Let’s Make America Great
There is nothing wrong with this slogan, but agreement on what this really
means is in question. It seems that the intended meaning is to restrict
immigration, company deregulation, reverse Roe v. Wade, shift more income and
wealth to the top 1%, alienate our former allies, reverse our trend of “free
trade” and provide support to the cause of “white” separatists.
I am not being critical, just stating the facts. Many folks completely
support the aforementioned agenda which is their right. However, when I last
checked, we still have a fairly democratic system and the majority do not support
most of these actions.
Reliable data supports the following shortcomings in our country, if
pursued, have the potential to “make America great again”:
- Quality, cost & availability of Healthcare (We have by far the highest per capita cost and rank 37th in quality of care. At the same time many citizens are not covered0
- An equitable living wage (income disparity and the lack of wage improvement)
- Climate change (mortgaging future generations for immediate gratification)
- The national debt (again we are mortgaging future generations for immediate gratification)
- Infrastructure (repair & upgrades)
- Comprehensive and effective immigration reform
The above is not a comprehensive list, but I contend that
if we pursue them and enact reasonable legislation, we will be moving in a
direction of improving our “greatness”.
The Healthcare Issue Revisited, again….
One of my top soapbox issues is the status of our
broken Healthcare system. It continues to bother me to no end. I suspect that I
will continue to revisit this subject often. Here are a few bullet points that
I hope will garner your attention:
- Our country has by far the most expensive system
among all counties
- In 2018 the cost of our healthcare system was
$11,600 for every man, woman & child!
- The average per capita cost for the EU, Canada,
Australia & NZ was about $3,800 or 3x our cost.
- According to the WHO (World Health Organization) almost
all of these countries deliver a superior healthcare product. (We rank 37th
among all counties)
- We spent $3.8 trillion on Healthcare in 2018 (over 18
% of GDP) making it by far our largest industry. https://www.forbes.com/sites/danmunro/2014/02/02/annual-u-s-healthcare-spending-hits-3-8-trillion/#17694b3a76a9
- The Government pays for less than 30% of this, $1.1
trillion in the form of Medicare & Medicaid. The remainder is paid either
by companies’ insurance benefits or by the tax payer in the form of premiums,
co-pays and for some self-insured it is simply out of pocket. I could not fund
a breakdown between what employers’ pay vs. others.
- The Cost of Medicare & Medicaid is the single
largest Budget Expense at almost twice that of what we spend on Defense and it the major
contributor to the annual deficit.
- Since there are much cheaper and better systems
available to our leaders their inaction levies a very high tax on the tax
payer. I have referred to this as a “hidden” tax since you do not realize that
you are paying it.
Many smaller industries have their hand in our very
lucrative system. For details on those I would refer you to earlier posts to my
blog. The solution is not very complicated and the reason that it will likely
never happen has to do with so much money being made in the private sector.
Again, I would refer you to prior posts on this same subject for the details.
The high cost of health
care can have several negative effects, including the following:
- When the government spends more on health care, the
national debt increases and/or funds available for other programs decrease.
- When people spend more on health care, they have
less money to spend for other things, and when health insurance is paid by
their employer, they are paid less.
- When employers spend more on health care, the costs
of their products and services increase, and jobs may be moved to countries with
lower health care costs.
- More people cannot afford health care insurance.
When people without health care insurance receive health care, they usually
cannot pay for it. As a result, this care is paid for by other people who are
paying into the health care system. Or, people without health care insurance
may not seek care when they need it and thus develop a serious disorder that
could have been prevented.
- Medical bills that are not covered by health
insurance can lead to bankruptcy. https://www.merckmanuals.com/home/fundamentals/financial-issues-in-health-care/overview-of-health-care-financing
Life Expectancy vs HALE
I recently read an ED OP in our local paper that was a reprint from a
publication from a Minnesota paper. The writer was pointing out that while most
EU countries were making positive progress to improve Life Expectancy, the US
has been heading in the opposite direction for several years. The narrative
stated that the CDC has placed part of the blame on drug overdoses and
suicides. I did a bit of math on these areas and discovered that the increases
in these areas has only had a minimal impact. The writer pointed out deficiencies
in our health care system and noted increases in pregnancy mortality &
heart disease, but again these numbers do not even come close to explaining
away the problem.
My opinion is that the issue lies with our broken and extremely expensive
healthcare system in combination with our inability (or unwillingness) to
maintain our immune systems through regular exercise and moderation of caloric
intake. Our healthcare system costs, on average, 2 ½ times that per capita
average for EU countries. Yet, according to the World Health organization we
only rank 31st in terms of quality of care. It is interesting that
this is exactly the rank that the US has with respect to Life Expectancy, again
31st. You would think that since we spend so much on health care we should be
getting the best? I think it important to not be
fooled by Life Expectancy as a true measure of quality. The better measure is
one termed HALE (Health Adjusted Life Expectancy). Following is taken from Very
Well Health: “How Is Healthy
Life Expectancy Calculated? This is a bit complicated and uses lots of different data
sources for each country. In a nutshell, the World Health Organization takes a
country’s data like mortality rates and health status information
and crunches them to look at things like how long people are expected to live
with about 135 health conditions. The calculation looks at the mortality rate
for different health conditions and adjusts it for the duration or severity of
What this measures is
your expectation of a healthy life span, not just how long we can keep you
alive! Again, we fall far behind the EU and in fact we fall to 35th
overall. The difference is significant. Currently our Life expectancy from
birth stands at 79.3, but our HALE stands at only 69.1. Keeping us alive those
additional 10 years is expensive and they are not our best years.
You might be surprised
to learn that the following countries have a better HALE than the US: The
United Arab Emirates, Slovenia, Malta, Maldives, Costa Rica, Chile & Cuba. Our
HALE is equal to that of China.