Health care nears tipping point

Friday, March 23, 2007 | 6:54 a.m.

CARSON CITY - The United States is 26th in the world in life expectancy, and 28th in infant mortality. At the same time, the U.S. spends more every year per capita on health care - $6,100 - than any other country.

In fact, consider this: Even though Costa Ricans spend less than 1/16th what we do on health care, they have a nearly identical life expectancy.

Americans are increasingly aware of this shabby and bewildering state of affairs, which helps explain why public opinion polls show they are turning health care reform into a political issue with more salience than at any time since the early 1990s. That's when then-first lady Hillary Clinton took on the issue for her husband, and was beaten badly. Some say she drove Congress into the arms of the Republicans in 1994.

Clinton returns to the issue this weekend in Las Vegas, along with other leading Democratic presidential candidates, Sens. Barack Obama and Chris Dodd, former Sen. John Edwards and New Mexico Gov. Bill Richardson. They are coming for a union-sponsored forum on health care at UNLV.

Democrats these days are speaking with near unanimity about universal health care, with Edwards, for instance, making it a centerpiece of his campaign.

Perhaps even more indicative of this health care moment, a Republican presidential candidate, former Gov. Mitt Romney, led an effort to bring universal health care to Massachusetts, in an effort being studied for duplication in states across the country, including California.

So how did we get to this point, when a strong majority of Americans believe in universal health care and reform of our system?

"The problems are objectively worse than when we had our last great debate," said Drew Altman, who heads the Kaiser Family Foundation, a health policy think tank. "We haven't solved the problems. Year after year, the problem of uninsured gets a little worse as does the problem of health care costs - and those problems are coming home to roost," he said.

Specifically, health care spending has increased 35 percent in the past three years alone, while the number of uninsured is now 46.6 million, according to the U.S. Census, an increase of 13 percent since 2001.

According to Kaiser Family Foundation polling, Americans' biggest worry - more than a terrorist attack, more than not being able to pay their rent - is losing their health care coverage and becoming sick.

Medical bills cause half of all bankruptcies, according to a Harvard study published in Health Affairs.

Moreover, the cost of health care has become a major burden for American business. General Motors says health care commitments add $1,500 to the price of every car.

What is to explain this bizarre situation, where Americans pay so much for health care, and get so little in return?

It's a complicated issue, but one answer is that we spend vast sums on people whose lives are nearly over. As Phillip Longman, a senior fellow at the New America Foundation, pointed out a few years ago in Washington Monthly, we spend 38 percent of our health care dollars on senior citizens, who at that time made up 12.4 percent of the population.

In Miami, he said, the average Medicare patient is treated by 25 specialists during the last six months of life. Then there are costly technology and pharmaceuticals, none of which extend life to any great degree.

These costs are shifted to everyone else.

The uninsured are another major factor. Bob Moffit, director of health policy studies for the conservative Heritage Foundation, said $41 billion in health care cost goes unpaid by those who incur them. This includes people without insurance who become sick and seek expensive care at emergency rooms, or develop preventable chronic diseases, such as diabetes, that must be treated indefinitely.

The entire perverse process has a ratcheting effect: Costs go up, which forces small and medium-size businesses to drop coverage, which in turn leads to more uninsured who go to emergency rooms and develop chronic diseases.

So, what to do?

In a single-payer health care system, everyone gets the same basic health insurance. Although the system would require higher taxes, it could reduce overall costs because there would no longer be a need for employer-based health insurance, which has proved inefficient. The private health insurance industry would fight this, as it could be its end.

The idea is often derided as "socialized medicine" by conservatives and is given no chance of passage in the U.S. Senate, where 41 senators can block a proposal with a filibuster.

He advocates taxing employer-based health benefits as income and using the proceeds to give tax credits to working people, so they can buy their own private insurance coverage. The hope is that the health insurance market would become more like auto or life insurance, where everyone has his own coverage, rather than being dependent on his employer. By shifting responsibility to the individual, the theory goes, behavior would change.

Davenport said she agrees the tax code is inequitable because those with good plans from their employers aren't taxed, while people who buy their own coverage don't get the same break. Still, she said, taxing health care benefits would cause many companies to drop coverage. Allowing that to happen before the new health insurance market is in place would cause massive numbers of newly uninsured, she said.

While the debate goes on, nearly everyone involved is recognizing what would seem rather obvious: Healthy lifestyles prevent sickness and more effectively extend life than expensive technological care.

As Longman points out, Costa Ricans live as long as Americans even though they have less access to modern medicine because they walk a lot and eat a diet heavy in fruit and vegetables, rice and beans and limited fried food.

Altman said although he sees broad agreement that government must act, the different solutions reflect the polarized ideologies that have paralyzed Washington.

In the absence of activity in Washington, state governments, and now the Democratic presidential candidates, have stepped in.

Altman seemed mildly optimistic about big change in 2009, once a new president is elected: "They blew it last time around," he said of the last reform effort. "But there isn't a voter in America who doesn't care about health care."