January 5

Fixing health care system is many baby steps away

Our comparatively shorter, more sickly lives will remain so until there’s a sea change in attitudes.

By Jim Doyle
St. Louis Post-Dispatch

ST. LOUIS — When federal lawmakers agreed in 2010 to pass the Affordable Care Act, they recognized that the U.S. health care system was in desperate straits.

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A patient waits in the hallway for a room to open up at a hospital in Houston, Texas. The U.S. health care system excels in treating patients in crisis, but the emphasis needs to shift to better preventive care if we’re to see costs drop and outcomes improve, experts say.


Not only was the cost of health care significantly higher than in other industrialized nations, but Americans were among the unhealthiest populations in the Western world.

Nearly four years later, the system remains in crisis. While the growth of health care spending has slowed, it is still climbing. And despite higher costs, Americans’ health outcomes have not significantly improved.

“Other wealthy nations achieve longer lives, lower infant mortality, better access to care, and higher care quality while spending far less,” states a January 2013 report by the nonpartisan Commonwealth Fund.

The Affordable Care Act was never intended to immediately halt these basic trends; improving health outcomes and quality of life while cutting costs is a tall order. But the nation’s volatile, partisan debate over what is popularly known as Obamacare seems to have missed that point.

The tech-savvy Obama administration was expected to deliver a user-friendly website that would increase Americans’ access to health care by subsidizing insurance coverage. But HealthCare.gov was a bug-ridden disaster. And many consumers have voiced “sticker shock” over the higher monthly premiums and higher deductibles of insurance plans for 2014 both on and off the online marketplaces, also known as health exchanges.


The stalled rollout has bolstered the new law’s opponents, including Sen. Ted Cruz, R-Texas, whose quasi-filibuster helped trigger a federal government shutdown last fall. Cruz has blasted the federal mandates on health insurance policies and vowed to “repeal every syllable of every word of Obamacare.”

“The most simple rule of economics is there ain’t no such thing as a free lunch,” Cruz told the Texas Tribune in 2012 when he was running for Senate. “Everything you mandate that an insurance policy cover drives up cost, which means there are more and more people that can’t afford to get insurance.”

But where does that leave us? Regardless of how you view the overall merits, regulatory strictures, or societal costs of Obamacare, consider these facts:

In the United States, health care spending eats up nearly 18 percent of the gross domestic product, which is the sum of all goods and services produced in the country. This figure could reach 21 percent by 2023.

On average, the United States spends twice as much on health care per capita, and 50 percent more as a share of GDP, compared to other industrialized nations.

Americans, whose life expectancy is about 78.6 years, live shorter lives than their counterparts in Western European nations.

Statistics are worse in poverty zones. The shortage of primary care physicians is felt the hardest in inner cities and rural areas, where uninsured residents and those enrolled in the Medicaid program have a difficult time getting doctor’s appointments.

The infant mortality rate in Pemiscot County in Missouri’s impoverished Bootheel is about 14 percent, according to the Delta Regional Authority. That statistic is echoed in the infant mortality rate of portions of north St. Louis.

“The poor in America, compared to other industrialized nations, don’t get as good care, don’t live as long, and are more likely to die younger,” said Thomas McAuliffe, a policy analyst for the Missouri Foundation for Health.

Health care spending gobbled up about $2.9 trillion in 2013. By 2023, it is likely to rise to $5.5 trillion, an increase of 90 percent over the decade, according to the Commonwealth Fund.

“There is broad evidence that much of that excess spending is wasteful,” the fund’s report states.

Stuart Guterman, the fund’s executive director, said the United States spends nearly $9,000 a year per person on health care, more than twice as much as either France or Sweden, countries that offer universal health care for its citizens.

(Continued on page 2)

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