The Most Basic Goal

Like many other American families, my family health care insurance will have a substantial increase for 2010. So what do the various reform packages do for my family and our future generations? Turn to page 621 of the Senate version, the section entitled "Transforming the Health Care Delivery System," and start reading. Does the bill end medicine's destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers those of us under attack from 20% increases are - - pilot programs!!!

Health-care costs are strangling our country - yet this massive and inefficient year long effort doesn't even meet the most basic goal of containing medical costs. Medical care now absorbs eighteen per cent of every dollar we earn. Between 1999 and 2009, the average annual premium for employer-sponsored family insurance coverage rose from $5,800 to $13,400, and the average cost per Medicare beneficiary went from $5,500 to $11,900. The costs of our dysfunctional health-care system have already helped sink our auto industry, are draining state and federal coffers, and could ultimately imperil our ability to sustain universal coverage.

What do I get by paying more than twice as much for medical care as I did a decade ago? The United States spends more on medical care per person than any country, yet life expectancy is shorter that in most other developed nations and many developing ones. We pay $7,290 per person (we are so out of sink with the rest of the world - Switzerland is #2 at $4,417 per person) with a life expectancy of roughly 78 years. Mexico, yes Mexico of drugs and incredible poverty, spends $823 per person and generates a life expectancy of 75 years. Japan has an average life expectancy of approximately 83 years, while spending $2,581 per person. I buy the argument that some of the apparent differences are social and cultural - - but clearly a huge portion of this is just very basic cost-benefit issues and problems.

Where does the $5,000 difference per person go? Where is the cost-benefit analysis? Where is the value engineering? Where is the input-output productivity thinking? Where is the systems analysis and thinking? Where are the engineers that understand all this?

When, how, where - are we going to meet the most basic goal in our health-care reform crisis?