Monday, May 31, 2010

Why are they Changing Health Care?


          Recently I was in a university math class when the boy beside me made some snide comments about my Canadian health care, punctuated withsome ill informed statements about the current American health care reform. This rather annoyed me as I was aware of some rather abysmal facts about the previous United States health care system.  That is the event which inspired me to investigate more closely the United States Heath Care System, its benefits, its shortcomings, and the newly introduced health care system.

          We are all aware of the benefits of health care, or at least we would quickly be if we did not have it.  Any health care is good health care, but our goal is not to have adequate health care, but the best possible to ensure a high quality of life.  In this publication I will examine some of the current health care problems, many of which this new system was, and is, being designed to correct.  This hopefully should allow you to understand why such a health reform is in process, and what issues need to be addressed.

          This publication is not meant to examine Obama's health care, or the United States health care in general, it was designed solely to show some of the reasons why a change is necessary or logical.  The United States has one of the best health care systems in the world. I am showing some statistics that focus in on why the United States needs to continue to reform, while doing so I am not focusing on the currently working programs of the United States health care except as they related to the negative ones.

PRICE

Something commendable about the United States Health Care is that they are not skimping on monetary support.  The United States spent 17.3% of their gross domestic product (GDP) in 2009 which is up from a little over 13% in 1999.   That is a rise of about 30% in the last ten years.  It is estimated that by 2017 the GDP percent will have raised to 19.5% a 3% rise in 7 years.  That's a total of $2,466,336,000,000 (2.5 Trillion) or $8,000 a person (307 million people in the USA).  There are a minimum of 15.3% of citizens uninsured (22,933,893) (excluding illegal citizens who still get emergency care).  So in reality the average American pays ($2,466,336,000,000 / (307,000,000(US POP) – 22,933,893(Uninsured))) $8,682 annually. That is 20 %( 2003 stat) of the long term American earning average of 43,000 a year.





             This amount of money in comparison to other countries is exorbitant. The next closest contender is Switzerland at a little over 11%, which would have to increase its price by 40% to match the United States GDP output towards health care.  It is 60% more than Canada's cost.

            Now heath and quality of life should be worth that money right?  So if the US is spending head over heels more than any other country then there should be Rudolph Giuliani stated "the best medical care in the world". And this could very arguable be true for the top medical centers in America but as the New York Times declared "the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care".



INTERNATIONAL OVERALL RANKINGS

            The World Health Organization preformed an assessment of the level of health and health care in countries around the world.  According to this study the United States Rates 37th in the world out of 191 countries, which is on the outside of the top quarter for overall health care system.  This was assessed by several factors.  Of those factors the funding and responsiveness significantly boosted this mark while the overall health in the United States and the fairness in financial contribution drug the mark down.  The following are the categories and ranking.










CategoryRank out of  191
Health Level24
Health Distribution32
Responsiveness Level1
Responsiveness Distribution3-38
Fairness in financial contribution        54-55
Overall Goal Attainment15
Health Expenditure per captia1
Overall level of health72
Overall health system performance  37

            Other notable countries rankings are:








CountryOverall Rank
France1
Italy2
The United Kingdom18
Canada30
Australia32
Chile33
Cuba39

            A second study done by the Common Wealth Fund compared with five comparable countries  (Australia, Canada, Germany, New Zealand, the United Kingdom)  the US ranks last (if GDP spending is not taken into the equation), or second to last (if GDP spending is taken into the equation as a positive).  From the Common Wealth Funk:

"Among the six nations studied—Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2006 and 2004…The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance…The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance"


CHILD CARE

            The association "Save the Children" published a report called "The State of the Worlds Mother Reports" where it gauges the combined and individual health care quality of care for mothers and children. The United States placed 28th out of the 43 in the "tier 1" countries overall ranking. Below is a listing of key developed countries in the weighted ranking system which I  have abbreviated.



