Health care system still in crisis

Four years after passage of reform, it’s clear the U.S. has a way to go. ANALYSIS

ST. LOUIS POST-DISPATCHJanuary 6, 2014 

ST. LOUIS — When federal lawmakers agreed in 2010 to pass the Affordable Care Act, they recognized that the U.S. health care system was in desperate straits.

Not only was the cost of health care significantly higher than in other industrialized nations, but Americans were among the unhealthiest populations in the Western world.

In the years since the Affordable Care Act was passed, the growth of health care spending has slowed, but it is still climbing. And despite higher costs, Americans’ health outcomes have not significantly improved.

“Other wealthy nations achieve longer lives, lower infant mortality, better access to care and higher care quality while spending far less,” states a January 2013 report by the nonpartisan Commonwealth Fund.

The Affordable Care Act was never intended to immediately halt these basic trends: improving health outcomes and quality of life while cutting costs is a tall order. But the nation’s volatile, partisan debate over what is known as Obamacare seems to have missed that point.

The stalled rollout of HealthCare.gov, intended to increase Americans’ access to health care by subsidizing coverage, has bolstered the new law’s opponents, including Sen. Ted Cruz, R-Texas. Cruz has blasted the federal mandates on health insurance policies and vowed to “repeal every syllable of every word of Obamacare.”

“The most simple rule of economics is there ain’t no such thing as a free lunch,” Cruz told the Texas Tribune in 2012 when he was running for Senate. “Everything you mandate that an insurance policy cover drives up cost, which means there are more and more people that can’t afford to get insurance.”

But where does that leave us? Regardless of how you view the overall merits, regulatory strictures or societal costs of the ACA, consider these facts:

- In the United States, health care spending eats up nearly 18 percent of the gross domestic product, which is the sum of all goods and services produced in the country. This figure could reach 21 percent by 2023.

- On average, the United States spends twice as much on health care per capita, and 50 percent more as a share of GDP, compared to other industrialized nations.

- Americans, whose life expectancy is about 78.6 years, live shorter lives than their counterparts in Western European nations.

THE POOR’S HARD ROAD TO GOOD HEALTH

Statistics are worse in poverty zones. The shortage of primary care physicians is felt the hardest in inner cities and rural areas, where uninsured residents and those enrolled in the Medicaid program have a difficult time getting doctor’s appointments.

The infant mortality rate in Pemiscot County in Missouri’s impoverished Bootheel is about 14 percent, according to the Delta Regional Authority.

“The poor in America, compared to other industrialized nations, don’t get as good care, don’t live as long and are more likely to die younger,” said Thomas McAuliffe, a policy analyst for the Missouri Foundation for Health.

INSURANCE NOT A PANACEA

One of the primary aims of the ACA was to decrease the percentage of uninsured Americans as a first step toward providing affordable health care for all. Studies have shown that adults with insurance are more likely to visit a primary physician, receive preventive care, stay healthy and live longer lives than those without coverage.

According to the U.S. Census Bureau, roughly 50 million Americans were without health insurance coverage in 2011.

Federal health officials hope that millions of Americans will buy a health plan on one of the new exchanges because of the law’s “individual mandate” to become insured or face a governmental penalty.

But the Massachusetts health reform experiment — nicknamed “Romneycare” because it was spearheaded by former Republican Gov. Mitt Romney — has shown that access alone to health care is not a panacea for fixing a broken health care system; it is only a first step. Seven years after mandating near-universal health insurance coverage for state tax filers, Massachusetts is still struggling to contain spiraling health care costs.

AN OUNCE OF PREVENTION

The U.S. health care system excels in treating patients in crisis, such as those suffering heart attacks or cancer. But physicians have a much more difficult time preventing or treating chronic diseases such as diabetes and heart disease — two conditions that are often related with obesity.

Cardiology labs and cancer treatment centers are huge profit centers for hospitals. Medicare and private insurers pay top dollar to specialists who save or prolong the lives of patients in crisis, but much less to primary care physicians.

Heidi Miller, a primary care physician with St. Louis-based Family Care Health Centers, said the best path to lowering health costs is to reduce the number of emergency room visits and hospitalizations by investing in primary care.

“We’re focusing (as a society) on end of life care, rather than keeping people healthy,” Miller said. “There needs to be greater parity in reimbursement for talking to patients, engaging them, motivating them, winning their trust. It’s that trusting relationship that causes them to make healthy decisions.”

Thomas Getzen, a Philadelphia-based health care consultant and executive director of the International Health Economics Association, said investing in primary care is “a sensible move in the right direction,” but it’s not a cure-all. “This is complicated stuff. No single initiative is going to do it.”

Even if the ACA’s rollout had been executed perfectly, Getzen and other analysts say, the new law would not have lowered the nation’s health care costs or solved its fundamental health issues.

The Institute of Medicine has concluded that, to improve the nation’s health, the government also needs to invest in preschool care, nutrition programs, assisted living for the elderly and other efforts to help the poor.

Two-thirds of Americans are either overweight or obese. Young Americans may comprise the first generation whose lives on average are shorter than their parents’. But it’s not easy to stay fit, especially if one is poor, when “junk food” is heavily advertised and is often the most affordable food.

“There are some easy answers, but all the easy answers are really difficult,” said Getzen, stressing the economics of lifestyle choices. “All we have to do to get people healthier is have people eat better and exercise more. … This is going to be hard work.”

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