|
Expensive and divisive:
How
America is losing patience with a failing system
Onus on workers to buy health insurance as rising costs force
firms to end perk
By Suzanne Goldenberg in Washington
09/13/07 "The
Guardian" -- -- It's nearing lunchtime and the few
people left on the hard chairs in the clinic waiting room are
glancing at the television hanging high on the wall. In his
examination room, Dr Jamal Gwathney has seen a two-month-old
baby, a young woman with a heart pacemaker and chemical burns
brought in after a fight with the police, and patients with
asthma and diabetes.
But in clinics such as this, just across the Anacostia river
from the great white dome of the Capitol, many of the ailments
have an underlying cause: none of these people have access to
adequate medical care.
"Their healthcare sometimes just takes a back seat to putting
food on the table and a roof over their heads," says Dr Gwathney.
"They don't come in until their health gets to a critical mass -
until they have been having chest pain every day for two or
three weeks, or until they start throwing up a little blood with
that ulcer that they have and it gets them worried."
On the west side of the dome, in the K Street offices of the
doctors profiled in local glossy magazines, medical practices
are moving towards concierge-style care: for an annual fee
topping $1,000 (£500), a trip to the doctor is akin to a visit
to the spa, with appointments on demand, and even the most
trivial ailments investigated by costly tests.
Between the two extremes is where America's healthcare system
has unravelled. A patchwork of employer benefits and government
assistance for the very poor and elderly has produced distinct
differences. Those with very good jobs and generous benefits
packages enjoy extensive, often almost wasteful, health cover.
Meanwhile, tens of millions regularly put their health on hold
because they cannot afford basic treatment, prescriptions, or
even a visit to the doctor.
"We see a lot of things that could have been treated a lot
earlier and even prevented, but they are unable to come in
because they don't have health insurance and they don't have the
funds to pay for it," says Dr Gwathney. He has spent three years
at this free clinic, run by Unity healthcare in a poor, almost
entirely African-American district of Washington. "You have to
have a tough skin," he says.
The disparities seem to have brought America to a tipping point,
and there is growing consensus - among business people,
politicians, and economists - that the time has come for a
change.
America spends more money on prevention and treatment of disease
than ever before, yet it is falling behind on such basic
indicators of health as infant mortality and life expectancy.
The US spends about 16% of GDP on healthcare, a proportion
expected to climb to 20% by 2015, according to the National
Coalition on Health Care. At present spending levels of $1.6
trillion a year, which works out at $6,700 per capita, is double
what is spent in countries such as France. And yet that still
leaves some 47 million Americans entirely without health
coverage, and tens of millions of others under-insured,
according to latest census figures.
It also fails to guarantee a better service to those Americans
with access to healthcare. The US ranks last or near the bottom
on quality, access, efficiency, equity and healthy lives,
according to a report in May 2007 from the Commonwealth Fund,
which studies healthcare.
"The US healthcare system is considered a dysfunctional mess,"
writes Ezekial Emanuel, chairman of the department of clinical
bioethics, in a recent issue of the Journal of the American
Medical Association.
Amy Robinson has known that all her life. She was born with a
kidney condition that required 25 operations by the time she was
eight. But in some ways the financial consequences have loomed
almost as large as the disease.
By the time she was 21, and her kidneys were failing, she was
spending up to $1,400 a month on medication as well as the
dialysis paid for by the state. By 23, she had a kidney
transplant. A year later, despite working two or three jobs to
pay off her medical bills, she was forced into bankruptcy by
debts of up to $10,000. Although the cost of the transplant and
other medications were supposed to be met by insurance and state
assistance, "things slipped through the cracks a lot".
Now 31, she works for a teaching union in Topeka, Kansas, and
although she has insurance, she still spends up to $500 a month
- nearly a third of her take-home pay - on medication, lab work,
vitamins, and doctors' visits.
Hers is a common experience of the chronically ill in America,
especially over recent years as the common expectation that a
good job would automatically include health benefits has been
repeatedly betrayed.
Since 2000, there has been a steady decline in the number of
employers who offer health coverage, particularly among small
businesses. Others are scaling back on the range of coverage. In
part that is because providing health coverage has grown too
expensive, with the lack of regulatory controls encouraging a
steady rise in costs. The average cost of insurance premiums
rose 7.7% last year, far above the rate of inflation or rise in
salaries, says the Kaiser Family Foundation, which studies
healthcare.
