Critics in both the media and academia who point to exploding costs and denial of care as maladies afflicting the U. S. health care system are getting part of the story right.
“In the last seven years, we’ve had over [a] 100 percent increase in insurance premiums and only a 27 percent increase in earnings,” University of Utah economist Norman J. Waitzman said in a roundtable sponsored by Continuum, the university’s magazine. Waitzman is co-director of the Behavioral Science and Health program at the University.
Unfortunately, too many analysts usually want to fix the part of the health care system that works. “When you compare the United States to Sweden, their infant mortality rate is about half,” Brent C. James, an adjunct professor at the University of Utah’s medical school said in the Continuum symposium. “As soon as you adjust for gestational age, the difference disappears.”
“What it says is that the Swedes are classifying premature infants differently—as stillbirths—while we’re classifying them as salvageable infants and we’re going to pull out all the stops to try to save them.” James is the executive director of the Institute for Health Care Delivery Research.
“There’s a phenomenon called ‘rescue care,’ which is this overwhelming feeling we have as human beings to help someone who’s suffering or facing death,” James said. “When it comes to the ‘rescue’ world, the United States is by far the best.”
“About half of all health care expenditures in the United States are incurred in the terminal episode of life that ends in death.” People who seek such “rescues” in health care might view this as the ultimate vindication of the American system, with all its flaws.
Nonetheless, James and his compadres view such care as problematic. “You end up not prolonging life, but prolonging dying,” James contends. “It’s a huge investment, and most people don’t want it.”
“But we don’t know where the boundary is and we can’t pull back.”
“And where we draw the line is a very complex question,” university official Kim Wirthlin said in the same forum. “And it happens at the beginning of life as well.” (Curiously, earlier in the forum, Wirthlin observed that “Nationally, two to three times as many people die from lack of access to health insurance than from homicide.” Wirthlin is the vice-president of Government Relations and associate vice-president of Health Science Public Affairs and Marketing at the University.)
“And hospitals are reimbursed to provide that type of care,” Waitzman notes. “The NICU [Neonatal Intensive Care Unit] is a huge profit center.” None dare call it rationing although, particularly in the government programs that consume at least 44% of all health care expenditures by the government’s own reckoning, that has been the solution du jour of nationalized health care systems for quite some time.
“This really requires a huge paradigm shift in the U. S. population—because we are all about rescue care, and as soon as there’s something that needs to be rescued, we go there,” Leigh Neumayer, professor of the University of Utah School of Medicine said in the Continuum conference. Newmayer is also a general surgeon.
Of the quartet, only James would acknowledge the role of government in exacerbating at least the cost side of the equation. “The United States is currently about 46 trillion dollars in debt in the sense of commitment to U. S. citizens through entitlement programs beyond current or projected levels of taxation,” James said. “It’s about the net value of the United States of America.”
“And two-thirds of the shortfall is Medicare, which is about 30 trillion dollars in debt for people currently alive. To get this in perspective, the social security debt is just 5.7 trillion.”
Dire as that prediction sounds, it is perfectly in keeping with the history of Medicare. Since Congress passed the program in 1965, Medicare’s costs have gone up about 2,900 percent and counting, Troy University professor Christopher T. Warden pointed out in an Accuracy in Academia seminar at the National Press Club on July 31.
The former editorial-page editor of Investor’s Business Daily, Warden is the author of Voodoo Anyone? Economics for Journalists, a textbook that AIA is publishing.