The financial crisis is getting all the headlines and, so it is claimed, occupying all the attention of at least one presidential candidate.
Yet a bigger economic issue is hardly being addressed: the exploding costs of health care in the U.S., where we spend a far greater share of our incomes on health than people in other rich countries. How do other countries avoid having health care attract an ever-growing share of resources under their systems of universal coverage and still produce health outcomes at least as good as ours?
One way was made clear yesterday, when, as a (temporary) citizen of Bonn, Germany, my wife received a letter saying she had been scheduled for a free mammogram at a particular time and place. With a preset appointment, no effort is required to arrange things; this arrangement would certainly not exist for most people at home.
Substituting the small cost of preventive care for the large costs of curative care for all citizens seems like a sensible way to contain medical costs under a universal health care system.
Maybe, as I think will happen, the U.S. will finally provide access to health care for all citizens; and it may be possible to do so without shifting still more resources into this sector.
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Want to know the root cause of our problem today with the loan bailout read below.
- New York Times, September 30, 1999
In a move that could help increase home ownership rates among minorities and low-income consumers, the Fannie Mae Corporation is easing the credit requirements on loans that it will purchase from banks and other lenders.
The action, which will begin as a pilot program involving 24 banks in 15 markets — including the New York metropolitan region — will encourage those banks to extend home mortgages to individuals whose credit is generally not good enough to qualify for conventional loans. Fannie Mae officials say they hope to make it a nationwide program by next spring.
Fannie Mae, the nation’s biggest underwriter of home mortgages, has been under increasing pressure from the Clinton Administration to expand mortgage loans among low and moderate income people and felt pressure from stock holders to maintain its phenomenal growth in profits.
“Fannie Mae has expanded home ownership for millions of families in the 1990′s by reducing down payment requirements,” said Franklin D. Raines, Fannie Mae’s chairman and chief executive officer. “Yet there remain too many borrowers whose credit is just a notch below what our underwriting has required who have been relegated to paying significantly higher mortgage rates in the so-called subprime market.”
I remember things like this well when I was an American Citizen student in a German public school. We got checkups, twice a year, at school, during the school day, in the on-campus doctor’s office. This killed many birds with one stone, no need for my parents to make an appointment, no need to take me out of school for said appointment, EVERYONE gets preventative care, no forgetting ones appointment, etc. . . I can’t wait for America to wake up and enjoy the benefits of universal coverage.
Preventative care is a start, but we also need to ration care (like the British NHS) so that we only pay for care that has positive cost/benefit payoff. We need to reduce duplication of services including the race of health care facilities to be the first with the latest equipment and technology. We also need to get rid of the dead weight provided by the insurance companies and have long wait for non-essential services that will cause many to have supplemental private insurance (like the British system).
Personally, I would prefer all that if it would reduce costs, but it would be unpalatable to the American public and vested interests.
“Substituting the small cost of preventive care for the large costs of curative care for all citizens seems like a sensible way to contain medical costs under a universal health care system.”"”
“seems like”???????????
where’s the data?
My hunch “seems like” is that screening and treating hypertension, colon cancer, and diabetes would be cost effective. Most other preventive care is expensive and unproven in cost terms.
In the U.S. we love having the most technologically-advanced, cutting-edge medical care/techniques/equipment available. This comes at a high monetary cost to develop initially, and also hurts our outcome stats since we are the “early-adopters” of the world. Until our new technologies have been proven and the costs come down, the rest of the world enjoys yesterdays technology which is cheaper and still highly effective.
We also get all wrapped in believing dozens of early detection tests count as “preventive care.” Those are good, but true preventive care is cheaper still: a healthy diet and regular excercise.
Schedualing is what the VA does. I get a letter in the mail notifing my of my appointments. if I need to change them I just call.
It always surprises me how miserly US insurance companies are about paying for preventive care. For example, our BC/BS state health plan will not pay for an annual pelvic exam for women, something that is crucial in detecting small problems before they become big ones.
You’d think, since private insurance co.’s are all about making profits, they’d be all about preventive care so they could avoid paying for expensive care down the line. Maybe it’s the constant focus on quarterly profits that keeps them from seeing the big picture?
A couple points.
1. Screening for disease is not preventive care, it is identification of illness for earlier intervention on the premise that this will cost less and be more efficacious. Unfortunately, many cost benefit analyses and long term survival studies do not find very strong support in the data. For example, mammogram probably moves up the detectable time frame for breast cancer by six to twelve months. However, the tumor has probably been present for several years at that point (based on tumor volume doubling calculations). If one “corrects” for the earlier detection, the increased longevity is not very impressive. If one then “cost benefits” the data, the cost per year of life gained is rather daunting.
2. Preventive care is virtually free. It amounts to life style changes in diet, exercise, habits, etc. One need not spend a dime on a physician. However, not very many US citizens are willing to make these changes in their lives so they come to physicians asking for prescriptions or operations to enable them to avoid those changes.