Following are some comments from this study regarding the low United States ranking






"One of the key indicators used to calculate well-being for mothers is lifetime risk of maternal death. The United States' rate for maternal mortality is 1 in 4,800 – one of the highest in the developed world. Thirty-five out of 43 developed countries performed better than the United States on this indicator, including all the Western, Northern and Southern European countries… A woman in the Unites States is more than five times as likely as a woman in Bosnia and Herzegovina, Greece or Italy to die from pregnancy-related"
"At this rate, a child in the U.S. is more than twice as likely as a child in Finland, Iceland, Sweden or Singapore to die before his or her fifth birthday."
"Only 61 percent of children in the United States are enrolled in preschool – making it the seventh lowest country in the developed world on this indicator."
"The United States has the least generous maternity leave policy – both in terms of duration and percent of wages paid – of any wealthy nation."
"The United States is also lagging behind with regard to the political status of women. Only 17 percent of seats in the House of Representatives are held by women, compared to 46 percent of seats in Sweden and 43 percent in Iceland."
          On the official United States of America's Central Intelligence Agency (CIA) the United States ranks 48th lowest infant mortality rate at birth with 6.7/1,000(2008) which is high comparative to other systems.  Furthermore is seems to be on the rise from 5/1,000 in 2006. As Medical New Today said:









"…the USA has fallen a long way behind [in the live birth death ratio]."
Below is a list of comparable countries.









CountryRankMortality Rate (X/1000)
Japan42.79
Hong Kong52.92
France83.33
Germany153.99
Australia294.75
United Kingdom324.85
Canada365.04
United States466.26
Russia7310.56


QUALITY OF HEALTH

            The quality of health of a country is a good indicator on the effectiveness of the health care system.  The health care system is specifically to support the people in becoming and staying healthy.  Although ultimately personal health is primarily the responsibility of the individual, the greatest testimony of a user system are the users.

     We have seen in the above health care assessment study that statistically the overall health of Americans ranks 72nd in the world.  As an established nation when we think of health we may firstly jump to the thought of weight, as that is the most common ailment in our society, this is a big contributor to this number but if this were the sole factor the united states would be ranked 191 out of 191.  The rank of 72nd is abysmally low for an established nation, this is below many south America countries, and is on par with Iraq.
            
Body Weight

    Having said this, statistically 30.6% of Americans are obese (Meaning that they have a BMI (body mass index) greater than 30 Kg/sq.meters).  This is over double the international average and the highest percent in the world.  It ranks high even in comparison to its immediate neighbors Canada and Mexico; Canada being ranked 11th at 14.3% and Mexico being ranked 2nd at 24.3%.

What is more is that a good majority of Americans are overweight (67%), making it the norm.  Possibly more disturbing is the rise of child obesity currently at 17%.  Being overweight makes it more difficult and more expensive to get health care.  It leads to a spectrum of illness and conditions, which brings down the overall health of the American people.  Although we cannot say that medical care is to blame on these statistics, it does shoulder a portion of the blame. What is clear is that what we are doing is not working, and it is not getting any better.

When it comes down to it, controlling weight is up to the individual, which means what has to change is the mentality.  This focus can start on a national level with health care. There is hope that in the new health care will focus more on child obesity, rising awareness, and getting doctors to focus more on keeping the citizens healthy.  With this focus in school, with regular check-ups and evaluations it is hoped to change the American mentality on weight.











Smoking

Aside from weight and the associated complications therein, America still has several health issues that it is trying to resolve.  One of these is smoking.  An article from "America's Health Rankings" summarized the recent efforts to cut smoking out of the American lifestyle:

"Despite focused efforts, nearly one in five Americans [or 21%(2003)] still smoke, which is only 8 million people fewer than 20 years ago."

Although this number may seem high to some, and the decrease of habitual smoking depressing, the percent of Americans that smoke is below the international average of 24%.  It is ranked 44th highest female smoking rate and 115th highest for men.  These statistics are on par with most of the established world nations.  Although this is a serious problem in the United States it has little to no negative effect on the overall ranked health of the United States in comparison with other nations.

