June 29, 2012
Addicted to Health Care
From Psychology Today:
What is missing from our health care debate—even as conducted by our most insightful and radical critics of the dysfunctional American health care system—is a recognition of what, underneath it all, drives the system. It is Americans' insatiable lust for health care. What Americans possess in overwhelming abundance is the urge to be treated for their maladies. Witness our massive formal addiction and mental health disease treatment and support system (as opposed to the informal community supports offered more readily around the world). And our most forward-thinking health care advocates can only imagine expanding this system exponentially (e.g., parity in health care coverage between physical and emotional illness).
American health care costs are driving America into the ground. These costs stand at from 2-3:1 compared with other nations (like the UK), and the chasm is widening since virtually all other nations have stablizied these costs, while we are only beginning to tackle the rate at which they increase. But Republicans can still run on simply resuming lock, stock and barrel the same old private care system, Americans in general dislike Obamacare, and Obamacare itself is built primarily around expanding coverage without controlling costs. This is because any effort to rein in such costs is met by accusations like "death panels" or "rationing," which immediately kills them like glassy-eyed dead fish floating on the surface of the stagnant pond that is our care system.
More from Stanton Peele here.
Posted by Henry Molofsky at 10:26 AM | Permalink
Comments
Oof. There is a lot that is wrong with this piece. The writer is an addiction specialist, not a health care policy or economics specialist, and succumbs to the old adage: when you have a hammer, everything looks like a nail. It is true that there are hypochondriacs out there, but in general Americans do not go to the doctor more than those in other countries. I don't know where the author gets his "data" that says otherwise.
In fact, Americans see the doctor much less than the Japanese, who still have half the health care costs we do. Also, it is not true that Americans have twice the prevalence of major diseases like cancer and diabetes compared to the UK and Europe. It isn't even close to true. We are definitely fatter, but our higher rates of illness are in general just a couple of percentage points higher.
Where America falls down is in the cost of each episode of care. Our treatments typically cost about twice as much as in other developed nations. Higher profit, higher income for providers, higher administrative cost due to system complexity, etc., are the culprits. Those things exist because the US has done a bad job of controlling the cost of care per unit/treatment/episode. The market has failed, and government has had its hands tied to correct it.
Posted by: Jonathan H | Jun 29, 2012 1:08:06 PM
Yeah, this only reminds me of why I don't read psychology today. This is a very flakey article, with no hard data and lots of assumptions. There is NO DATA cited in the article that would justify calling US use of health care an addiction. I think it's more than a little silly to assume that all of the costs are due to demand for mental health services (as if they are less worthy). This is the kind of crap article you get when you ask an addiction counselor rather than an actual scientist a scientific question. No offense, but people like him specialize in nebulous and elusive solutions. The success rate for this method of treatment is quite low. It should give one pause.
Posted by: ray butlers | Jun 29, 2012 2:00:51 PM
Peele was right to point out the singular focus on "health care" tends to neglect (ignore, crowd out, what have you) the role of well-known etiological variables responsible for mental and physical health. He understands and appreciates the significance of the new legislation but asks that we put it in proper perspective.
The use of the term "addiction" strikes this reader as a fairly innocuous metaphor in this case. Moreover, the relevant scientific data was the link to a very nice article: http://www.annualreviews.org/eprint/iESYF775U2MwVfrxfAR2/full/10.1146/annurev-publhealth-031811-124649 As noted in the abstract, the United States "has not seen the scale of improvements in health outcomes enjoyed by most other developed countries, despite spending increasing amounts of its economy on health care services." That is the crux of the matter and to dismiss Peele's piece without addressing this fact reflects careless reading of both Peele and the germane evidence. In fact, Peele's complaint is not new. Consider, as representative of similar arguments made in different contexts and for different reasons, the material in Michael Marmot and Richard G. Wilkinson, eds., Social Determinants of Health (New York: Oxford University Press, 2nd ed., 2006), and the following from Norman Daniels:
"We have known for over 150 years that an individual's life and death are patterned according to social class: the more affluent and better educated people are, the longer and healthier their lives. These patterns persist--even when there is universal access to health care--a finding quite surprising to those who think financial access to medical services is the primary determinant of health status. In fact, recent cross-national evidence suggests that the greater the degree of socio-economic inequality that exists within a society, the steeper the gradient of health inequality. As a result, middle-income groups in a more unequal society will have worse health than comparable or even poorer groups in a society with greater equality. Of course, we cannot infer causation from correlation, but there are plausible hypotheses about pathways which link social inequalities to health and, even if more work needs to be done to clarify the exact mechanisms, it is not unreasonable to talk here about the social 'determinants' of health.
If we have obligations of social justice to provide equality of opportunity, as in Rawls's robust notion of fair equality of opportunity, then we have social obligations to promote normal functioning [i.e., to prevent significant mental or physical pathology] and to distribute it equitably within society by designing our institutions properly.
The broad determinants of health and its distribution in a population include income and wealth, education, political participation, the distribution of rights and powers, and opportunity. These are quite centrally the goods that any general theory of social justice is concerned about. We cannot achieve effective promotion of health in a society as well as its fair distribution without a just distribution of these other goods. Putting together the key results from the epidemiology literature with Rawls's principles of justice as fairness, we learn why justice is good for our health and we get a general answer to the question 'When is a health inequality unjust?'"
In short (references omitted), "The United States spends an enormous amount of money on medical care: For 2009, the estimate is $2.5 trillion, or close to 18% of GDP. Using the WHO statistics for 2007, the proportion of the entire world's health care budget spent in the United States is 42%. Most of the healthier nations spend 12% or less of GDP on health care. That the health ranking of the United States is far behind that of other developed nations points out the limitations of health care spending in producing health. A study that assumed that health care produces health and compared the cost-effectiveness of 19 nations' health care systems in reducing mortality rates found the U.S. system among the least effective.
The limited impact on health of medical care is presented in a variety of reputable sources from reviews to public health textbooks and various analyses. The benefits of universal health care coverage in advancing population health are similarly of limited effect."
Posted by: Patrick S. O'Donnell | Jun 29, 2012 9:01:02 PM
For all the doctor visits Americans allegedly make they still seem to lead the world in obesity, diabetes and certain forms of cancer - the US healthy care system is hella-broken and all Mr Peele has is an imaginary hammer :)
Posted by: Kim Cascone | Jun 30, 2012 8:37:14 PM
http://www.foxnews.com/opinion/2012/06/28/beyond-obamacare-debate-why-does-health-care-cost-so-much/
Posted by: Kim Cascone | Jun 30, 2012 8:41:26 PM
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