By Jack Markowitz
FOR THE TRIBUNE-REVIEW
Sunday, December 15, 2002
For astronomical numbers, there’s no reason to look beyond earth. The head spins perfectly well contemplating health care in the United States, increasingly called a “crisis.”
We are spending $1.5 trillion on it this year, 15 percent of gross domestic product. Two decades ago, it was 8 percent. We outspend every other country in the world to stay — but more often to get — well. Five percent of us, when sick, generate 60 percent of the bills.
The cost approaches $5,000 a year for every man, woman and child, even though 42 million of us go out into the risky day without a dime of medical insurance.
Meanwhile, the average new doctor graduates from medical school $125,000 in debt, and veteran docs are retiring early as never before. Malpractice premiums are killing them. On the other hand, medical errors kill an estimate 500 people a day in this country, while our lawmakers drive up insurance costs by “mandating” more coverages that their voters want. Prescription drug subsidies are just over the horizon.
There’s a sense that something’s got to give. What if it should prove to be freedom?
Don’t think socialized medicine died in the defeat of Hillary Clinton’s 1993 national health scheme. It gets stronger legs every day under a new euphemism: “single-payer insurance.” The single-payer being the government. Meaning the taxpayers. All would pay for all under the illusion that insurance for everybody can somehow be “free” for the needy.
The University of Pittsburgh and Pfizer Inc. recently aired some of these paradoxes at a “mini-medical school” for members of the public.
Hospitals “make a lot of money at the end of life,” Jeffrey A. Romoff bluntly pointed out. “We make no profit on prevention.”
Romoff is president of UPMC Health System, Pitt’s medical offshoot that’s now the region’s largest employer: 36,000 jobs, 20 hospitals, annual research funding of $250 million. Next step for free marketers, he suggested, ought to be to recruit manufacturers of pharmaceuticals and medical devices. But marketplace solutions will appeal less in the giving of care itself. Consolidations of hospitals will continue (“the big are eating the little”) and medical insurance providers, even if private, are apt to come down to an oligopoly of “3, 4 or 5” giants.
Dr. Arthur S. Levine, dean of the Pitt medical school, said 75 percent of health care costs stem from “preventable illnesses” rooted in negative habits and life styles. If we’d all draw up “living wills” to discourage hopeless treatments for terminal illnesses, he said, the country might save enough “to insure all the uninsured.” Genetic research offers the hope of getting at 5,000 to 10,000 “targets” in the human cell to fight disease. All drugs currently on the market have only 300 such targets.
Among the forces driving health costs higher, Professor Judith R. Lave cited a backlash against 1990s-style managed care. But the aging population, although often blamed, does not seem to be a major factor. Baby boomers are no slouches as medical consumers.
By 2010, health care looks to absorb 16 percent of an ever larger GDP. This may be scarier than it sounds. We are, after all, a service economy; manufactured goods take fewer of our dollars. And some health costs are under personal control, by way of personal habits.
The “crisis” may turn out to be this: Can the values of free markets and personal liberty keep that single payer out of our lives?