Life Expectancy

As the purpose of health care is to support and encourage good health a great measure of its effectiveness is how long a person lives.  The United Nations publishes a "Human Development Index" which measured the quality of life in selected developed and developing countries.  This index, or ranking is weighted on three dimensions: Life expectancy, Education, and standard of living.

In their assessment of life expectancy they placed the United States ranked 38th highest life expectancy in the world with a life expectancy of 78.2 years (75.6 for females and 80.8 for males). This is above the international average of 67.2 (2005) by 11 years.  Below is a comparison of a few countries and life expectancy.









CountryRankLife Expectancy
Japan182.6
Australia581.2
Canada1080.7
France10=80.7
United Kingdom2279.4
Germany2379.4
United States3878.2
Mexico4876.2
Russia13765.5

  So although the United States does have an above average score, but compared to other economically leading countries, the average is much lower then would be expected.

Below is a graph showing the correspondence between amount paid to life expectation.










Years of Potential Life Lost (YPLL)

Year of Potential Life Lost (YPLL) is a measure of premature death.  It shows the additional years a person would have lived if they had not prematurely died.  It examines the overall expected life expectancy of the desired sample group, then calculating the difference between actually life length and the expected age (Expected Life - Age of Death = Potential Life Lost). To get a country's YPLL you calculate the cumulative number of years lost of a sample size, the total YPLL is generally calculated per 100,000 people. The United States is currently rated the 3rd highest YPLL country with 10%.  Comparatively this is 48% higher than its northern neighbor Canada which has a rate of 6.7%.   Below is some key countries YPLL.









CountryRankYPLL% Compared to US
Mexico16,778+73%
United States34,9620%
New Zealand83,644-36%
France93,459-43%
United Kingdom103,392-46%
Canada113,361-48%
Australia153,118-59%
Japan292,614-90%

A health care should be striving to minimize premature death.  Some may assert that these years are generally not related to health care as much as the United States homicide, suicide, and accident rates.  It is true that the US has an above average homicide rate in established nations, it being three time the amount in Canada.  But in comparison to overall world homicide average, it is much lower with it being only 10% of the homicide rate of Honduras rates.  Although the US has a higher than average homicide rate for an established nation it does not hugely effect the overall YPLL rate of the United States as out of 100,000 deaths only 4.2 are murders, to find the actually effect of murder is on the YPLL you need to multiply this number by the years they lost.  The mean age of murder victim is 27, 51.2 years younger than the US average of 78.2. Thus the YPLL attributed to murder for the US is around 215 years (51.2 X 4.2), which accounts for only 4.4% of total YPLL.

A large percent comes from infant and child deaths, as we have discussed above, but the Majority of the YPLL comes from medical reasons.  Some of those medical fatalities are for reasons that our current medical knowledge considers unpreventable, or untreatable.  But a large portion of these years come from people who are uninsured or underinsured.  45,000 people die a year because they do not have insurance. Many die because they do not receive medical preventive measure because their insurance will not adequately cover the treatments, or because they simply do not have the money to make the copayments to combat chronic illnesses.  I am not suggesting that the majority, or even a large minority, is because of lack of medical care, but a significant number do die due to problems with health care.  Below is a graph showing the breakdown for premature death. Keep in mind that this accounts for reasons of death and not PYLL.










 Death Amenable to Health Care            

To get down to some "real" health care meaty statistics we can look at the extreme topic of death  amenable  to health care, or death that could have been prevented to timely and effective health care.  This is quite simply how many people died a year when they didn't have to.  This is one of the best ways to measure the quality and coverage of national health care.

            In a study published in the peer-reviewed research and commentary "Health Affair" it aims precisely at this topic. The goal of the study was to see how the countries that participated in the World Health Organization's health care ranking system would be ranked if all the other factors were stripped away and all that was left was death amenable to health care.  The way this is tabulated is that they took the World Health Organizations constructed list of ailments or conditions that can generally be treated at their corresponding ages by proper health care attention.  Then they took the countries with highest quality mortality documentation and plugged it into the list that was constructed. Then they received the list of people that hypothetically could have been saved if they had access to proper medical care at the proper time.

