By William A. Haseltine, Special to CNN
Editor’s note: William A. Haseltine is president of ACCESS Health International, a non-profit that aims to improve access to health care worldwide, and the author of ‘Affordable Excellence: The Singapore Healthcare Story.’
The American health care system is failing. Despite spiraling costs compared with other highly developed nations, the outcomes or results we are getting for all of our expenditures often don’t compare favorably. We spend almost 18 percent of our gross domestic product on health care – an astounding amount of money translating to $2.8 trillion dollars per year. In contrast, Japan spends just over nine percent of GDP; France is below 12 percent; and the United Kingdom spends 9.5 percent.
Some argue that we pay more but get the best health care in the world. Unfortunately, that just is not true – we are most definitely not getting what we are paying for. A recent survey by the National Institutes of Health looked at health care outcomes in high-income countries around the world, and we simply did not measure up. We had the highest rates of mortality for newborns and for children less than five years of age. We had the shortest overall longevity rates, and the highest rates of death from lung and heart disease. There are many other comparisons I could cite, but the unavoidable conclusion is that our system simply does not deliver.
Of course, the health of a nation is dependent not only on the quality of its healthcare system and the skill of its doctors, nurses, and other professionals; it depends also on the lifestyle choices of its citizens. Unfortunately, our citizens are making some bad choices, and the results are all too apparent. Obesity, for example, is at epidemic proportions in our country, bringing with it a host of chronic illnesses.
According to the Centers for Medicare and Medicaid Services, American health spending will reach nearly $5 trillion by 2021. Now we are talking about real money, outflows of such magnitude that they will cripple our economy and our nation. These costs will threaten our ability to fund our military, maintain or improve our infrastructure, keep Social Security afloat, keep our industries competitive in the global marketplace. They will also increase income disparity, keeping the poor in poverty and preventing the middle class from ever rising higher on the income scale.
Yet, although I have painted a dire picture, I believe that we can avoid this approaching disaster. We can rein in costs and at the same time improve the quality of care in this country.
I am a scientist, and one of the things I study is the way other countries approach health care. Countries like Singapore, South Korea, Japan, and Taiwan have developed systems that are better and less costly than ours. They spend roughly half the percentage of their GDP that we spend on care, yet they are healthier than we are, and their medical outcomes are in many cases measurably better than ours. In science we call that “proof of principle.” In other words, they have proved it can be done – they are doing it over there. Now we have to figure out how to do it here.
So it can be done. The question is, how? What should we do? In looking at successful health care systems all around the world, I’ve come to believe that there are several basic concepts that, if adopted here, can reform and improve the American system of health care.
Higher co-payments for patients. We already have them and we accept them. I would make them higher so that we begin to pay a significant portion of our care out of our own pockets. Raising co-pays would make us all think about what tests, treatments and other procedures we really need. For the first time, we’d think about the cost of our care. The level of co-pay would be subject to a means test and scaled to income. Those with more would pay more, those without would pay less. The irony is that right now we all pay out of pocket without any kind of adjustments or means testing – a multi-millionaire can have the same co-pay as an assembly line worker. We should change that.
Bundled payments to providers. Right now the standard way medical professionals are paid is fee-for-service: the more testing and treating they do for a patient, the more money they receive. That should change. I believe a system of bundled payments should replace fee-for-service. In other words, a reasonable, specific amount of money would go to a provider based on the patient’s diagnosis. The payment would cover all medical treatments associated with the diagnosis. Doing it this way, we would no longer be incentivizing doctors and others to over-treat: they would receive reasonable fees for reasonable treatments.
Price transparency. We can go online and shop for cars, vacuum cleaners, bicycles. We can compare prices, repair records, user opinions. Try that for the colonoscopy or the knee operation you are told you need. It is not possible. We need to move quickly towards easily available published costs for common medical procedures and hospital stays. We need to know what we are paying for, what the costs will be, and whether we would be better off going to a different, less costly hospital or doctor. Singapore does it, as do other East Asian nations. In fact, their systems demand it. We should as well.
Collective, grassroots action. How then, can we begin to reform our health care system – especially now that our nation is divided on so many issues, and Washington seems incapable of rising above partisanship to get anything done?
The effort to reform health care needs to be undertaken at the local level – city, state, and region. Interest groups need to come together to solve the problem: business, labor, local government and taxpayer. All of these groups are being harmed by soaring health care costs, and while there is much finger points amongst them, they are not causing the problem.
In many ways, we are the most individualistic nation in the world, with personal rights and self-interest at the forefront of our national psyche. But In times of crisis, we come together as a nation and our collective needs trump our individualist tendencies. Most often these occur in national security crises, but it does prove that in calamity we begin to understand exercise the power of the collective. That’s what we need now, and to some degree it is beginning to happen.
Business leaders know that the costs of health care are hurting their competitiveness; our state and local governments are beginning – painfully – to rein in the funding costs of public employee health care benefits; our military leaders and concerned about how to provide care for our armed forces in the face of slashed budgets; unions are seeing the damage done to the well being of their members; and the middle class is beginning to understand that they are being held back by the rising percentages of their income they must devote to care.
All of these multiple interests are coming to understand the issue of health care costs must be addressed, and I firmly believe that if they are provided with solutions, they will begin to work towards implementing them.
The choice becomes rationing of care, which no one wants, or becoming more efficient and cost effective. I believe – and hope – that as a nation we will choose the latter.