed in the American diet. Nixon was reelected, the corn farmers received their payments, and the manufacturers of fertilizer, diesel fuel, and farm equipment prospered for many years--at the expense of the rest of the American economy, which pays hundreds of billions of dollars to treat obesity, diabetes, and heart disease.

It might actually be less expensive to pay all those involved in the manufacture of high-fructose corn syrup simply to close shop and retire. At the very least, the United States should stop borrowing dollars to buy agricultural commodities that are turned into junk food. Americans need to redirect their economy from the treatment of disease and the production of junk food to the promotion of health and the cultivation of delicious, healthy food.

  • Casscells SW, Critchley HP, Herbst-Greer SM, Kaiser L, Zogby J. Americans on health care reform: results from polls conducted with Zogby International, Inc. Trans Am Clin Climatol Assoc. 2010,121:267-79, discussion 279-80.