In 2011 when my book, Radical Surgery: Reconstructing the American Health Care System was published, I predicted that healthcare costs would rise to over $2.6 Trillion by 2011. It is now 2011 and forecasters predict that healthcare expenditures (HCE) will surpass $2.8 Trillion dollars. Prophetic but hardly cause for celebration.
According the U.S. Department of Commerce’s Bureau of Economic Analysis, aggregate Personal Income (PI) for the United States at the end of the third quarter of 2011 was $12.975 Trillion. This means that HCE will represent a staggering 21.7 percent of Personal Income. Scariest of all is the fact that there is no end in sight in the rise of health care expenditures and if the next decade experiences the same rate of increase, by the end of the year 2020 HCE will hit $5 Trillion dollars.
If you are wondering what, if anything, can be done about this runaway train, the answer is not a blessed thing until we make radical changes in the way we pay for the delivery of health care services in the U.S. To paraphrase the famous quote of the late Senator Everett Dirkson, Republican from Illinois, “a trillion here and a trillion there and pretty soon you’re talking about big money.”
Most frightening of all estimates of the number of Americans who lack health care coverage range as high as 50 million people. Given the exorbitant cost of health care services, lack of health care coverage is virtually the same as lack of access to medical care. Whatever our opinion about President Obama’s health plan, we do not yet know whether or not the plan will appreciably reduce the number of Americans without health coverage. What we do know is that the Obama plan increases our nation’s dependence on the health insurance industry. As a result, we can rest assured it will have little or no impact on the aggregate cost of care.
Fee-For-Service is the engine that drives the American health care system and its burgeoning cost. It is very much like the way automobiles contribute to the greenhouse effect. As long automobiles are powered by gasoline combustion engines, they will continue to pump carbon emissions into the atmosphere. As long as we continue to practice FFS medicine, the cost of health care will inevitably rise. The fact that we rely on the health insurance industry to manage the overwhelming bulk of health care services is comparable to adding a high powered fuel-injection system with dual-barrel carburetors to the engine of your car. The health insurance industry siphons off hundreds of billions of dollars that would otherwise go to providers and thus, give no direct benefit to patients.
We need a new solution and we are not talking about socialized medicine. We do need radical changes but, unfortunately, Americans have become so obsessed with their fear of socialized medicine that they slap that brand on any solution they do not take the time to understand. If only we are willing to open our minds to a new idea, we can find a way to provide comprehensive healthcare and prescription drugs to all Americans, at a cost that we can afford to pay. We can do it in such a way that:
- Limits the role of government to the very few things government does well;
- Allows us to bring rising health care costs under control;
- Everyone pays, proportionate to their income, irrespective of source;
- Gives patients the freedom to not only choose their own doctor but also change doctors;
- Returns the control of the practice of medicine to the physician and his or her patients;
- Relies on free-market forces to drive both quality and accountability; and,
- That eliminates health insurance, managed-care, Medicare, and Medicaid.
In the posts to follow, we will reprint, in small sections at a time, Radical Surgery: Reconstructing the American Health Care System, taking opportunities to update the text with current data relative to healthcare expenditures and with other things that the author has learned in the decade since the book was published. The reader is encouraged to read with an open mind, seeking to understand before they choose whether or not to condemn. We also ask the reader to comment and to pass the post on to their family, friends, and colleagues.
Until we open up a fresh dialogue about healthcare, an issue that affects the lives of every single American, we will not only continue to make the same mistakes we have made for more than a half-century, we will continue to pay dearly for them.
