What it's worth
Jan 18,2008 00:00 by the St. Louis Post-Dispatch

Voters and politicians talk a lot about health care reform these days, usually about reducing the number of uninsured - 47 million Americans and growing fast.

Reducing those numbers is important, but it's just one piece of the very complicated puzzle that is health care in America. Indeed, reducing the number of uninsured may be the easiest part of the puzzle to solve. Whether the system that emerges involves Massachusetts-style coverage mandates and tax credits or expands existing programs such as Medicare, the bottom line on covering the uninsured is money and the political will to spend it.

Two other major health care challenges in the news last week merit immediate attention. Both are arguably bigger problems than covering the uninsured and harder to solve.

- Total cost. A new study shows Americans spent more than $2.1 trillion on health care in 2006. That's almost as much as China's entire overheated economy - the $2.5 trillion economic output of all of China's 1.3 billion citizens - was worth in 2006.

The $2.1 trillion we spent is just 16 percent of our overall economy. But even compared to other Western nations, we spend a lot. We spend more than twice as much per person as most European nations.

Health spending is growing faster here than in most of the developed world. It jumped by 55 percent between 2000 and 2006, and by 87 percent between 1997 and 2006.

In the past, few Americans, at least those with health insurance, spent much time thinking about it. But the country's skyrocketing medical bill is, indirectly at least, driving most voters' anxiety about health care. It leads to higher health insurance premiums, which is where the big picture gets painfully personal.

The cost of group coverage provided by businesses to their workers jumped 78 percent between 2001 and 2007. That's led many employers to stop offering insurance. Those that still do have shifted more costs onto workers. After inflation, families' out-of-pocket health care spending - co-pays and deductibles - grew by 16 percent between 2001 and 2004. Add families' share of insurance premiums and it jumped 21 percent. That's money you don't have for other needs, particularly since wages grew just 19 percent between 2001 and 2007.

If those extra costs paid for better quality care, the costs might be worth it. But another study published last week raises serious questions about that. That's the second big intractable problem.

- Quality of care. Medical care provided by American doctors and hospitals is often among the best in the world. But sometimes it's not, as has been noted in many studies including several from the Institute of Medicine, part of the National Academies of Science. Spending more is no guarantee of better care.

A new study, published last week by the Commonwealth Fund, found that the United States had the highest preventable death rates among 19 Western nations. That's even worse than a similar study done in 1998, when we ranked 15th.

"Preventable deaths" is a broad category that includes childhood deaths from diseases that could be prevented from vaccination; deaths among younger adults from certain forms of cancer; and deaths from strokes, vascular disease, diabetes and some kinds of heart attacks that could have been avoided with better preventive care.

In other countries, preventable deaths fell by an average of 17 percent in men and 14 percent in women. In the United States, they fell by only 4 percent in men and about 5 percent in women.

The rate of preventable deaths in our country is 43 percent higher than in Canada and a humbling 69 percent higher than in France, which had the lowest rates. If our country met even the average rate among Western nations, 75,000 fewer Americans would die each year.

Yes, we should cover the uninsured. But real reform won't be possible until we address how much we spend on care and what we're getting for it.

Reprinted from the St. Louis Post-Dispatch – CNS.