A Single-Payer Federal Health System Structured to Promote Wellness

A wellness lifestyle is not a faith-based philosophy. It is a lifestyle shown by incontrovertible evidence to be effective at reducing the need for medical care while boosting quality of life. It is a disciplined approach characterized by reason, motivated by exuberance, grounded by athleticism and made possible by liberty. Liberty is viewed as the exercise of maximum personal and societal freedom.

Despite the Obama Administration’s success in getting the “The Patient Protection and Affordable Care Act” (PPACA) through Congress, medical care costs are higher than ever and expected to increase even more. Drastic action is needed.

The time has come for a revolutionary perspective, if we are ever to become healthy here (the U.S.) and healthy now (within the next couple years). Attention must be given both to the organization and to the purposes of an integrated health care system. What we have is a fragmented medical delivery business. It’s time to seek a new foundation for a system capable of supporting a national goal of citizen wellness.

The next health care debate should be addressed to absolute reform of the health sector from start to finish, from bottom to top. We need three separate but equal and interdependent goal parts:

1) vastly better health status outcomes;
2) dramatic cost reductions; and
3) improved medical care delivery.

Before continuing, please take a quick two-question quiz. Question one, and please make your best estimate right off the proverbial “top of your head,” is: How much does the average American spend annually for medical care, including drugs? OK?

Make a guess.

The answer is $7,960 per person, as of 2009. Let’s call it $8,000 a year – it’s probably closer to $9,000, now that two years have passed since the massive amounts of data needed to do this were analyzed. That is the average spent by every man, woman and child. How much did YOU spend on medical care last year? Chances are, it was not even close to this amount. The high average cost is due to extraordinary bills incurred by a small segment of the population-the aged, the afflicted and the masses who live worseness lifestyles and thus suffer terrible illnesses that otherwise might have been avoided. On second thought, maybe this latter category encompasses a majority of American adults.

One more question: What do you suppose other nations spend on health care? Well, the answer is “nothing close to what we spend.” The country that invests the most on medical care after us is Norway-$5,352 per person. Next in line of big health sector spenders are England ($3,487) and France ($3,978). (Source: “Health at a Glance 2011,” OECD Indicators, November 23, 2011.)

The practical implications of this American medical largess is that expensive medical care limits all other federal initiatives, it raises employer costs and thus inhibits salary increases while adding to our crushing Federal deficit.

To say it’s “the best in the world,” a claim ritually put forward by all Republicans vying for that party’s presidential nomination, is not consistent with our health status relative to other Western nations. We are spending far more while doing much less well.

No independent health care experts believe our system is the best; most in fact think it’s dreadful. A report from the OECD (the Organization for Economic Cooperation and Development) addressed this claim. The OECD concluded that claims that America’s health system is the “best in the world” “are not true.” (Maria Bartiromo, “Is America Faltering as a Health Care Leader?” USA Today, One on One, October 18, 2011.)

How, specifically, is it not true? Why do world health leaders fail to recognize what seems self-evident to patriotic, god-fearing, America-loving Republican candidates? Why do these foreigners miss recognizing the obvious-that ours is the best health care system in the whole wide world?

Let me review very briefly a few of the reasons that might influence their thinking:

* The focus of our system in on treatment, not prevention or wellness promotion.

* The costs of our medical services are greater than anywhere else.

* Our system is organized to deliver the most expensive services available, often when not even needed, which can have serious side effects.

* U.S. life expectancy is 78.2 years; Japan’s is 83 years and Western nations average 79.5 years. Republicans wave the flag of American “exceptionalism.” We’re exceptional all right. With respect to health, we’re exceptionally ill-not even average healthy. With respect to our system and to our health status, we rank with Chile and the Czech Republic. (Source: Robert J. Samuelson, “A grim diagnosis for our ailing health care system,” Washington Post, November 27, 2011.)

* We have fewer doctors per capital than other developed nations. This is not necessarily an unfavorable indicator, though we might benefit from a better ratio of primary care to specialized doctors. We could most benefit if we led the way not so much with more medical doctors but rather with more wellness coaches, educators, programs and incentives.

* The U.S. medical system favors more expensive procedures. Knee replacement surgery costs more in the U.S. ($14,946) than in France ($12,424) and Canada ($9,910). The same is true of most other categories, such as MRI exams and angioplasties. Yet, despite high costs, we do more of all these and other costly procedures.

We do derive value for the big bucks invested treating multiple disease conditions exacerbated by high-risk lifestyles. Patients with breast cancer have a longer survival rate by a factor of about six percent, though we fare less well treating diabetes and asthma. (Editorial, USA Today, “Dutch Treat – a medical system with full coverage, lower costs,” October 19, 2011.)

In summary, the U.S. health care system is, in fact, the best in the world-for doctors, hospitals, insurance and drug companies. Not, unfortunately, for individual consumers or American society.

Fee-for-service reimbursement encourages doctors to administer more services than necessary, adding to their profit and patient risks. Government oversight is minimal, despite the insistence of Republican politicians that medical care would be cheap and we’d all live forever if only government got out of the way of public-spirited free enterprise job creators.

My recommendation for better health now and here is a bit radical, but these are radically hazardous times. To control costs and promote health status, the U.S. needs a government-administered single-payer system. We need a national campaign to create a system that promotes REAL wellness education, lifestyle practices and socio-cultural supports. Little fixes will not reduce costs nor promote well-being. The situation is dire, financially and in terms of a population growing fatter and sicker. Revolutionary reforms must find their way to the negotiating table. The challenge is epic-it involves a fifth of the economy and 100 percent of the nation’s health.

Robert Green Ingersoll, America’s greatest orator of the 19th century, said: “If, with all the time at my disposal, with all the wealth of the resources of this vast universe, to do with as I will, I could not produce a better scheme of life than now prevails, I would be ashamed of my efforts and consider my work a humiliating failure.” Well, our challenge is far less daunting than producing “a better scheme of life. Out task is to design a better medical system that costs less than the one we have but does vastly more to promote health here and now, as soon as possible.