Why can't we address the REAL problems in health care costs?

You know, I think that the reason I called this blog "critical nation" is that I believe that the U.S., and specifically I mean citizens of the U.S., are not applying critical thinking to the issues and questions before them. "Critical thinking" does not mean "criticizing", though it may include that. Rather, by "critical thinking", I mean the ability to analyze and evaluate data, information, and arguments and then come to some conclusions. Unfortunately, when it comes to the big issues facing the American public, people fail to ask even the most basic questions when arguments are put forth by the respective sides. Therefore, we must be a "critical nation". The use of the word "nation" is intentional as it implies the people, rather than just the government or other leaders.

So, I suppose we should start with one of the most complex and yet most important issues facing the U.S.: health care. We spend more of our GDP on health care than other modern Western countries yet, by almost all measures, our health care is worse than most modern Western nations. What gives? Well, there are lots of answers to that, but I don't want to address that point.

Instead, I want to ask: how do we improve health care coverage without blowing the economic bank on health care? I bring this up in response to a Washington Post editorial that addresses the most serious problem in the rise in health care costs: the costs associated with catastrophic care.

Republicans love to argue that health care costs have risen so much due medical malpractice claims that have gone through the roof. This, of course, they blame on unscrupulous lawyers. Though such lawyers may be unscrupulous and though medical malpractice premiums have risen, the costs of such problems are but a drop in the bucket of overall health care costs.

President Bush has argued that giving people more control over their health care dollars (through health savings accounts, HSAs) would save on costs. The theory is that people don't mind spending tons of money when it's someone else's but will be more judicious with such money when it is their own. Although I don't doubt such a theory, the reality is that it doesn't apply to health care. Bush has suggested that, when spending their own money, people will make sure not to get expensive but unnecessary tests. Sounds great, right? No more "unnecessary tests", which, according to Bush and other Republicans, are the great boogeymen (along with lawyers) of health care. Of course, I have no idea how extensive or expensive such "unnecessary tests" really are -- i.e. do they really contribute much to the astronomical cost of our health care premiums? I have no idea.

BUT, but, but . . . there is a GIANT flaw in Bush's argument. The average American consumer has absolutely NO IDEA whether a test is necessary. Let's say you walk into your doctor's office complaining of some problem. The doctor says, "well, there are a number of possibilities, but we'll have to do tests A, B, and C." So, as the patient, you tell me, which test is necessary? I have my Ph.D. in biology, which probably means that, except for doctors and some nurses, I know more than the average American about basic medicine. However, I can tell you right now that, if my doctor wants tests A, B, and C, I have no idea whether any of them are necessary. So, now, are we supposed to play roulette with our medical care? Is that Bush's plan for saving medical costs? Really, it's just a dumb idea.

The number one reason our premiums are so high is catastrophic illness/accidents. Forty percent of every health care dollar is spent on less than 1% of the patients (I wish I had the link for this). These are the people who have suffered tremendous illness or an accident and, with our highly advance medical system, we put a lot of money and resources into helping them live. So, what should we do about this? Well, there's no easy answer. It's a matter of whether you think we're putting too many resources into advances in this are.

The key is, though, that this is a decision that Americans need to make, but no one has ever presented it to them as a choice: Save money or help people live an extra 6 months. These aren't easy decisions, but people should at least be told the truth and be given the opportunity, as a nation, to make the decision.