The two critical words here are “Health” and “Care”. Health should be understood to mean absence of disease. It should not be defined as access to drugs, tests and treatments. We are healthy when all the major systems of our bodies are working well and in concert with each other. The most efficient and effective approach to health care will focus on the circumstances that cause our systems to fail, and it will seek to remedy these failures.
There is abundant reliable research that concludes that poverty, food insecurity, lack of decent housing and social isolation lead to physical and mental illness. Addressing these underlying economic and social issues affecting Americans today will in the long term lead to a healthier society in the future. Study after study concludes that in the long run, the cost of prevention will effectively and dramatically lower the cost of health care. When we look at research comparing one drug with another and one treatment with another, the hard endpoints are mortality and morbidity. These are generally in the range of 1 to 25% improvement.
There is not a single drug or treatment study that can compare favorably to the results of prevention. For example, cigarette smoking is responsible for more death and disability than car accidents and gun violence combined. It is the leading cause of preventable disease and death in the United States. Smoking accounts for more than 480,000 deaths per year (1 in every 5 deaths). Studies show that quitting leads to a 70% reduction in death and disability, better than any drug or medical intervention. Here are some astonishing figures that assess current health care costs. According to the CDC:
So how do we address the issue of health care? This must be approached as a basic human right, not a privilege. Our current system compared to those in other developed countries falls woefully short in both providing good care and cost containment. The ACA is imperfect, but has moved us closer to what I believe should be a single-payer system. We have learned from the ACA that a system that includes all potential patients will lower overall cost. This is supported by studies by the CBO (Congressional Budget Office) and Rand Health that show a mandate is required.
After the law went into effect, increases in overall health care spending slowed, including premiums for employer-based insurance plans. The ACA fails in two respects: it does not eliminate the burden of profit from the system and it leaves 26 million without coverage. If we believe as I do that health care is a right, not a privilege, and that our government has a moral obligation to protect and empower its citizenry, then we need to move to a system that places people above profit. We have had a system, Medicare, in place since the mid-1960s. That system can be expanded to include all citizens. The private and profit-driven health insurance industry can continue to provide deluxe, boutique health care for the 1% of the population that may prefer it. If we view health care in the greater context of public health and the economy (jobs, business development and growth) and see how this system is connected to all other systems (the environment, national security, and education) we can clearly see there is great opportunity for cost containment and economic growth.