Niko Karvounis
Health Beat Blog (www.healthbeatblog.org)
December 05, 2007
On Monday the CDC released a landmark, and in many ways devastating, report on health care in the U.S. The report contains a wealth of data that, while not surprising to some, should help silence the dwindling few who insist that America’s health care system is doing just fine. As a public service, I thought it’d be helpful to list some of the myths that the report demolishes (with some help from other sources as needed).
Myth: If people don’t have health insurance or get medical care, it’s because they don’t want it.
Reality: Actually, the big issue with access is cost. According to the CDC report, more than 40 million Americans–almost one in five Americans over the age of 18–have foregone one of the following in the past year because they couldn’t afford it: medical care, prescription medicines, mental health care, dental care, or eyeglasses.
It’s not that uninsured people don’t understand the value of coverage. Last year a study from the Urban Institute found that less than 3 percent of uninsured adults and children have never had insurance or report having no need for insurance. That same report also found that the high cost of coverage alone explained over 50 percent of those cases where people are uninsured
And even when the uninsured cite job-related difficulties as the reason why they can’t access employer sponsored coverage, the problem isn’t just that they can’t get it through work–it’s also that they can’t afford individual policies. (Individual policies are much more expensive than group policies, and in many states private insurers can charge individuals astronomical premiums if individuals have any “pre-existing conditions.) According to the Urban Institute, for 79 percent of adults and 74 percent of children who are uninsured because of job-related problems, the high cost of individual insurance is a major problem.
Myth: The American system relies mostly, if not exclusively, on private enterprise to support health care.
Reality: Yes and no. While the U.S. does have the biggest private sector share of health expenditures in the world, making up 55 percent of our funding, personal health care expenditures (i.e. spending on actual patient care) is mostly public. The CDC reports that in 2005 the federal government and state and local governments combined paid 45 percent of personal health care expenditures; private insurers only paid 36 percent, with 15 percent coming from out-of-pocket payments. So much for the libertarian utopia.
There’s also a bigger public sector coverage presence than many would like to admit. Though two-thirds of insurance policyholders have private coverage, a Census bureau report from earlier this year noted that more than one quarter of Americans (about 27 percent) are covered by government insurance. The American model is much more of a private-public mix than some pundits–and candidates–are willing to admit.
Myth: East coast liberals and the urban poor are the only ones who want a stronger public sector in health care.
Reality: Health care reform is often stigmatized as being something that only socialist, bleeding hearts dream of…But in fact, one particular area that could greatly benefit from a more proactive public sector is Middle America.
The CDC report notes that 4 percent of counties across the nation have no physicians. None. And more than 90 percent of these physician-less counties are non-metropolitan, i.e. do not contain a town of at least 10,000 people. In fact, across the nation only 9 percent of all of the nonfederal patient care physicians in the U.S. are located in these rural counties.
These sparsely populated locales are pretty much where you’d expect them to be: the Plains states and the Southwest (think Texas, the Dakotas, Oklahoma, Alaska)–home to many good old fashioned middle Americans. Initiatives to connect patients in these regions with physicians have come from the government, not the private sector. The FCC, for example, has just selected North Carolina as the first U.S. region to get a grant under the Rural Health Care Pilot Program–a $400 million initiative–to let patients in rural North Carolina connect with the nation’s top doctors over the Internet. The pilot program is meant to provide “underserved communities with a broadband telemedicine network in 42 states and three U.S. territories.”
While this isn’t comprehensive, system-wide health care reform, it is leveraging the public sector to make care more accessible to isolated populations. And as much as critics tend to suggest that rogue liberals are the only ones who want reform, there are plenty of conservative folks across the nation who could benefit from a revitalized public sector making care accessible to regions where the medical market is non-existent. Beefing up the public sector role in our health care system isn’t an insidious big government strategy perpetrated by elites or welfare queens–it’s a way to get health care to the conservative base.
Myth: America has the most and best medical technology of any country in the world, and by God we should use it!
Reality: While the U.S. does rank high in terms of MRI and CT scanners per population relative to most other nations, (27 and 32 units per one million population respectively) our title as most technological heath care system is no sure thing. Japan knocks us out of the park with 40 MRI units and 93 CT scanners per one million people, the most in the world. And, as the CDC report notes, Austria comes close with 29 CT scanners per population and South Korea meets us at 32.
Of course, medical technology is not a game of oneupmanship–and even if it were, this might be one competition we would be better off losing. On November 29, the New England Journal of Medicine published a report from Columbia University’s Center for Radiological Research that raises some big concerns about over-reliance on CT scanners.
“It is estimated that more than 62 million CT scans per year are currently obtained in the United States, including at least 4 million for children,” the report begins, before noting that “CT involves larger radiation doses than the more common, conventional x-ray imaging procedures.” Big doses of radiation are rarely good for the human body, and since the U.S. has become so scan-happy, “it has been estimated that about 0.4 percent of all cancers in the United States [from 1991 to 1996] may be attributable to the radiation from CT studies.” Scale these numbers up for our more frequent CT use today, and “this estimate might now be in the range of 1.5 to 2.0 percent.”
Sure, CT scans do a world of good–so long as we’re giving them to the right people. But “if it is true that about one third of all CT scans are not justified by medical need, and it appears to be likely, perhaps 20 million adults and, crucially, more than 1 million children per year in the United States are being irradiated unnecessarily.” Even if we do someday claim the throne as most technology-rich health care system in the world, the mad rush to use technology just because we have it holds hidden dangers.
So there you have it–a few hard–to-shake myths, some of which are already on their last legs, have been dealt yet another crippling blow by that little thing we call reality.
