Two of the most important issues this time around are health care and the federal budget. This year, the debt limit of the government received special scrutiny, and with it, the fact that we grossly overspend what we make as a country. The federal debt is in the trillions of dollars. We are practically bankrupt as a country, and can barely afford to pay the interest on our outstanding debts. Regardless of how you personally feel that we should increase our income (tax the rich vs tax everyone), it is clear that we must reduce the amount we spend. Like any poorly managed household, it is the fact that we spend more than we make that is forcing us in to ever more debt.
That brings us to the second hot issue of 2012: health care. With the passing of Obamacare, everyone is talking about it. For those of you who are not well versed on the topic, the major issue in the health care debate is not how to deliver it, or the quality, or even who should get what services. The issue is who will pay for all of the healthcare that we deliver.
Why, you might ask, is who pays so important? Well, it is because of the sheer amount we spend on health care. In America, we spend about $7,538 per person on health care. This is by far the most of any industrialized country. In fact, it is almost 1.5 times as much as the next biggest (Norway at $5,003). Here is a bar chart showing the average per person health expenditure for the major industrialized nations:
As you can see, we outstrip everyone else in healthcare spending. This comes to a staggering total of 2.26 TRILLION dollars. To put it another way, healthcare spending accounts for about 16% of our Gross Domestic Product, meaning about 1 out of every 6 dollars that US industry and jobs produce goes to health care.
Thus, the who pays for it discussion. To understand the debate, you have to understand who pays for it now. About 15% of Americans are uninsured, meaning that they pay for it themselves. Accordingly, about half of all bankruptcies are due to medical expenses. The other 85% is split between private insurance (36%), the federal government (34%), state/ local government (11%), and miscellaneous (4%). Obamacare is mainly aimed at the 15% or so who don't have insurance. The federal government aims to provide insurance to those people, absorbing the additional cost, as well as a myriad of other costs so that everyone will have health insurance.
While this is a noble goal, and no one should have to go without at least essential and emergency health care, we have to ask what we are getting in return. Surely, if we spend the most of healthcare, we must be the healthiest nation on the planet, right? Nope. In fact, we are one of the sickest industrialized nations on earth. Below is a listing of life expectancy for developed nations:
As you can see, the United States is no where near the top of the list. In fact, as of 2011, we rank 42nd globally in life expectancy. This is terrible, considering the amount we spend on health care. Thus, the question must be asked, why are we so sick?
Some people would say that this is an indicator of poor quality health care. I may be somewhat biased, being a doctor, but I disagree. We have by far the best health care system in terms of quality in the world. No one can surpass our developments in pharmaceuticals and life saving technology. We are sick despite our quality health care.
In truth, the health problem and the money problem are related to the same thing: our personal choices. We choose not to take care of ourselves, and suffer the consequences. The vast majority of the diseases we suffer from today in America are what I like to call diseases of lifestyle: cancer, heart disease, high blood pressure, type II diabetes, stroke, chronic pain and obesity. I call these diseases of lifestyle because whether or not you develop them is almost directly related to what you eat and whether or not you choose to exercise. The fact is, in America, we eat mostly processed crap, and exercise little if at all. I have covered this at length in prior posts, so I will not go into it here. Click on the links if you want more info.
Thus, the problem with health care is not health care itself, but the amount we deliver. We are forced to deliver way too much healthcare, because we do whatever we want, and ignore the consequences. A recent study showed that obese people suck up over $2,000 more per person in health care dollars than a non-obese person. Maybe if we actually took care of ourselves, we would not have to spend five times more on health care than on national defense. If we only took care of ourselves, we could solve the healthcare crisis and the budget crisis without any help from the federal government. As a nation, we need to begin to regard the consequences of our actions, and adjust those actions to avoid the collapse that is coming.
Regardless of who you plan to vote for, politicians and government cannot solve our problems. Only we as individuals can!
M. Jacob Ott, M.D.
