The Cost of Caring

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Although the Supreme Court upheld the Patient Protection and Affordable Care Act (ACA) today, 30 million uninsured Americans may still have to endure the 2012 election before securing health coverage as a result. Until then they will continue to hang in the balance. Yet somehow America manages to substantially spend more on health care per person than any other nation in the world. Included in these trillions of dollars of expenses is the emergency care of the uninsured and the underinsured, those with minimal healthcare plans who forgo treatment due to expensive co-payments and coverage holes. Affordable access to both primary and emergency health care is an essential right that America fails to deliver. People’s lives and their livelihood have an intrinsic value that the government is obligated to protect.

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

~Article 25.1, UN Declaration of Human Rights

Since the World Health Organization released its often cited and hotly contested ranking of national health systems in 2000 ( a ranking that slotted America at 37th in the world), the majority of the subsequent statistical evidence  has corroborated the implication that the United States operates a subpar healthcare system compared to most other developed countries. America ranks 38th in infant mortality and 50th in life expectancy (Source: CIA). These catch-all statistics may in part reflect other facets of the American lifestyle—like our insanely high obesity and car accident rates—but overall they delineate very well between industrialized and developing countries. Our rankings match with the majority of the latter group. No system achieves perfection across all dimensions, but the U.S. system has been routinely flagged for exorbitant costs and overly-selective coverage. A reduction in costs and the expansion of coverage would boost the overall efficacy of the system. The premise of ACA is that the two are strongly related factors that weigh down an otherwise effective healthcare system.

Costs directly inhibit access to health care. The Organization for Economic Co-operation and Development (OECD) cites the United States as spending more per capita on health care than any other nation in the world. Compared to the 2nd place country, Morocco, the US spends 16% more per person. (Source: OECD). The average American family spends $3,157 annually on healthcare (Source: Bureau of Labor Statistics). That amounts to 6.3% of the average family’s income.  Unpaid medical bills are a substantial factor in many middle class bankruptcies. Furthermore, a couple million Americans are classified as “underinsured,” meaning that they have only barebones insurance or excessively high premiums that persuade them from utilizing their insurance.  They effectively join the ranks of uninsured. (Source: Common Wealth Fund).

“It’s a fallacy to think that people don’t want coverage. They just can’t afford it.”

~Wendell Potter, Center for Public Integrity

With regard to coverage, health care should be handled similarly to police protection or firefighting services. Every American should enjoy blanket coverage regardless of the cost. America spares almost no expense to capture and incarcerate criminals or fight fires, but lobbyists have deterred the decision-makers in Washington from dismantling our draconian health care system. It would be insane to deny a neighborhood police protection because it has “pre-existing violence” that raises the cost of resources expended on protecting its residents. The funding model for health care cannot be exactly the same; however, that same commitment to providing service should be carried over to hospitals and doctor offices. It’s some hypocrisy that Congressmen and Senators with the best plan in the nation—one that money can’t buy—would argue that people don’t want insurance.  Few people realize how much they need insurance until some type of medical crisis emerges. It’s unacceptable that nearly 16% of the nation has to face a medical emergency before they receive care. The Organization for Economic Co-operation and Development (OECD) is international economic organization whose 34 member states include much of the developed Western world. The OECD contains three nations that insure their populations at a rate less than 98.4%: Mexico (50% uninsured), Turkey (16%), and America (Source: OECD, 2004).

(Source: US Census Bureau)

High costs, coverage gaps and ineffectiveness have amplifying effects on each other. Uninsured individuals can always use emergency services since it’s illegal to deny them. The uninsured have a visit rate to the ER twice that of the insured (Source: CDC). Many, some estimates say near 5 million, have “pre-existing conditions” that result in health care companies declining to cover them if they seek to gain coverage. The cost of emergency care of the uninsured is passed back to the pool of patients that do have coverage through their insurance providers. Driving up premiums and co-payments, this pushes some individuals down to the ranks of the uninsured or more likely the underinsured. The cycle repeats to create the 37^th best, but most expensive system in the world. Certainly closing the coverage gap would boost our performance compared to our international counterparts. A 2008 study concluded that 100,000 less people would die per year if our system worked as well the ones in France, Australia or Japan (Source: Reuters). Often discussed in the coverage debate is the excellence of American care for those who do have access. The American system does excel once you’ve cleared the barrier of substantial coverage, but our medical proficiency matters only for those who can manage to stay in the system.

For these reasons we must not turn a blind eye to Americans who have been left out. The goal of the health care industry should be to provide coverage first, not simply cherry pick the most profitable Americans to insure. I will only accept that argument that people don’t need health care when its loudest proponents—politicians and well-paid news commentators—get rid of their own coverage. Until then, I’ll continue to endorse health care as a right. Today’s decision by the Supreme Court has given new life to Affordable Care Act which will help America join the rest of developed world. The cost of caring for people, the cost of caring about people pales in comparison to the cost of not caring.