Addressing Health Care Costs
Addressing Health Care Costs
There has been a lot of confusion among the general public in regards the reconstructing of the Affordable Care Act in Washington DC. This is to be expected as the original bill is quite complex as is our health system in general. In addition, our nation continues to be mired in huge debt with policy makers and politicians struggling with how to fund legacy programs like social security which is on track to run out of money in the near future.
Much of this debt is predicated on rising health care costs now reaching close to 20% of our gross national product. The American paradox widely known among both health care economists and politicians is the United States spends more on healthcare than any country in the world and yet has worse outcomes. Essentially spending more is getting us less. Maybe it is time we need to start looking at this with a different mindset.
Up until recently few people have looked at the social determinants of health as it relates to the quality of people’s health in this country. Forward thinking healthcare economists have realized the social determinants of health (examples include reliable housing, ensuring sufficient food security, safe drinking water, adequate employment programs, support services for older adults, etc.) probably have as much to do with the quality of health care as do the usual things we think about (the cost of physicians and hospital visits, surgeries, outpatient radiological procedures, etc). If we spend more than twice as much on health care as our developed world counterparts why are we dying before others in the world? Why do we have higher infant mortality rates and pregnancy related maternal death rates? It turns out there is a much better balance between spending for social determinants of health and what we traditionally see as spending for traditional health care in those countries performing better than the US. France, Sweden, Austria and Switzerland spend about as much (if not more) on these social determinants of health care as they do traditional health care and as a result have much better health care outcomes and spend about 8-10 percent of their GNP on healthcare, half of what we spend.
Let’s take a look at a real world US scenario. Our patient is 35 years old and has had insulin dependent diabetes since he was ten. He has little in the way of family support. He works when able as his health permits but has no health insurance. He spends much of his time in homeless shelters. He has lost a foot secondary to his poorly controlled diabetes which is in part due to his food insecurity and inability to afford his insulin on a regular basis. The cost of this care depending on the part of the country he lives is over $14,000 just for the amputation and now we are looking at the cost of a prosthetic. Our health care system (and we as tax payers) have absorbed the cost of this patient’s acute care and will absorb the cost of his ongoing care (including his long term disability and Medicaid insurance) as long as he or she lives adding up to thousands of dollars. Diabetic shoes cost less than $100, this patient’s medicine probably costs less than $2,000 per year. Food stamps are much less than what we are currently paying for his ongoing care. Think of this same 35 year old with a primary care physician, adequate health insurance, a decent place to live, no food insecurity, well controlled diabetes and a decent job. None of this scenario unfolds and his/her health care costs are a fraction of what they now are.
The US Congress is currently talking about getting rid of Medicaid as we currently know it. They would like to turn the program into a series of block grants. By definition, block grants will mean state governments will have almost complete control over Medicaid spending and this is a great idea. We all would like to have control of social programs at a local level. Unfortunately, what this also means is these block grants will cover a fraction of the cost of Medicaid as it now exists and the entire program will most likely be funded (or not)by state governments. The states will have all the control but none of the funding. The federal budget will be partly balanced on the backs of the state governments as it relates to Medicaid expenditures. State governors are concerned as they should be.
What this most likely means is many fewer people on the lower end of the socioeconomic scale will have health care, This care will move from primary care offices back to emergency rooms. Patients won’t access care until there is a critical need (this translates usually into life threatening, costly illness) and our health care costs continue to skyrocket as we as tax payers continue to shoulder the bill. This also puts critical access hospital systems and hospitals in general in dire financial situations and will lead to a decrease in services provided to the community (translate mental health inpatient programs among others which are loss leaders in most hospital systems) and possible closure of smaller institutions.
The US Congress is also considering cuts in programs affecting the social determinants of health. The health care industry and social support systems have rarely been coordinated. As we have seen in other countries paying more upfront for primary care and access to primary care services, preventative services and social determinants of health care may mean a much lower bill nationally on the back side bringing our total health care expenditures back down in the 10% range of our GNP. As our leaders are looking to redefine the health care system now would be the time to consider changes to our system in ways we have not considered.
I write this because now is the time to speak to your state and congressional representatives. Let your voices be heard. In Congress, reach out to Virginia Foxx, Mark Meadows, Thom Tillis and Richard Burr. In the Unifour, reach out in Burke County to Hugh Blackwell and Warren Daniel; in Caldwell County, Virginia Foxx and Deanna Ballard; in Catawba County, Jay Adams and Mitchell Setzer. It is worth at least having a dialogue despite what differences you may have.