Pick Any Number but Make it 18,314
By Gretchen Gibbs
Governor Christie got himself in trouble over the traffic jam his aides created at the George Washington Bridge partly because emergency vehicles could not get through and because there was the possibility that one 90-year old woman might have died because she did not get to the hospital in time.
We take death seriously in this country. Or do we? I recently finished reading The Healing of America by H.R. Reid, which I highly recommend. I have been avoiding the debate about Obamacare because it is so complicated and so partisan. But Reid, a long-time correspondent for The Washington Post, both explains the Affordable Care Act and presents health care in a straightforward way. He went from country to country with his bad shoulder to see what different health systems would prescribe and charge. In the U.S., doctors recommended a total shoulder replacement, a procedure with many potential side effects and a cost of about $10,000. In India, however, Reid stayed at a clinic for $42 a night, including food and treatments, and found the massage and herbal remedies reduced the pain and increased the mobility of his shoulder.
Reid’s central point is that health care is a moral issue. We are the only industrialized country that does not provide universal health care and which apparently does not believe that health care is a basic human right to which all are entitled. Our constitution says that all of us have a right to life, but apparently we don’t really believe that. When people do not have health care, they can die.
Reid cites a study done in 2000 about the number of preventable deaths that occurred each year because 30 million people did not have health care. The number was 18,314. A similar study, done in 2009 when there were more than 45 million uninsured people, estimated the number to be 44,789.
To be conservative, let us use the smaller number, and let us remember it: 18,314. How should we react when we hear that 18,314 of our citizens die needlessly every year? When approximately 3,000 people were killed at Pearl Harbor, we entered World War II, with an enormous cost of money and lives. When about an equal number were killed on 9/11, we started another costly war.
So when do we begin the war on insurance companies? Our health care plans are not really so different from those in other countries, like Germany and Japan, which also have insurance companies. But rates for procedures are set by the governments of those countries. Only in America do insurance companies make profits, and of course the incentive when you are trying to maximize profits is to charge a lot for everything and to deny care rather than to offer it. Incidentally, this also makes our health care the most expensive of any developed nation as well as about the least effective. We spend 16.5 percent of our GDP on health care (vs. 8.1 percent in Japan), while, according to the World Health Organization, we rank 37th in quality and fairness of the system, behind Costa Rica. We rank 24th in the world in average life expectancy.
I have learned more about Obamacare, and I can see there are good and bad features. Some constraints on insurance companies (good), some burdens on some individuals who will see their payments increase and who have to negotiate a lot of red tape (bad). For me, the biggest plus is that by 2019, 32 million more people will have health insurance, both through Medicaid and through private insurers. Of course, the estimate is that 23 million will be uninsured. There still will be needless deaths of Americans running into the thousands, but we should be cutting down that 18,314 number.
So when are we going to be a real democracy with equal rights for all, with a moral regard for our fellow citizens, and eliminate all those deaths?
Tags: Gretchen Gibbs, H.R. Reid, Washington Post
January 16th, 2014 at 9:58 pm
I agree with much you have written! Health care should not be for profit. Not for anyone’s profit not insurance companies, doctors or for-profit hospitals. I’m hoping that the Affordable Care Act is only the beginning of good changes in the healthcare for our country. Thank you for a thoughtful article.
January 17th, 2014 at 1:12 pm
I agree that providing medical care is a moral issue, and I’m glad to see your article emphasizing that point. I hope that the (flawed) ACA will succeed as a first step in improving things. I doubt, however, that a war on insurance companies is the right focus for further improvement. From what I’ve read, the insurance companies aren’t the ones responsible for the high cost of care. They are guilty of pushing policies that only give the illusion of coverage (the ACA should stop that) and of looking for loopholes to deny coverage (I’m afraid that’s likely to continue). But their profit margins are pretty small and aren’t made larger by covering over-expensive procedures. For excessive costs of care, look to the drug companies (huge profits) and care providers (who decides that a shoulder replacement is the treatment of choice when cheaper options are available?) To some extent, we can also blame the American people. Many will complain mightily if a doctor doesn’t prescribe the latest, most technologically advanced procedure or heavily-advertised drug.
January 18th, 2014 at 1:28 pm
According to Reid, drug company excesses (and they certainly do charge much more than companies in other countries) and doctor profits are not enough to account for the high level of medical spending in the U.S. Although doctor income is disparate between countries, American profits are not quite so excessive as they seem. For one thing, most U.S. doctors start their practice with huge debts ($100,000) from their medical training, training that is free in most other countries. Malpractice insurance is also a huge expense, only in the U.S. Even though doctors’ fees are regulated in many other countries, most manage to make a good income regardless.
Ms. Pogglioli raises the issue of for-profit hospitals, and I don’t know anything about the economics of this, although I suspect it’s a problem. I find it annoying to find ads for hospitals as though they were colleges to choose between.
Again according to Reid, insurance companies in the U.S. have administrative costs, which include profits, of 20%, compared to Medicare or the Canadian system, which have 3%.
Although many people do want the “latest” procedure, most of us have come to accept generic drugs, and many are interested in alternative health practices, like the kind Reid received in India.
I am sure there are other factors, and other sources will provide other figures. As a provider of psychological services myself, I should reveal that I am biased against insurance companies because of their failure to pay providers for services. The latest story I’ve heard is a qualified professional on the Blue Cross panel who has three patients with Blue Cross insurance. She has filed the paper work again and again, and been in touch with the company repeatedly. It has been over a year now of her treating the three patients, and she finally got three months payment for one of the three! She is going to stop accepting patients with this company, and more and more psychologists are not accepting any insurance because of similar problems.
January 19th, 2014 at 10:34 pm
The number 18,314 is oddly precise. It is also far below the range of annual deaths reported in several major studies as revealed by a simple google search. https://www.google.com/#q=how+many+die+each+year+from+lack+of+healthcare
But I won’t quibble over the picayune details of how many deaths will it take til we know that too many people have died.
Obamacare is indeed quite complicated. Way TOO complicated. Yes, as you say, it does have its “good points”. But the saddest and ugliest thing about it lies in its opportunity cost. Despite arguments to the contrary, Obamacare, by cementing the relationship between employment and insurance and by its bolstering of private profiteering insurance companies as primary means of health care financing, has taken a huge step away from, not toward, single payer universal coverage. Moreover, it has made health care such a politically charged minefield that few elected officials will touch it again anytime soon.
Oh, and one more minor bit of nitpiking; “right to life” is not mentioned in the Constitution, but rather in the Declaration of Independence. (And, of course, the phrase has no connection to its current use in the context of abortion.)
January 20th, 2014 at 5:56 pm
Thanks for the comment. Right about the Declaration of Independence – I was going to look it up but didn’t get to it.
I wanted to share a comment sent to me personally by Nancy O’Hagan, who gave me permission to share it. She writes:
Isn’t it an obvious conflict of interest to anyone who thinks about it that for-profit insurance companies exist to “earn” money for their shareholders, rather than to provide payments for health services. DENYING coverage for services is ovbiously in their shareholders’ interest. Also, CEO’s of insurance companies take incredible amounts of money out of their consumers’ premiums. I remember a few years ago the woman who was CEO of Wellstone, I think it was, had an INCREASE in salary of $5 million. She had received only $8 million, but it was increased to $13 million. In no way did she actually earn that amount of money.
It’s the mission of these various groups that says it all to me. Why do insurance companies exist? To make a profit. Why do single-payer systems exist? To provide affordable services to everyone. Insurance companies’ reason for being has nothing to do with providing care and is merely a secondary concern at best. Leaving access to care to the whims of the market strikes me as unbelievably crazy and barbaric.