FEST Writing Group

I am thinking about the impact of resources (too many or too few) on human behavior. An abundance of resources may impinge on overall functioning; likewise a lack of resources could do the same. All of this would be influenced by the instinctive nature of man and his ability or inability to regulate his instinctual or automatic responses. A more even distribution of resources is probably not possible except in the most mature and even then unlikely to be maintained over time if one allows for changing environments, changing levels of threat and variation in ability to self regulate.

In reading about the health care system, The Healing of America by T.R.Reid, the author reviews a number of health systems in the developed world as well as the US.  Although the Affordable Care Act reduced the number of uninsured appreciably, we still have 22 million uninsured in the US. We are the only developed country in the world that does not act on a principle that everyone has a right to health care, much as they have a right to education at least through high school that is provided and paid for by the state and federal government. All states provide a university system that greatly reduces the price tag of higher education but no state to my knowledge provides free higher education although some did in the past.

In policy debates over the years, one can sense a fear of national health insurance that is equated with socialized medicine in the minds of many. Related to this is the perceived threat that an increase in government control leads to a loss of individual control and a decrease in available choices. Socialized medicine became a popular term in 1947, when it was used by a public relations firm representing the American Medical Association. Their goal was to undermine President Truman’s proposal for a national health care system. It was a label used to accentuate the fear of communism, another perceived threat of the time. Instigating fear in people seems to be part of an effort to control the outcome.

Americans factually have had and continue to have government run health care for the elderly, veterans disabled, Native Americans, citizens with end stage renal disease and members of Congress. For everybody else, health care demands a reliance on a for profit health care system or personal income to pay the bills or some combination of that.

Prior to the Affordable Care Act, 15% or 45 million Americans were without health insurance. The Affordable Care Act reduced that number to something close to 23 million. In addition to this, tens of millions of Americans have such limited coverage that they are not protected from financial ruin in the presence of serious illness. In a joint study by Harvard Law School and Harvard Medical School, it was found that the annual number of individuals/families who face financial ruin secondary to medical care expenses is 700,000 in the US ( again this statistic may be somewhat dated).

So lets see where the US stands in comparison with other countries using common benchmarks for assessing the success and fairness of a health care system.

In terms of fairness, the US always come in last amongst the developed countries since we do not cover everyone.

One benchmark for a national medical system is ‘avoidable mortality’ or how well a system works in curing diseases that are curable or at least treatable. A 2008 report from the Commonwealth Fund regarding research on deaths before age 75 from conditions that are modifiable by effective medical care showed the US coming in last among the world’s developed countries. The US ranked 19 in a study of 19 wealthy countries.

Comparing the survival rate from major diseases is another way of ranking a country’s health care system. The US does not fare well here either in comparison to other rich countries, with the exception of specific diseases such as breast cancer survival rate at five years.  Again these figures may be somewhat different since the Affordable Care Act insured a significant percentage of the uninsured and prevented insurance companies from refusing to insure people with serious diseases amongst other more egregious offenses.

There was a greater risk of surgical or medical mishaps in a US hospital in comparison to other developed countries.

In terms of health life expectancy at age sixty, the US tied for last place among 23 countries in a 2006 survey by the Commonwealth Fund.

In a 2008 survey, the infant mortality rate in the US was 6.37/1000 births. In Sweden it was 2.76/1000 births. A key factor in understanding this discrepancy is that other rich countries offer prenatal and neonatal care for every mother and baby. Not so in the US.

Surprisingly, we spend more on health care than anyone else. American health care providers make more than their counterparts overseas. But overseas, higher education is free or minimal cost. Malpractice insurance is approximately $1400.00/year for a GP in Germany and the likelihood of a lawsuit is minimal. An American physician can expect to pay a hundred times as much in malpractice insurance and is likely to be sued several times during his/her career.

American prescriptions can be two to ten times more than the same drug would cost overseas.

With a national health care system comes regulation of cost of drugs and medical services. Fees are the same across the board, no matter what provider, hospital or insurance company is involved in providing the service.

The US is the only developed country that relies on for profit health insurance to pay for basic or essential care as well as elective care. Insurance companies are allowed to make a profit in other countries on elective care.  In other words, we are the only developed country whose investors can make a profit on the backs of sick people for their basic medical care. Many countries made these changes from for profit to non profit health care long ago. It was done in response to the question – Does everyone have a right to basic or essential health care or do they not? All other developed countries have answered this question differently than the US except in the poorest of countries where health care is only available to the people who can pay for it. Other citizens simply go without.

In other developed countries insurance plans, be they public or private, cannot make a profit on basic or essential care. So they exist to pay medical bills, not to provide dividends for investors. It is assessed that American insurance companies pay 20% of every dollar on administrative costs and profit. As one might expect, the US health care system has the highest administrative costs of any other health care payer in the world. But there are exceptions, even in America. Medicare, a government-run-single-payer system has administrative costs of about 3-5%.

Is it possible that wealth or accumulation of resources leads to greater competition for the available resources? Are you more invested in maintaining the status quo as your wealth increases?

What makes national health care so unacceptable to the US, a nation that is super rich and super powerful? What makes health care such a polarizing issue in this country?

Like most societal issues, it seems to come down to the level of differentiation. How do we focus on the common good when it may mean a financial cost to each of us? If I have the resource, should I be concerned with those who do not? If I think health care should be available to all, could I present my thinking to the opposition without getting caught in a polarization or criticism of the opposing viewpoint?

At higher levels of differentiation, people are naturally aware of their responsibility for self and to others.