Our health’s in jeopardy: Current system doesn’t hold the answers

Let’s look at health care reform, “Jeopardy” style. Here’s the answer: “It’s a health care system where some people complain that they pay too much for care, some complain that they have to wait too long for treatment, and no one is completely satisfied.”

Buzz all you like, and give any answer you care to, they’re all correct. The only certainties in the current health care reform debate are that no matter how it turns out, someone will be unhappy with it. But you’d also be correct if you rang in to remind us that this is also the system we have now.

Americans have a unique world view; we’re like the classroom of school parents who all want the “My Child is Above Average” bumper sticker.

We have an amazing ability to overlook the flaws in ourselves while focusing on the imperfections of others. We all believe we’re “above average,” whether we’re driving a car, singing karaoke or taking IQ tests.

When it comes to health care, we run into the same thinking. When the World Health Organization last ranked worldwide health care systems in 2000, the United States scored first in “level of responsiveness” — we tend to be ahead of the curve when it comes to adequately tackling new challenges. (The current efforts to create a “swine flu” vaccine are a good example.)
But we also ranked first in health expenditure per capita — clearly leadership comes at a price.

Where the United States fails — and the main reason a system that spends the most and responds the quickest can fall to No. 37 overall in that WHO report — is that our overall health levels rank 72nd in the world. How can that be? Because most of us spend more time debating the health care of others and less time taking care of ourselves. (At last look, 30 minutes of waving a protest sign doesn’t count as aerobic exercise.)

We’re a fat country — and I’m not just talking about waistlines. We have a fat health care system that has ballooned by doing nothing more than expanding itself to fit the framework we’ve created. And much of this bloat has been allowed because not enough of us have stopped to look at the life cycle of our own health care dollars.

The best place to start is at the beginning. Out of every paycheck, those of us with insurance contribute pre-tax dollars for premiums. Our employers usually kick in some percentage as well; that money also comes off the books at tax time. So from the start, we’ve created a system of “subsidized” health care where every day is a tax “holiday.”

Compound that “discount” with the fact that we never actually see the money (it comes out before we get our checks), and it’s easy to lose track of what we’re actually paying each month.

Within this framework, it’s easier for health insurance companies to raise premiums year to year, because we don’t notice them much, so long as our cost-of-living wage increase is enough to keep our paychecks the same. In fact, we probably wouldn’t even be having this conversation now if the economy hadn’t turned and flat hadn’t become the new raise.

Now, in the hands of the insurance companies, 20 percent of those premiums go to overhead (compared with 3 percent for the government-run Medicare program). Those costs cover expenses including: corporate jets, administrators hired to deny claims and kick people out of the pool, and advertising and lobbying — including the costs to ship “protestors” around the country to disrupt town hall meetings.

That’s a lot of money being spent on things other than care.

Now move up a layer and look at prescription drugs. While we’re charged more for them than other countries, we don’t feel it because we don’t really pay for the drugs — we just pay our standard co-pays. I won’t deny that some of that extra cost does serve as payback for the companies’ initial layout in research, but too much of it also goes to television ads letting us know (all too often) that no matter what ails us, there’s a pill to cure it.

So, we live in a country where we eat Twinkies on the way to the political rally. And then take Lipitor when our cholesterol gets too high. We have a responsive system, but it’s mainly solving problems we’ve created for ourselves.

You may not like what’s passing for reform in the debate, but if we stop and look at where we are now, I’d say the current American way of doing business is putting us all in jeopardy.

Clements’ column runs every Monday on the editorial page.