The PULSE
Osteopathic Emergency Medicine Quarterly VOLUME XXXIII NO. 2
April 2008
“Who is Paying for American Health Care?” Presidential Viewpoints Peter A. Bell, D.O., FACOEP In my Winter ’08 comments, I emphasized the need for all of our members to engage in the process of health policy formulation. We hold one of the few degrees most respected by the public and have the earning power that wields influence within our society. As emergency physicians, we are the safety net of American health care. We are obligated to speak on behalf of our patients, and our profession. Our objective must be a friendlier, faster, and more cost effective delivery of comprehensive, universal, health care. While we best know the emergent nature of health care, we must take the higher ground in our opinions. Demonstrating an understanding of each stakeholders’ viewpoint and thinking holistically, we place ourselves in a position of leadership. I regularly review health policy reports, survey results, and governmental statistics. While I am cautious when relying on any one report or statistic as absolute fact, there is much to be learned from the trends. It is reported that our percentage of Gross Domestic Product (GDP) spent on health care has doubled from 1970 to 2000 (7.2% to 14.5%). This translates into $75 billion or $356 per person in 1970, to $1.4 trillion or $4,950 per person in 2000. In addition, economists have long argued that our economy cannot tolerate greater than 15% of the GDP spent on health care, and yet
we now stand greater than 16%! In 2007, the growth in the U.S. population coupled with increased spending exceeded $2.2 trillion in health care dollars (approximately $7500 per person). The economists have also predicted that based on the trends of the past 37 years, we can expect our health care spending to exceed 20% of the GDP by 2017. Unfortunately, the predicated trends of the past twenty years have correlated very closely with the measured trends. It appears that the economists have found a reliable forecasting model. http://www.census.gov/prod/2007pubs/ 08abstract/pop.pdf http://www.kff.org/ insurance/upload/7692.pdf Where do our health care dollars come from? Public programs make up about 45% of all health care dollars while private health insurance is approximately 35%. The remaining 20% comes from a variety of sources such as charities, self-pay, trusts etc. Here is where the double jeopardy argument is made. The public programs are fueled by our tax dollars. In 2006, the Internal Revenue Service collected $2.2 Trillion in taxes net of refunds. Approximately 45% came from taxation on individuals ($990 Billion). That same year, approximately 5% of U.S. households reported making greater than $154K. (What was your reported household income in 2006?) This 5% of tax payers represented approximately 60% of the total individual tax collection ($594 Billion). Reality? As a highly compensated professionals, we are paying for our own health insurance coverage and the lion share of the public supported health insurance programs. http://en.wikipedia.org/wiki/
The PULSE APRIL 2008
Internal_Revenue_Service. It behooves all of us to get involved! So how are our health care dollars being spent? Again reports vary, but for point of discussion, I will simplify the numbers. About 1% of the U.S. population consumes 20%, 5% consumes 50%, and 20% consumes 80%. Between 27-30% of all Medicare dollars are spent in the last year of life. While only God knows when life will end, we as health care practitioners have the skill sets and experience to reasonably predict the end. Instead of spending resources on futile care, a viable solution may be Hospice. (This has been shown to produce savings of 25-40%.) http://64.85.16.230/ educate/content/elements/expendituresforeolcare.html Another solution is greater emphasis on preventative health care and health maintenance. This is not only consistent with Osteopathic philosophy, but in alignment with AOA President Ajluni’s theme of ‘Fit for Life’. Multiple studies have demonstrated substantial cost savings, an increase in the quality of life, and a decrease in episodic care with the application of preventative medicine. http://www. pmri.org/?p=nwr Any approach to reshaping our health care system, must consider current trends, new ideas, and physician expertise. Similar to the economists who have predicated our health care expenditures, we must predict patient outcomes using the best evidence based medicine and gestalt. We can not afford to pay for all things for all people when a negative outcome is most likely. This concept alone will require a change continued on page 4