HARVARD SQUARE COMMENTARY

December 31, 2007
We Should Live So Long

Jerome Richard


Hey, we're number 42!  That's where the United States ranks in regards to life expectancy according to the latest figures from the U.S. Census Bureau's National Center for Health Statistics.  (The 2006 United Nations World Population Prospects report puts us at 38, just behind Cuba.  France is number 10, Canada 11, and the United Kingdom 22;  If you don't believe the U.N., how about our own CIA?  Their 2005 World Factbook ranks life expectancy in the United States at number 46, just ahead of Saint Helena, a volcanic island in the mid-Atlantic where Napoleon was sent to die.  The CIA ranks Canada at number 12, France at 16, and the U.K. at 38.)

What do most of the countries ranked ahead of us in life expectancy have that the United States does not have?  A government run health care system.  Yet, suggest such a system here and people tremble and cover their ears.  Socialized medicine ranks somewhere between communism and terrorism as scary terms.  Some politicians can't bring themselves to utter the phrase even in condemnation.  Threatening to veto the SCHIP bill passed by Congress which would have covered more children than under the current program, President Bush said, "I see this as a first step towards the federalization of health care." (9/20/07).

What did he think Medicare and Medicaid were?  His own medical care and that of all members of Congress is of course federally insured and provided by government employed doctors at government run facilities, and none of them are demanding that it be privatized.  It probably helps account for the longevity of so many senators and representatives.  All of our present presidential candidates, many of them senators or representatives, shy away from proposing a government run or single-payer system.

The problem is certainly not that the U.S. is cheap when it comes to paying for medical care.  In fact, we spend more per capita than any of the countries where people live longer, and we still have about 47 million people who are uninsured  (www.nchc.org).  The one area where we do better than most other countries is in the promptness of appointments for elective surgery.  Socialized systems prioritize health care needs according to urgency.  That sometimes leaves people wanting an elective procedure with long waits.  If they can afford it, they sometimes choose to come to the United States for their operations rather than wait. Those are the people defenders of our privatized system point to as evidence of the failure of government run systems.

During a recent vacation in Barcelona I got sick.  Fever, chills, nausea.  My wife asked the hotel desk clerk to recommend a doctor and we were directed to a clinic not far away.  There, without an appointment and in less than an hour we were introduced to an English speaking physician.  Afterwards, prescription in hand, we asked what the exam would cost and were told that it was too bad we were not from a European Union country.  If we were, there would be no charge.  As it turned out, rather than go through the paper work necessary to charge us, he sent us on our way.  "It's a gift from Spain," he said.

Of course, care in these countries is not free.  It is paid for through taxes, which is cheaper than paying for it through insurance premiums, hospital and doctor bills, and prescription prices to multiple companies with redundant administrative expenses and profits.

Competition is supposed to keep prices down in a privatized system.  Obviously, that is not working.  A major reason is that prices are seldom discussed.  Doctors and hospitals do not post price lists, and patients are embarrassed to ask.  Or, costs are covered by insurance so patients don't care, even as they complain about the price of insurance.  The move away from employer covered insurance will exasperate those complaints.

Back in the 1970s, Ralph Nader's Public Interest Research Groups launched efforts to publicize physician prices.  In Bellingham, Washington some students from Western Washington University and I canvassed local doctors and produced a booklet with that information, but it proved impractical to keep it current.  Not only do prices change, but it turns out that some physicians and hospitals have more than one price for the same procedure, depending on a patient's insurance, and sometimes on the patient.  In a New York Times story by Michael Mason (2/27/07), Timothy Cahill, president of a website company called My Medical Control (www.mymedicalcontrol.com) is quoted as saying: "The average provider-doctors or hospitals-has between 5 and 100 reimbursement rates for the exact same procedure."  My Medical Control negotiates lower rates for patients for a commission.

There is another way to beat the high cost of American medical care.  Some people-over 100,000 last year-are going overseas.  In countries such as India, Thailand, South Africa, Costa Rica, and others, patients are finding American-trained doctors in facilities equal to American clinics and hospitals, with the same equipment, but charging approximately half as much.  Transportation increases the cost, but many people simply add a vacation to their hospital stay or dental care.  Patients Beyond Borders by Josef Woodman (Healthy Travel Media, 2007. www.patientsbeyondborders.com) is a guide to the practice, or Google "medical tourism."

Must we say to our ill neighbors or family members: "There's to your health!"


Jerome Richard's website is: www.jeromerichard1.com


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