 So how does the US stack up against the other countries?

The following are the statistics from 1997 – 1998 study a little more than 10 years ago.

 The United States is on the lower quadrant of the graph, but from statistics that we have already seen this is not a big surprise.  Overall it is not doing all too terribly but is only a little behind the average.

The following are the statistics from 2002 – 2003 only 5 years later.









            An important note is that everyone is decreasing in deaths  amenable to health care, this is a good sign, and it means that we are continuing to hone our health care systems and techniques.  The average improvement of any given country in this graph is 16%.  If we look at the United States though we notice that it only decreased by 4%, a much lower rate of decline than any other country on the graph. What is more it is now has the highest mortality rate  amenable to health care out of all of the countries listed.  So apparently this can tell us that the Health Care system is considerably underperforming in comparison with other developed countries and what is more, is that it is not significantly improving. The United States could take a couple leaves  out of the other countries books when it come to health care.







                    The major contributor to these low number is that all those other developed countries have universal health care whereas the United States has been working off of privatized health care, where money talk;   If you have the money to pay for health care you can have the some of the best health care in the world.  But if you don't, well then you can come to the hospital is you are dying, but don't expect too much.



COVERAGE 

The narrow coverage of the United States health care is the source of the majority of negative attention in international health comparisons.  The U.S. Census Bureau estimates that 45.7 million Americans (15.3% of the total population) have no health insurance coverage. The Commonwealth Fund published an article in Health Affair that states 16,000,000 (16 million) (5.3%) (2003 statistic) Americans were underinsured.  That is a huge percent! One in every five Americans have inadequate insurance.

The following are some statistics retrieved from surveys:








"Among adults surveyed in the U.S., 37% reported that they had foregone needed medical care in the previous year because of cost… 42%—among those with chronic conditions"
"19% of U.S. adults surveyed reported serious problems paying medical bills, more than double the rate in the next highest country [in the study]."

Mental Health









In one study the United States dominated a study of 14 countries in prevalence of mental illness at a rate of 26% of the population is mentally ill, or will be diagnosed as such.  This could also be linked to diagnosis practices and effectiveness for less developed countries, but for established countries it is fairly accurate.  A look to Canada shows an estimated 20% that will suffer from mental illness, this is still a 30% lower rate than the US, but it is much higher than the other countries in the study. There is currently a lack medical coverage for mental health. It is estimated that less than half of those suffering a mental illness receive treatment for it because of lack of access to care or because of stigma. This leads to more and more serious conditions then if they would have received health care in a timely and efficient manner.

The Medically Uninsurable and Underwriting

With privatized medicine it isn't focused on the people as much as it is about the money. It is a business and a competition. In most states the people go through a medical screening process called underwriting.  This is essentially the policy that the private medical country has the right to deny coverage based on the health information provided, and also to set the rate of the premium. This is to ensure that the company makes a profit off that plan. All in all it is an investment and a gamble.  The Medical Insurance is betting that you will pay more money in then you will get out, while you are betting against those odds.  Because of this practice there are some people out there that insurance companies will not bet on, and thus they are labeled as "uninsurable". These are those who are not able to get health care anywhere because of preexisting conditions. Disease is a big part of the factors that keep these people uninsurable but also common ailments such as acne or being overweight or underweight.  An estimated 5,000,000 in America are considered uninsurable because of preexisting conditions.

A survey of a large company showed that 13% of all applicants were denied plans, out of the 87% that were accepted 22% were offered higher than average insurance rates, which the other 78% received regular rates.  Insurance acceptance rises correspondently with age, thus it will be easier and cheaper to have insurance when you are young, as the insurance companies see it as a easy bet.










