Article archive / July 1, 2013
Originally published: . Volume 4, No. 11. Source pages: 14.
We have big problems when it comes to health, healthcare, and healthcare costs in the US.
We rank 1st in health costs, but last in industrialized nations for many measures of health status. A report in the New England Journal of Medicine noted that 18 percent of patients are harmed by medical care.
In 2000 the Institutes of Medicine reported that medical errors were the eighth leading cause of death in the US. An estimated 450,000 preventable medication-related events occur in the US yearly, according to Mercola.com. He notes that 3.68 billion prescriptions were filled in the US in 2009, averaging to 12 prescriptions for every person in the country.
According to the Kaiser Foundation and the CDC, the main drivers of health care costs are technology and prescription drugs, chronic disease, aging of the population, and administrative costs.
Kaiser also points out that health costs are not equally distributed. In a given year, it is the top 5 percent who spends almost 50 percent of all health care dollars. On the other end, 80 percent spend about $4500 or less. And nearly half, the bottom 50 percent, spend only $829 or less.
Will Obamacare solve our real problems? Not likely. Overlaying one bad system with another bad system won’t get at the underlying misalignments. Third-party health payments now seem hopelessly meshed with catastrophic coverage, each requiring different interventions. The consumer is uninformed and herded by his fast think brain toward superficial solutions.
I’m reminded of a recent Medscape column by Dr. John Marshall. In “Walking Improves Cancer Outcomes,” he noted a study in Journal of Clinical Oncology that people who had colon cancer did much better if they exercised. He wrote that with 8.75 hours of exercise per week, the risk reduction is 0.58. “That is better than any chemotherapy we have given to anyone,” he said.
But only a consumer could make such a choice, not easy in a culture that promotes high tech, costly symptom treatments. And everyone knows that lifestyle changes can be much more difficult and complicated than taking a pill, or for that matter, going in for chemo.
Looking at the most radical changes I’ve seen in my lifetime, with the impact on the taxpayer and business notwithstanding, I’m astounded that anyone would attempt such a thing. It seems both naïve and tremendously overconfident. I can tell you from experience that even a simple, well thought out intervention in a large social system is extremely tricky. There is just too much about human behavior that is invisible and unpredictable.
And, I’m no economist, but just roughly looking at the subsidies offered I think the government is going to need a bigger printing press.
Having said that, I think that there are opportunities for those in the psychological and behavioral sciences to help make things work better, to help align incentives, and help uncover more of the important variables in the healthcare industry.
Obamacare might just be a springboard for some of the more innovative and creative people in our community to build in win-win approaches to our large-scale problems.
Where does health care spending come from? Most of the healthcare spending in a given year is by the top 5 percent of the population, as shown in this graph from the Kaiser Family Foundation. The bottom 50 percent spends less than $829. The bottom 80 percent spends $4,639 or less. According to the Kaiser and the CDC, the main drivers of health care costs are technology and prescription drugs, chronic disease, aging of the population, and administrative costs.
This article is part of a historical newspaper archive. Read the original issue for its original layout, photographs and graphics.