Debunking Five Myths About U.S. Healthcare
Early signs are good that the incoming administration of President-elect Barack Obama will push major healthcare reform early next year. As that effort gears up, though, expect to see opponents unleash a blizzard of misinformation aimed at delaying or preventing real change -- largely because any serious reform will directly jeopardize the business models of powerful hospitals, health-insurance providers and other big players in our complex but dysfunctional healthcare system.
Which is why it's nice to see that Overtreated author Shannon Brownlee and oncologist Ezekiel Emanuel -- who is also the brother of incoming White House Chief of Staff Rahm Emanuel -- recently published a helpful debunking of five persistent myths about the need for reform and its possible cost and scope.
Myth #1: America has the best healthcare in the world. Although less prevalent than it used to be, the idea that the U.S. medical system outperforms those in other nations has proven surprisingly stubborn -- not least because of a public fascination with costly high-tech equipment and "miracle" drugs that rarely prove anywhere near as effective as advertised. In aggregate, the U.S. spends far more per capita on healthcare than any other country, but fares poorly in major health measures ranging from life expectancy to obesity to cancer and heart-disease survival.
Myth #2: Somebody else is paying for your health insurance. Most people don't realize that employer-provided health insurance depresses wages -- and that the effect is getting worse over time as insurance costs skyrocket. Over the past five years, insurance premiums have risen four times faster than wages, and businesses are increasingly forcing workers to pay a larger share as a result.
Myth #3: We would save a lot if we could cut the administrative waste of private insurance. This notion has been an article of faith in the progressive movement for years, but Brownlee and Emanuel argue that even if administrative costs are higher at private insurers than in government programs like Medicare, lowering them wouldn't save enough money to expand coverage to the uninsured -- and that this "health dividend" would be a one-time event, because administrative costs have relatively little to do with medical-cost inflation.
Myth #4: Healthcare reform is going to cost a bundle. Done right, reform would reduce overuse of expensive healthcare technology and cut back on preventable medical error -- probably two of the greatest cost drivers in the entire system. Emphasizing evidence-based medicine and making better use of IT systems such as electronic medical records are the best bets for changing what these writers call "the spectacularly wasteful and expensive way doctors and hospitals deliver care." Comprehensive reform could conceivable save as much as $1.4 trillion over ten years while extending coverage to the uninsured.
Myth #5: Americans aren't ready for a major overhaul of the health-care system. In fact, the healthcare system's limitations are growing more obvious as rising premiums and cost-shifting render insurance coverage unaffordable for increasing numbers employers and individuals. A recent survey in the New England Journal of Medicine found that 40 percent of Americans give the U.S. system a poor rating, and 70 percent believe it needs major changes or a complete overhaul.
As Brownlee and Emanuel conclude:
Now is not the time to think small, to cover a few million Americans and leave the bigger job of controlling costs and improving quality for another day. We can't afford not to reform the delivery system as soon as possible. At 17 percent of gross domestic product, health care is the biggest single sector of the economy, and it's consuming a larger and larger proportion every year. According to CBO projections, health care will account for 25 percent of GDP by 2025 and 49 percent by 2082. That's simply unsustainable. Any plan that reforms health care has to do more than simply cover the uninsured. The nation's health and wealth depend on it.Image of Myth Busters Jamie Hyneman and Adam Savage via Flickr user Rob Lee, CC 2.0
