My son is a junior in college and he tells me that his generation is worried. They are well aware that most growth in real income has gone to the folks that already have most of the money. In fact, he has been somewhat insulated from this as the son of a physician.  It seems that the money has been transferred from the average American’s pocket into the pockets of those of us who provide heathcare (as quoted by Kaiser Family Foundation):

Since 1999, the cost of health insurance provided by an employer rose on average by 160%. In roughly the same time frame, the median household income, after adjusting for inflation, fell by 8.9%. Those two figures, both released in the past two weeks, are connected more than people realize.

As I have spent a lot of time and effort describing (here and here, for example), we as a country spend a lot of money on health care and have relatively  poor health to show for it. Now that a possible candidate for the Republican nomination for the presidency has a little weight problem, once again American obesity is being blamed on our health care costs. Although I tire of putting these words to paper (or blogosphere), while obesity is a problem, preventing obese Americans from accessing our health care sustem is not the answer to our health care inflation.

A big part of the problem is that accessing the health care system is not an activity amenable to the insurance model. As posted on PNHP:

Insurance is a great mechanism that people can use to offset their risk of losing some material thing of great value like their house, boat, car or jewelry….

But for something that is predictable, ongoing, needed by everyone, or necessary for the welfare of our community, an insurance model makes absolutely no sense.l…

We know that almost everyone will eventually need some health care and much of it will be ongoing. For a defined population, the health care needs are predictable, and we know that the health of individuals affects the overall welfare of our community. In addition, most believe that people should get treated for illnesses, diseases and injuries that might befall them and expect that everyone should have access to preventive services like prenatal care and immunizations that make our communities a healthier and better place.

A second problem with the blame the victim mentality is that although some costs are predictable (based on certain identifiable risks including weight), most are not (per KFF):

While discussions about the costs of health care often focus on the average amount spent per person, spending on health services is actually quite skewed. About ten percent of people account for 63% of spending on health services; 21% of health spending is for only 1% of the population. At the other end of the spectrum, the one-half of the population with the lowest health spending accounts for just over 3% of spending.

Lastly, it seems that America’s real income has stagnated, her health care costs have skyrocket, and, as Josh Freeman describes, we physicians as a group are guilty of becoming “job creators” by creating demand for unneeded procedures:

A key finding of the study that also supports Goertz’ argument is that [my bold] “Overall, fees paid by Medicare to US physicians for office visits are comparable to those paid by public insurers in several other countries, and fees paid by US private insurers are slightly higher than those paid by private insurers in other countries. In contrast, fees paid by public payers to orthopedic surgeons for hip replacements in the United States are considerably higher than comparable fees for hip replacements in other countries, and fees paid by private insurers in the United States for this service are double the fees paid in the private sector elsewhere .” This is exacerbated by the fact that “In general, Americans are very low users of office visits and relatively high users of hip replacement surgery.”

To my son’s credit, although he is bright enough to get into medical school he would rather work towards a different America. One, I hope, where as health care professionals we give needed care to people suffering from illness, avoid blaming the victim where possible, and all become a little less greedy. Good luck, Henry.

 

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