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Friday, July 24, 2009

Health Care in the USA

Today, $18 out of every $100 of our Gross National Product (the pie we all have to share) is spent on health care, and it is headed for $30 in five years, if current trends continue. Those dollars crowd out investments in education, highways, defense and other important uses because the size of the "slice" is growing faster than the "pie".

This might be defensible if we were getting good value for this money, but the truth is that our health is not as good as most other developed countries on almost every measurement.

The President has made controlling health care expenditures the hall mark of his administration, and he made a quite good speech about it the other day. But he ducked the real issue.

We can make some improvements in making medical records more widely and easily available and that can reduce some costs. Since a stunning 30% of all Americans are clinically obese, there are some significant cost reductions associated with achieving a healthier life style.

But the only real source of cost control is the R word, rationing. Estimates vary depending on assumptions, but 80% or 50% of all health care dollars are spent on the last two months or two years, of life. So there is no question that the real source of cost containment lies in some very, very difficult questions and their answers.

Fortunately, the subject is being gingerly introduced for public discussion. On July 20, 2009, the Los Angeles Times ran an editorial entitled, "The reality of rationing". A couple of weeks ago, the President raised the topic in a meeting with doctors and other health care professionals. He used a personal example to make the point. His grandmother was diagnosed with terminal cancer and given nine months to live. Some months later, she fell and broke her hip. Should she have received an artificial hip, with its months of recovery time, at government expense?

The more you think about that little story, the more you realize just how difficult making such decisions will be. But before you get to discouraged, remember that insurance companies have been making exactly these decisions for a long time now, but they have been making them out of sight.

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