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Financial Barriers
The biggest barrier that's talked about most of all is financial. People can't get healthier because they can't afford health insurance, or they can’t afford an office visit or their medications. People are forced to choose between housing, food, and healthcare, and health often comes in last. In the United States 47 million people are uninsured. In Utah we have anywhere from 306,000-390,000 uninsured people.
On many levels, the cost of having so many uninsured affects everyone. On a financial level, we’re all paying for it. If you have insurance, you are paying about 17% more to help offset the costs for the uninsured. The personal toll is also high. According to a 2003 Institute of Medicine Report, about 18,000 deaths occur in the United States simply because people don’t have insurance, they don’t have access to care. And that figure doesn’t even come close to the number of people suffering with illnesses that are treatable.
As medical costs continue to rise, more and more people will be unable to afford care. According to Dr. Brent James of Intermountain Healthcare, “This year we will spend $6800 per American on health care delivery. That's roughly twice of what the rest of the world spends. It's 2.2 trillion dollars. It's 2.2 million, million dollars. It's roughly four times what we spend as a country on defense, even with the Iraqi war effort. It's a massive expenditure. It's not just that it's enough; it's probably too much. We have good reason to believe that because of waste within the system that we could cut that by almost half and get a better health outcome result.”
So why are our healthcare costs so high? Answers and opinions vary. Many attribute it to increasing technology and the fact that we aren’t aware of how much our healthcare really costs. There is, as Dr. James calls it, a “Medical Industrial Complex. It's the idea that one person's waste is another person's profit and it's endemic in the system. What you find are these big companies who come with some new idea that they argue will improve someone's health usually in an emergency setting. The trouble is that very often the amount of improvement is tiny and the amount of cost is huge. Now they definitely don't want to bring that to a standard market place. If you were paying for that out of pocket, you'd never buy it, so they want it to be part of the public system so that it's free to the people who would use it.”
Many analysts also attribute our lack of rationing critical care as another reason costs continue to rise. According to a 2007 Kaiser Report (.pdf), “Almost half of health care spending is used to treat just 5 percent of the population.” A 2007 McKinsey Report (.pdf) states that along with out lack of “incentives or mandates to promote rational supply” of healthcare, the bureaucracy of the United States system also “incurs a range of costs not borne in other countries, which are unique to the US system with its significant for-profit element and its multiple-state and multiple-payor administrative structure.”
Finally, we need to look at our personal choices and behaviors. As Dr. John Nelson, former president of the American Medical Association tell us, “Think of these subjects; obesity, teen pregnancy, sexually transmitted disease, violence, suicide, accidents, tobacco and alcohol abuse. Those eight behaviors, those eight choices or groups of choices that people make for the most part account for 1.13 trillion of the 1.9 trillion we spend (2004 figures). Now I'm not Pollyanna--we're not going to eliminate all of those things at once for sure. What if we eliminate those by 25%? Gosh, there's 250 billion right away that we could use towards access to health care for all people.” In order to have a healthcare system that is accessible to all, we will have to create a system that contains costs and promotes healthier behaviors.