SOCIALIZED MEDICINE AND HEALTH CARE

          As discussed in my previous post "Propagating Propaganda", a way to manipulate people and their ideas is to latch on words with negative connotations to influence the people to reject the idea, not based on content but based on association. It comes from the human desire to put everything into a box. If you can link negative images and emotions in the mind of a person the object then becomes associated in negative ways. The government constantly uses this in even small ways such as changing "The Department of War's" name to "The Department of Defense". In our minds we associate war with negative emotions, and defense with positive emotion.  We see war as bad and defense as good, even though the functions of the department didn't change the thoughts, emotions and connotations changed because of the change of name.  It gets placed in a different box because of the title we give it.

           During and post World War II there was and is a huge communist scare.  There were many people calling others "communists" as a dirty word, a way to label people.  Communism in general is not inherently evil; if it were conducted purely it has many, many good effects and very few negatives.  The obvious problem in the soviet system was that it wasn't being conducted that way, and as far as we know there have been no successful communistic societies.

           Universal health care is the focus of pejoratively.  It is labeled unaffectionately by many Americans as socialized health care this to predispose the people against it.  The term first came around to public usage to employ this propaganda method against Harry Truman's health care initiative in 1947.

 Universal health care goes back to the Germans who introduced a universal health care in 1882.  Britain constructed their universal health plan in 1911. Most other developed nations adopted it shortly after World War II concluded as a result of the Universal Declaration of Human Rights. This article was presented by the United Nations to set a standard of rights that everyone is entitled to.  In it was discussed the right of life, the right of equality, the right of freedom, the right of non-discrimination,  the right of presumed innocence, the right of privacy, and several other fundamental issues that were not observed during World War II.  It was signed by the majority of developed countries at the time.  The United States did not ratify the 25th article which states:

  1)Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

           For this cause at this time most of the developed countries adopted universal health care, which generally greatly improved the general health of the countries.

           Despite what may be said about Universal health care, it is the most widely used health care system in developed countries; it has and is replacing the privatized medicine.  The top ranked (according to the World Health Organization's ranking) medical care countries are all using universal health care.

Below is a map from Wikipedia made before the new United States health care decision which shows the prevalence of universal health care. Both blue and green are Universal health care systems where grey are other systems or where there was no data available.









CONCLUSION

How much is a human life worth?  Having discussed this topic with many Americans due to the current reform, and the propaganda spread about universal health care, in particular Canada's health care, I have noticed a prevailing selfish attitude among the majority of people.  Many get angry that they would have to pay for someone else to receive health care. The health care in the United States is catered for the rich while is buries the poor. According to the statistics for 2002-2003 there around 337,700 people that die every year that don't have to, that is the size of New Orleans. The American people are griping about paying less to save more lives, not because of the price, but because that means they feel they are paying for indolence, that they may in the process help someone who doesn't deserve to be helped.

 Where is the most expensive medical work preformed? The hospital. The United States public is already paying for the health care of those uninsured and underinsured by the means of hospital bills. Rather than these people getting the preventative measured they need they are forced, or choose, to go without because of the exorbitant price.  In a few months they will get the care they need from the hospital staff, but you can bet this far down the road it will not be their last visit.  At this point they will need to make regular stops at their hospitals, they will not able to secure health insurance, and will be caught in the rapid whirlpool of health care with no hope of escape.  As the platitude rightly states:

"An ounce of prevention is worth a pound of cure."

Out of the federal budget (not GDP) the United States spends 23% on the Department of Defense, formerly the Department of War, which for 2011 has a predicted budget of $1.003–$1.223 trillion $1,223,000,000,000.00.  That is about $4,000 a person. Maybe instead of sending off trillions of dollars to other countries to fix their governments, the United States should look to fix their own first.  Instead of spending their money on guns that are in part responsible for the 5,400 Americans that have died in war this past decade and 120,000 Afghanis and Iraqis, maybe it should be spend in saving the lives of the (estimated) 3,377,000 Americans that, in the same amount of time, died unnecessarily due to the inefficiency of health care. 



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