On Healthcare in the United States: an Open Letter (Part 1)

On Mon, Jul 7, 2008 at 1:25 PM, Eddie Bearnot [redacted]@gmail.com wrote:

benny -
i am lost as to what we need in regards [to] healthcare reform. talk to me. you can't possibly be that busy.

e

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My little brother is quite right, if somewhat rude - there's no particularly good reason I haven't gotten back to him more quickly. I have plenty to share on the subject, and more time on my hands than I will at any point in the foreseeable future. In light of this, what follows is the first installment of what will be a serialized open-letter response to Eddie’s questions on healthcare and healthcare reform in the United States.

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Yo Ed –

Thanks for being so persistent. Part of my reluctance in getting back to you has been the magnitude of the questions you are asking. I am very excited that you have been asked to think critically about the healthcare system in the US since arriving in Washington D.C. several weeks ago - but healthcare and related biomedical science are issues of particular significance to me, and I would be disappointed in myself if I supplied incomplete answers.

Because of the scale and infinite complexity of these topics, I will do my best to provide you with some concise answers in a format that you will hopefully find readily accessible. It’ll probably take me a couple of installments to get all of the salient points down, but I encourage you to ask for clarification whenever necessary. It’s important that I learn to write lucidly about these topics as well. Let’s get started then, shall we:

The most disheartening piece of the healthcare crisis in the United States – and the component that I will focus on for you here – is the system’s gross inefficiencies. The US spends approximately 15% of its GDP on healthcare each year. In 2006 this sum eclipsed $2 trillion, or $7,000 per American. And while this percentage and absolute total are the highest in the world by a significant margin, the United States lags behind many other developed countries in basic metrics of nationwide health (average life expectancy, infant mortality rates). This is even more problematic when coupled with the observation that there are still nearly 50 million Americans living without health insurance. In short: we are paying significantly more for our care while missing out on the benefits of this spending.

So, if this $2 trillion (that’s 2 followed by 12 zeros) isn’t going towards the provision of the best possible care, where is it going? Here is a partial list of the most conspicuous answers to that question as our health system is currently structured:

Expensive drugs and devices researched and developed by pharmaceutical companies. Because of the way US patent law works, these corporations have every incentive to charge usurious prices for these products during the finite number of years in which they are protected by patent. And while astute advocates of free-market economics correctly point out that these big paydays make it possible for big pharma to lavishly spend on the expensive basic science to develop and trial new and wonderful discoveries, many of the products brought to market are debatably superior to the preexisting drugs/devices in their class, while costing many times more.

Health Maintenance Organizations (HMOs). These private companies were originally designed to prevent unnecessary healthcare spending, pooling risk while simultaneously encouraging the “health maintenance” of policy holders by covering preventative care costs. But because these HMOs are private corporations, responsible to shareholders and board members, they are driven by their inherent profit motive to keep costs down and maximize income. This has resulted in systematic attempts to reject legitimate reimbursement claims submitted by physicians and patients, refuse coverage to patients deemed high risk, and to provide substandard compensation for the primary care physicians who act in the essential role of gatekeeper for further medical services – causing an increasing number of physicians to enter more specialized fields where they might be compensated more fairly.

I guess I’ll leave off here for now. Next time I’ll tell you more about the current state of medical malpractice and tort reform, the ongoing failure of Medicare and Medicaid to pull us out of this downward spiral, and expound further the intrinsic incompatibilities of excellent medical care and profit motive.

Hope you’re well and I can’t wait to talk with you again soon.

Love,
Ben