The Presidential candidates are putting forth health care reform proposals. Major reforms of some kind are in our future but we resist change even when we need it badly. The passage of medicare during LBJ’s administration was the last sweeping change in health care in the USA. It has provided care for the nations senior citizens for over 40 years. No matter what the opinion about efficiency, payments and administration, the people it covers are better off than they were before it was enacted.

Everyone needs access to health care

Universal health care is the name of programs intended to provide every citizen some form of health insurance. Everyone is afraid to say single-payer. That is the basic British and Canadian system. The government writes the check and makes the regulations, and enforces them as well as administering the programs. Like our system it is aimed at sick care and not prevention. To keep health care costs down, we need fewer sick people. We also need to decide what works and what does not work in terms of efficacy. We can not afford to spend on treatments that are dubious or on the more expensive of equally effective therapies.

Everyone could have coverage for what we spend now

What about the amount the government spends. How much is it and how does that compare to the budgets of other countries for health care?

According to the Center for Medicare and Medicaid, the governments direct share is around 46-48% of all dollars spent on health care. On the blog Health Populi, author Jane Sarasohn-Kahn, writes that the number one item of expenditure in our national budget (private + public spending) is for health care. It consumes 17% of the gross domestic product (GDP) and amounts to 1,587.7 billion dollars. 46% of that figure is $730.35 billion dollars. We spend more government dollars on health care than any other country and have less to show for it.

A study done in 2002 looked at tax-financed health care in the USA. The studies authors say that accounting by the Center for Medicare (CMS) only counts dollars spent directly and not indirectly by the government on health care. So, soldiers, people on medicare, and grants to states for medicaid are counted. If you are a federal employee in the FBI or other federal agency, you are insured in the federal program (FEHBP) Hillary Clinton wants to extend to all uninsured people not eligible for other programs are not counted by CMS. The health care costs are paid by the insurer but the premiums are paid with tax dollars. These are not counted in CMS stats but are tax financed and included in the Federal budget by the OMB.

That studies authors also report on an invisible expense shared by everyone who pays taxes and that is tax exemptions on money spent on health insurance by business for its employees. You will see that many of the candidate plans include tax “incentives” (read less or no taxes on money spent for certain purposes). The authors cover this point well so visit the link to see their example and the math. The point is, even those without access to care, the working poor and others who pay taxes share this burden without any benefit. The burden is the taxes that must be paid to make up for the reduced revenue from tax exemptions for health insurance premiums to business and individuals. The uninsured help to pay for the insurance for all federal workers and all who get an exemption for their premium expenses.

Another area of concern is administrative costs that run around 30% of total costs. EMRs (electronic medical records) might save some money though I doubt that, but streamlining our admin costs from 30% to 10% could save us $333.2 billion dollars. That is a big number to spend on prevention and other services.

Regular exercise saves lives

I have heard scathing reports on Michael Moore’s film Sicko. I did not see it because I did not like his approach in a prior film. He is accused of saying he wants us to have a health care system like Cuba’s. I have heard lots of criticism aimed at him for this statement. The paper The Guardian of London, England went to Cuba to investigate.

They found that expenses per capita in Cuba were about $260 (US) per person per year. In contrast we spend about $6,500 per person per year with about the same results (life expectencey in Cuba and the USA is 79 y/o). What is the difference? Cubans all walk frequently. No one has a car and public transportation is poor or nonexistent. Their system has one general practitioner per 175-250 people (each doctor is paid $20/month yet a anesthesiologist in the US averages $354,000) and the emphasis is on prevention.

There are 10 major diseases that account for most of the untimely deaths of US citizens. The universal antidote for these, the one thing that could delay or prevent the onset is walking one hour per day. If we had our neighborhoods set up to walk and if they were safe, we could reduce the number of early deaths and the number of dollars spent on sick care (0ne trillion dollars per year on treatment of chronic disease). Any plan to reform health care has to address the health of our citizens and how to make it better. I haven’t heard much of that in any plan.

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