The rising costs have shifted the burden of cover on to the
individual. In 1996, about 15.8% of adults under 65 spent 10% or
more of their disposable income on insurance premiums and other
healthcare costs. By 2003, it was 19.2%, says the Commonwealth
Fund. For those at the lower end of the income scale, healthcare
is not affordable.
"If you don't work for an employer who offers insurance your
options are very limited unless you are a child or very, very
poor," says Sara Collins, an economist at the Fund.
Healthcare experts say that there is sometimes no rational
reason for the rising costs, and that there are huge disparities
across the country. In Miami, for example, it will cost $11,352
a year to treat the average pensioner, but just $4,273 to treat
one in Salem, Oregon, says the Dartmouth Atlas of Health Care.
The cost of dying also varies from hospital to hospital, and
state to state, the study found.
Americans say they are determined to fix a broken system. In
March more than 30 major corporations from Safeway to Pepsi
joined together to lobby for healthcare. America's unions have
also adopted the cause and all three frontrunners in the
Democratic race for the White House have tuned in early. One
Republican contender, Mitt Romney, introduced a system of
universal health cover as governor of Massachusetts.
None of the mainstream proposals would move America towards the
national healthcare systems of Europe or Canada. That idea
remains taboo. But there is strong support for building on the
existing system to make sure all children have healthcare, and a
growing proportion of the working poor.
Under the Massachusetts plan, which became law last year, all
residents must buy private health insurance or face a fine. As
well as extending coverage of children and the elderly,
Massachusetts required employers to provide health insurance, or
join an insurance scheme that would subsidise the cost for
staff. Similar proposals are under consideration in states from
Illinois to California.
On the campaign trail, meanwhile, John Edwards, who was the
first Democratic contender to unveil his health plan, has
proposed subsidising insurance for the middle class, a scheme he
would fund by rolling back George Bush's tax cuts. His rival,
Barack Obama, has proposed a similar fix, while Hillary Clinton
has focused on cutting costs via better access to preventive
medicine.
But if any of those initiatives are to cure America's health
system, they will have to move quickly to help the likes of Amy
Robinson. After paying for her medicine, she sinks $200 further
into debt each month. "Every bit of money I spend is a decision.
Even the McDonald's coffee I bought this morning. Every dime,"
she says. "I'm probably never going to get out of the hole. Even
if the status quo holds with my kidney, all I am looking at is
more medical bills."
Explainer: US and the NHS
Successive health secretaries, grappling with a vast and
cumbersome NHS, have looked across the Atlantic for inspiration.
But the most they manage is to cherry-pick an idea here and
there. While they admire the skills and technological advances
of the best US hospitals, no politician wants to risk electoral
wrath by tampering with the founding principle of Nye Bevan's
NHS - that healthcare provision in the UK should be universal
and free at the point of access.
Even in the UK, though, some patients are more equal than
others. Those in deprived areas and members of ethnic minorities
are more likely to fall ill and receive poorer healthcare than
their more affluent, argumentative compatriots. But the
government recognises this inequality and tries to address it
with funding.
However, the US has - with this government's encouragement -
made inroads here. United Health, a US healthcare provider based
in Minneapolis, arrived in the UK in 2004 to develop a scheme
which had succeeded in keeping frail and elderly people out of
hospital in the US, although an evaluation in November showed it
had reduced neither the number of admissions nor deaths.
But arguably these developments in the UK are just adjustments.
The National Institute for Health and Clinical Excellence
decides which drugs the NHS can use, leading to patient
outcries. But the government says a state-funded system cannot
afford everything. Sarah Boseley
© Guardian News and Media Limited 2007
Click
on "comments" below to
read or post comments
Comment
Guidelines
Be succinct, constructive and
relevant to the story.
We
encourage engaging, diverse and
meaningful commentary. Do not
include personal information such
as names, addresses, phone
numbers and emails. Comments
falling outside our guidelines
– those including personal
attacks and profanity – are
not permitted.
See our complete
Comment
Policy and
use
this link to notify us if you
have concerns about a comment.
We’ll promptly review and
remove any inappropriate
postings.
Send Page To a Friend
In accordance
with Title 17 U.S.C. Section 107, this material
is distributed without profit to those who have
expressed a prior interest in receiving the
included information for research and educational
purposes. Information Clearing House has no
affiliation whatsoever with the originator of
this article nor is Information ClearingHouse
endorsed or sponsored by the originator.)
|
