Monday, August 17, 2009

What you get for your money

To continue my train of thought on the Wall Street Journal opinion piece from yesterday. The United States spends 17% of its GDP on health care but what do we get for it? I would bet we take care of more sick patients than any other industrialized country in the world. By sick I don't mean just acutely ill, but also chronically ill. We have the highest rate of obesity in the world. We probably have more people with coronary artery disease, diabetes, hypertension, cancer, congenital defects, renal and liver failure, alcoholism, and drug abuse than any other first world country. We take care of more extremely premature infants, and more centenarians than any other advanced nation. Just in the last month I saw an orthopedic surgeon put in a new hip on a 95 year old patient, a gastroenterologist perform an ERCP on a 103 year old, and another gastroenterologist put in a PEG on a demented 92 year old. All those patients got million dollar workups and consultations during their hospital stays. How many other countries in the world can boast that claim?

In this country, where every life, even the unborn, is considered precious, we are going to have to spend more money than anybody else. Our societal expectations, along with our legal obligations, ensures that we will spend top dollar to treat everybody equally. Nobody gets short shrift on health care regardless of their ability, or inability, to pay. Whether they are citizens, legal residents, or illegal immigrants, all patients who walk through the emergency room doors get treated equally.

So what if Japan only spends 8% of its GDP on health care. Or that South Korea spends 6%. I've been to hospitals in Asia. They spend less but they also get less. Most rooms are like the old hospital suites we used to have here, 2-4 patients per room or more. Sure you can have a private room, but you'll pay more for it. They are extremely understaffed. If you want a nurse's attention, you better hire your own private nurse. If the patient doesn't get better, they don't usually call the first malpractice lawyer they see on a TV commercial.

Perhaps spending 17% of our GDP for health care is commensurate with our quality of care for our given patient population. We spend more because we need more. We have sicker patients than most other industrialized countries. Other first world countries in general are healthier than us, with lower rates of obesity, alcoholism, and drug abuse. They can afford to spend less on their health care. If we want to improve the quality of our health care, given our country's health status, perhaps we need to spend even more, not less.

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