By Gerard F. Anderson and Bianca K. Frogner
Health Affairs
November/December 2008
In 2005 the United States continued to spend much more on health care than any other OECD country. In spite of myriad cost containment initiatives during the past thirty-five years, the annual rate of increase in real U.S. health care spending is slightly above the average annual rate of increase in the median OECD country. And the United States experienced the largest increase in the percentage of its GDP dedicated to health care among all OECD countries during 1970-2005. What does the country have to show for this higher level of spending? U.S. life expectancy is lower than would be predicted based on U.S. per capita income. The United States is just as likely to be in the bottom or top half on a series of health indicators. The value per dollar for health care in the United States is further complicated by limitations in access to care; the country is not able to provide universal insurance coverage, despite its high levels of private and public spending per capita. Health reform efforts should focus on improving the value per dollar spent on health care, in addition to other reform goals of extending coverage to all and reducing unnecessary health care spending, so that Americans get the health care system they are already paying for.
http://content.healthaffairs.org/cgi/content/abstract/27/6/1718
Comment:
By Don McCanne, MD
The United States spends far more per capita on health care than any other nation, yet we are obtaining very poor value for our spending. How many times have we heard that? And it doesn’t change.
Although much of the discussion on reform has been on how we can get everyone covered, many in the policy community have cautioned that universal coverage is not enough. We need to introduce reforms that will result in a high performance system.
Some have used this to dismiss single payer as being inadequate because it only expands coverage without addressing the serious deficiencies in our health care system. Nothing could be further from the truth. Single payer not only covers everyone, it also creates our own public monopsony, or single purchaser of health care services and products. The single payer system, functioning as our own purchasing agent, finally would be in a position to demand value for our health care investment. We will never receive that from the private insurance industry, even though we have given them over half of a century to try to provide us with value.
We’re paying for a high performance system. It’s high time that we get it.
