A primary contributor to Costa Rica’s success has been its focus on the well being of its people.  For Costa Rica, health and education are priorities for the success of their nation.

The attention to health has brought this middle-wealth country’s health indicators in line with those of OECD countries.[viii]  In 2001 the average life expectancy at birth in Costa Rica was 76.6 years.[ix]  In 2000, 97% of births were attended by skilled professionals, 89% of the pregnant women were given prenatal care, and 93% of children under 1 had health insurance.[x]  From 1990 to 2000 life expectancy increased by 0.8 years, the fertility rate dropped, and the population grew due to an influx of Nicaraguan immigrants.[xi]  In 2000 there were 16 physicians and 3.2 nurses per 10,000 population.[xii]  In 1999 there were 12,000 people living with HIV/AIDS, giving an adult prevalence rate of 0.54%.[xiii]  However, Costa is the only Central American country to provide antiretroviral treatment to all patients through its social security system.[xiv]  The leading causes of death were cardiovascular disease and neoplasms, which is comparable to many OECD countries.[xv]  Spending on health care has increased steadily over recent years, and in 2000 it composed 9% of the national GDP.[xvi]

(report to the Global Economic Council, 2002)

I received an e-mail today from Doctors for America. This group is a “national movement of physicians and medical students fighting for a system in which everyone has equal access to quality healthcare.” I signed up (membership is free) when the “Obamacare” debate was raging to express my core belief in access to quality healthcare publicly. Several other physicians in my group signed up as well. At one point there was a map and we accounted for a large majority of the Alabama membership.

Today’s e-mail (also found on their blog) pointed out that the Ryan health care plan was going to be voted on in the Senate and urged us to contact our elected representative to let out voices be heard. My voice often carries a message at odds with our congressional delegation and I tire of writing to them but I recommend that you read the blog post for yourself. To use their summary of the the high points, if passed (and signed by the president) the new law would:

  • Eliminate traditional Medicare and replace it with a voucher for seniors and disabled Americans to buy their own insurance. Each person would receive a fixed-amount voucher to choose a private insurance plan. The value of the voucher would increase with time, but would not rise at the same rate as insurance premium increases.
  • Cut Medicaid funding for states by turning it into a fixed-amount federal block grant program.  With the block grant program, states that are already struggling to cover Medicaid patients would have to make do with decreased federal help.  The Kaiser Family Foundation estimates that within 10 years, 44 million people who would have been on Medicaid in would not have coverage – that includes children, pregnant women, seniors in long-term care, and the disabled.

The proposed changes in the Ryan budget would:

  • Decrease access to health care.  Seniors, disabled, children, and low-income Americans would lose the safety net that currently protects the health and security of millions.
  • Decrease quality and ineffectively control costs. Vouchers and block grants will not reduce the underlying drivers of health care cost growth. Lasting cost control will come from a transformation of the ways we deliver and pay for health care. It will not come from simply shifting the responsibility for paying to America’s seniors and most vulnerable.  Many new delivery system reform projects, such as the Accountable Care Organizations and Patient Centered Medical Homes, will work to encourage quality of care (reduced waste, greater coordination, and improved efficiency), rather than the high quantity of care that is driving up health care costs and doing little to improve patient health.
  • Put patients at increased financial risk. Vouchers for insurance premium support and block grants will control federal health spending over time, but they will do so by shifting financial risk and administrative burdens onto state and local providers, families, communities and vulnerable beneficiaries.

President Obama will veto this if it passes. I remain disappointed in our elected legislators who have an opportunity provided by the Affordable Care Act to force health care providers, big pharma, and to a certain extent patients into producing and consuming more cost effective care. If this effort were undertaken, it should lead directly to better health outcomes and less spending on health care—money that could be spent on other goods and services. Instead they are participating in a thought exercise regarding whether or not health care is a commodity that will respond to market forces.

The American public is of one voice. They do not want a change in benefits, and they want someone else to pay for those benefits. If that ends up with me in a defined contribution plan for health care during the most expensive 30 years of my life, I’m moving.

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