Health Policy II

From the California HealthCare Foundation, health care was 16.2% of the GDP in 2007, $7421 per capita. 31% was spent on hospital care, 21% on physician and clinical services, 10% on dental and other professionals, and 10% on prescription drugs. Only 7% was spent on administration.

Who pays this? Private insurance covers 34.6%, out-of-pocket payments cover 12%, and other private monies cover 7.2%. The federal government foots the bill in 33.7% of payments (19.1% Medicare, 8.3% Medicaid) and states and local governments fill in the last 12.6%.

This is a problem. Though in recent years, we've tried to curb costs and spending, health care still outpaces inflation; growth rates of the consumer price index are consistently several points below national health spending growth rates. Our costs are out of control.

Cost containment fails, I think, because we're Americans. Our consumers demand. We resist limited choices, we love the power of industries (device manufacturers and drug companies), our political system acts as a glacier. But we need to control costs; there's no alternative. Each dollar that's spent on health care is a dollar less from schools or the environment or jobs. Without cost containment, we can't insure more people; without cost containment, people will still find themselves bankrupt from emergency appendicitis. Yet our system hangs around because it seems "good enough"; too many special interests groups exist that are afraid that change will hurt them so they stick with what we have now.

Things will change; they may be at the brink of change now. But what I've come to understand is that our system now is unjustifiable and unsustainable. With medicine's focus on evidence-based practice, where is the evidence here? We're spending all this money, and our outcomes are not very good. What went wrong? Can we fix it?