Healthcare in America-Part I

David Kelly, 2012-2013 President, HOSA-Future Health Professionals

Medical Student, College of Medicine, The University of Oklahoma

For the last several years, healthcare has dominated political conversation in the United States. This is not without good reason – healthcare is an incredibly costly undertaking (nearly 1/5th of our GDP), and the degree to which we as a society want to subsidize or collectivize it can be (and is!) debated ad nauseam with valid points made from many angles. But the conversation I want to have today isn’t political. Today I’d like to talk about why costs are rising independent of what happens in Washington. First, though, I feel that I need to share how it’s possible that the healthcare conversation need not be political.

Popular culture in recent years might have you believe that the rising cost of healthcare is largely due to legislation. I think that this is overly simplistic. Healthcare, as Future Health Professionals know, is a hugely complex system with many different players: providers, patients, insurance companies, pharmaceutical companies, medical technology companies, and governments (among many, many others). There is an argument to be made that cutting one or more of these agents out of the loop might lower healthcare costs, but that is a debate for another time. Governments can for example control insurance companies to a certain extent, but as we’ve seen over the last few years, any restriction inevitably has unintended consequences. There is a delicate balance between government and industry here, but what I want to talk about is far more significant but far less complex than that balance. Healthcare costs have steadily increased for the past few decades independent of many of the actions of government - why? I believe that there are two answers – we are using more healthcare and we are using more expensive healthcare. In this article, I’ll examine these two phenomena and propose why they are contributing to rising costs. In my next article, I’ll attempt to both posit a few solutions to these issues and discuss where we may actually be heading.

The single largest thing pushing healthcare costs higher in the last half-century is our increased use of the system. This is driven in large part by our increased average life expectancy. Not all of increased use is unavoidable, though. People need more healthcare than ever before due to phenomena like the obesity epidemic. Type two diabetes and heart disease (which in many cases stem from obesity) are chronic diseases that cost insurance companies (and thus patients) incredible amounts of money over time. Insurance companies control costs for healthy subscribers somewhat by labeling these as pre-existing conditions and placing these subscribers in a higher risk (read: more expensive) pool. The debate over this practice is, again, a conversation for another time. If everybody was healthy, our costs would naturally plummet. Obesity and its comorbidities are just one prominent example, but hopefully you can see that in order to reduce healthcare costs, we can’t simply manipulate one part of the system – we have to learn to use it less through changes in our lifestyles.

Discrete from but parallel to the increased use issue is our use of more expensive healthcare. This is an equally difficult issue to deal with, because lowering costs may indeed require some manipulation of the system (in this case pharmaceutical and medical technology companies). The classical argument to be made is between patients who feel that drug prices should be regulated and companies that counter that the high price of drugs pays for their development and supports future research. Regardless of where you stand on this issue, incredible advances in healthcare research are giving patients better outcomes. These advances come at great cost to the system and thus to patients, but they nevertheless are extending our lives and making us healthier (even though, as discussed earlier, we are as a whole getting sicker). Years ago, large pharmaceutical companies couldn’t develop compounds with the precision that they do today. Medical technology companies couldn’t create robots to perform surgery. In a way, you could say that healthcare is getting more expensive because we are keeping sicker people in better health. How ironic!

One interesting category of healthcare use blends these two trends - the extraordinary measures taken near a patient’s end-of-life. In recent years, debate has raged over the cost of these extraordinary measures that may only extend a patient’s life by hours or minutes. We can artificially sustain life pretty well, continually resuscitating patients and placing them on life-sustaining machines that breathe, eat, and drink for them. The questions that loved ones must ask themselves in these circumstances have become more difficult to answer as technology has blurred the lines of life and death.

More than anything, my goal today was simply to impress upon you how misguided I think the current healthcare conversation in the United States is. Shortly after my time as HOSA National President, I was invited to represent HOSA at an ideas roundtable in Washington, D.C. We discussed over two days how to make this conversational shift from one of healthcare to one of health. I can already see this change beginning to happen, and in my next post, I’d like to talk about how we might make this change happen faster and what might come out of these discussions.