By Tim Johnson
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“We Americans have the best health care in the world.” That’s what politicians tell us. And if you are (a) wealthy, (b) well insured, and/or (c) have the right connections, you have probably experienced the truth of that statement. But many of us also know people who do not fall into those categories and who have had great difficulty in getting timely, quality medical care.
And as a result of the ongoing and heated debate about health care reform, we also hear that other countries have health care just as good as ours, provide health insurance to all their citizens—and do so at a significantly lower cost. So what is the truth? Do we Americans really have “the best health care in the world”? And if we truly have the best, why does it need reform?
Alas, when the subject of reform comes up, we usually find ourselves awash in a tsunami of political posturing and caustic catchphrases, such as “government takeover,” “market mayhem,” or “death panels”—all of which are calculated to scare the daylights out of us, so we stop thinking about the underlying issues. But we need to start thinking and start talking. I recognize that for most Americans, finding out “the truth” about current problems or possible fixes is virtually impossible amid all the emotionally charged rhetoric. If you’re in that camp, I would like to reach out and help you.
I have reported on health for ABC News part-time since 1975, when I joined a new program called Good Morning America, and full-time since 1984, when I became the Medical Editor of ABC News. Until the late 1990s, the majority of my time was spent on reporting and commenting about new developments in clinical medicine (such as an innovative technique for treating heart disease or a new drug for cancer) and promoting old ideas for good health (such as the importance of good nutrition and regular exercise).
But as we all entered this new century, I became increasingly concerned about the major problems with the way we Americans often receive and pay for our health care. Clearly, some of us have been blessed to receive the best care available anywhere in the world. However, because we don’t have anything that could be called a national “system” of health care in this country, many Americans are falling between the cracks and not getting any care—or getting care that is either inferior or too costly or both.
We do have many mini-systems of health care and insurance programs in this country, such as private medical systems like the Cleveland or Mayo clinics, or public insurance programs like Medicare or Medicaid. However, there is no national system that binds them together in a working whole. And when you’re scrambling to find health care insurance you can afford—when you or a spouse lose a job, when your company decides it can no longer afford health insurance, when a young adult finishes or drops out of school—you are faced with the reality that there is no national plan as a backup or replacement.
During this past decade at ABC News, I began to realize that it was just as important for me to report and talk about health care problems as about new medical developments. Lack of health insurance can be just as deadly as lack of antibiotics, as it is often the cause of delay in getting good medical care.
I also began to realize that most Americans (myself included) had no idea how costly and complicated our health care had become, and how often politicians used rhetoric that was either deliberately misleading or downright false. So I decided that I had to start talking and writing about health care in the same way I have reported on medical discoveries all these years: with honesty and using terms that people could understand. And, quite frankly, I am also motivated to do this on behalf of my children and grandchildren, because they are going to face disaster if we don’t fix the current problems with American health care.
That’s why I have spent increasing amounts of my professional time studying health care in America. And I would like to share with you the most important insights I have gained. Here is an overview.
CHAPTER ONE: THE BIG QUESTION: First, I will explore the exploding costs of American health care and whether or not we get full value for the money we spend. In this chapter, and throughout the book, I will try to pinpoint the factors that have driven up U.S. health care costs higher and faster than in other developed countries.
CHAPTER TWO: THE BIG PROBLEM: What’s the biggest obstacle to health care reform in this country? One of them is certainly our unrealistic expectations as to what our health care can and should do. To put it bluntly, most of us want a gourmet platter of care and services at a blue-plate-special price. And, all too often, we expect top-notch results without any personal effort to improve what we can about our health through such proven techniques as regular exercise or improved nutrition.
I’ll illustrate how those expectations translate into the current gridlock in Congress, and why our politicians don’t dare limit care and/or increase costs for the voters who elect them. This chapter will also introduce the big players—hospitals, doctors, insurers, lawyers, drug and medical device companies, and the media—who create and contribute to the reform traffic jam. Also, I’ll begin to explore the devastating effects of the growing lack of primary care in our country.
CHAPTER THREE: THE BIG FEAR: According to many experts, any truly effective control of costs and improvement in quality in American health care would require more government regulation. But in the current political environment, which plays off understandable fears about “big government” in general and “government takeover” of health care in particular, that idea seems less and less palatable. Nevertheless, I will describe an industry in this country that might serve as a model for a sensible partnership between government and private industry. I will also discuss how the federal government of another major developed country plays an essential role in health care, and how we might learn from that country.
CHAPTER FOUR: THE BIG SERMON: Is health care a right or a privilege? Is there any moral obligation for our nation to provide health care to all? In this chapter I will put on my ministerial collar—I am also an ordained Protestant minister—and explore some of the teachings from my own religious tradition that might speak to these questions.
CHAPTER FIVE: THE BIG PREDICTION: Here, I will be brutally honest in predicting what I think will actually happen to our health care in the long term and what would be needed to truly control costs and improve quality.
Throughout the book, I will also discuss how some of the ideas in the new Patient Protection and Affordable Care Act (usually described by opponents as ObamaCare) might affect our future health care. I will not go into an in-depth analysis of that new legislation, because most of the essential details will certainly change over time. In other words, this book is about essential principles rather than policy details.
My intent is to be as honest as humanly possible about the problems we face with American health care. I have no political axe to grind. I am independent in my political judgments; I vote for the person, not the party. Yes, like any human being, I do have opinions, even biases. But I hope they are informed by facts and figures, not by fables or fiction. You will have to decide for yourself. Now that I am no longer the full-time Medical Editor of ABC News, I can more freely express my opinions on this vital subject.
My goal is to help you understand what I think are some of the most important issues that need to be addressed by any honest proposals to reform our health care. I hope to foster a dialogue that will get all of us—whatever our particular political or social opinions—talking seriously about how we can help to solve the problems we face. So let’s get going.
The Big Question
I begin with what I believe is the most important question that needs to be asked (and answered) if we are ever going to make the right changes for health care in our country. So here it is:
Why does the United States spend more than twice as much per person on health care as all other industrialized countries when, paradoxically, it is still the only one that doesn’t provide basic health insurance for all its citizens?
Think about it: twice as much per person as the average of all industrialized nations. How does that translate into dollars? Let’s look at the health care spending in some other industrialized nations. According to the Organization for Economic Co-operation and Development, in 2008 (the last year for which numbers were available), the five highest and the five lowest per person spenders were:
Top 5 Spenders
United States $7,538
Bottom 5 Spenders
- On Sale
- Oct 12, 2010
- Page Count
- 80 pages
- Hachette Books