American citizens have several cultural attitudes toward health care and savings that has resulted in an economy that spends one-sixth of the GDP on medical care. Other countries don’t pay so much and many of them have universal medical coverage.
So what’s our problem?
A major issue is that Americans have stopped saving anything. Many of us have retirement accounts, which work because it’s not easy to tap into them, but most of us do not have savings accounts. I recently read an article by a financial guru who spent most of the article ripping into Dave Ramsey for suggesting that paying off debt and having 3-6 months of living expenses in savings made no sense to her. You should be investing those funds, not leaving them in the bank account.
So, naturally, since, they don’t believe in savings, the American middle class does not believe in saving up for medical care expenses. The idea that you should have $10,000 to 15,000 in savings for a potential acute medical episode is ridiculous in most people’s minds. This isn’t pre-World War 2 America, nor are we a 3rd world country. That’s “wasted money” just sitting in a bank.
We object to paying one-sixth of our personal income directly on health-and-medical expenses, but we also resent paying one-sixth of the government’s treasury on health-and-medical expenses. We are less willing to spend public funds to pay for health maintenance than we are to pay for medical services, even though study after study shows that we get better results from getting people to change unhealthy lifestyles than from treating the consequences of those lifestyles. You can’t really blame the American middle class from objecting to paying taxes in order to support people who are very poor or very sick when they themselves work hard to have an income and to take care of their health. Americans are not Scandinavians. We believe in personal responsibility, if only for other people.
Americans, especially medical care providers, do not want to think of medical care as a commodity that is bought and sold in an open market subject to supply and demand rules. Providers want to be paid (and paid well), but they don’t want to think of themselves as capitalists selling their services, so they prefer payment that comes from third parties where the price is hidden from consumers.
Americans are individualists at heart and object to telling other people how to live their lives or being told by others how to live theirs. This means that the right to live an unhealthy lifestyle is considered sacrosanct in the United States. Under the ACA or universal coverage, that means that healthier individuals pay for the poor choices of less healthy individuals.
Americans also tend to live in a state of denial about some health choices, so that about one-quarter of our population engages in unhealthy lifestyles that have long-term medical care expense consequences, the cost of which are born by people who take care of themselves rather than the poor decision makers who require the expensive long-term care.
Americans enjoy being “early adopters” of new treatments, which are often much more expensive in their early, experimental stages than when they have been available for many years. Forty years ago, when medical care was a smaller share of the economy, we could afford that attitude, but new treatment options now require expensive equipment and highly-trained specialists. Although these treatments promise incredible results, they are expensive to the individuals receiving the treatments … or the group that’s paying the bills.
All of these attitudes conspire to make the “Affordable” Care Act, or any replacement other than the free market, incredibly and increasingly expensive for all of us. Universal coverage will only exacerbate the problems that these cultural attitudes engender, leading inevitably in medical care rationing and resultant lack of availability of care, with the end results being similar to England’s 45% higher mortality rate.
Yes, we could choose universal coverage and then attempt to outlaw everything that makes people unhealthy. Good luck with that! It hasn’t worked in France and England, which is one reason England has a 45% higher mortality rate than the US.
Alternatively, we could work with human nature and return our medical care system to the free market it began in. Lift the government-created restrictions against individuals forming groups to drive down medical insurance costs. Lift the government-created restrictions that prevent us from buying insurance across state lines. Life the government-created monopoly against increasing medical schools and opening clinics. Yes, that would mean that some people wouldn’t make good health choices and wouldn’t have medical care coverage when those choices require them to seek medical care. That would be the consequence of being a poor-decision maker and it might drive some of this group to make better choices. Additionally, medical care would become less expensive because government-created barriers to care and affordable insurance would no longer be a factor in price.
We have a choice to make in this country. Do we want reduced access to expensive care, but everybody having insurance or do we want improved access to affordable care with some people choosing (for themselves) not to have insurance?
I know which one I prefer and which one I believe would result in improved health results.