Health Care System Melting Down, Says Creighton University Expert
By: Source: AARP.org Date Posted: 2007-12-19 16:25:19.269624-05:00
Richard L. O'Brien, M.D., is Professor at the Center for Health Policy and Ethics at Creighton University. He serves as Co-Chair of the Nebraska Medical Association's Health Care Reform Task Force. AARP Nebraska recently interviewed Dr. O'Brien about the state of health care in Nebraska and the U.S. AARP will closely monitor any proposed state-level health care reforms during the 2008 legislative session.
You have said that America's health care system is on the path to meltdown. Why is this happening and what are the major contributing factors?
The primary cause of the meltdown is rapidly escalating cost. The U.S. spends more than twice as much on health care as the median expenditure of other developed nations. High costs are driving more employers and individuals out of the insurance market leaving ever increasing numbers of uninsured and underinsured Americans without timely access to needed care. This contributes to higher costs because underinsured and uninsured persons avoid necessary care they can't afford, ultimately resulting in more costly care for advanced disease. Other contributors to high costs include: inadequate care coordination, uninsured persons resorting to ERs for care, high administrative (overhead) costs, system inefficiencies, and utilization of unnecessary services.
Our system has other shortcomings. Many people lack adequate access because of where they live. Nebraska has many rural health services shortage areas; in urban settings people of limited means may have difficulty getting to providers. There are serious problems of quality, notably medical errors and hospital acquired infections. In 2003 there were 636 reported "medical misadventures" in Nebraska resulting in patient injury or death. These "misadventures" add to high costs; those injuries and infections require costly treatment.
These system failures lead to public dissatisfaction. Costs eat into families' disposable income, people worry they won't be able to get high quality care when they need it; they feel hassled by administrative hang-ups. Medical debt is the primary or an important contributor to nearly half of personal bankruptcies in the U.S. People are fed up.
How does health care quality in the U.S. compare to other advanced industrialized countries?
The quality of care in the U.S. is good, though not better than most other advanced economies. However, it is good only if you can get it when you need it. Tens of millions of Americans can't. The U.S. lags behind most developed nations in health outcomes and even behind some less developed countries. The U.S. ranks 32nd in the world in life expectancy; 35 nations have fewer premature deaths (before age 60) than we do. Too many Americans have lack adequate access to timely high quality care.
What is the level of public support for health care reform in the U.S. and Nebraska?
Large national majorities have long favored universal health coverage. In recent polls, large majorities have said that the system requires "fundamental" change or should be "completely" rebuilt. These opinions cut across partisan lines. A 2005 survey by the Bureau of Sociological Research at the University of Nebraska-Lincoln revealed that 68% of Nebraskans believe that the state is not doing enough to help people get and pay for health care.
Can you summarize the recommendations from the Nebraska Medical Association's Health Care Reform Task Force to extend health care coverage to uninsured Nebraskans?
Our proposal asks all Nebraskans to share responsibility for health care. All Nebraskans should have a basic benefit package to meet essential needs. Few Nebraskans realize that those who are insured already pay for costly care for the uninsured. We believe all should share the burden. Insurance would be made affordable by providing subsidies for low income persons and requiring insurance companies to offer coverage to all without rejecting those with pre-existing conditions or charging them inflated premiums. It also proposes means of controlling costs, improving quality, and improving access for Nebraskans who live in shortage areas.
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