There are probably fewer issues more important than healthcare right now in the US. Regardless of whether you agree with the Obama plan, the current statistics paint an ugly picture:
- Employer Contribution Rates are twice those of Canada, and six those of the UK. Toyota pays $1400 less per vehicle for healthcare costs in Canada, compared to operating in the US.
- The US spends 15% of its GDP on healthcare where 16% of the population has no insurance, compared to 10% in France and 8% in the UK, both of which have full coverage.
- While insurance premiums have risen 8 times faster than US income growth, profits at the top ten insurance companies have grown 1000%. More money is spent in administration that care-provision.
- Inability to pay medical bills is the leading cause of bankruptcy and foreclosure in 2007.
- The CEO of Cigna was paid $25mm in 2007 (a 20% rise from the previous year), the sort of salary that even a Goldman executive might be embarrassed about.
Howard Dean's book illustrates quite clearly how nobody could claim with a straight face that this system is working. Currently, the model seeks to raise premiums, exclude patients from pre-existing conditions, deny payments, and ensure an ever-healthier return to the insurance companies' shareholders. The net effect is that this cripples global competitiveness, locks people in their jobs, and bankrupts people who believe they had coverage when they are unfortunate enough to discover they have a chronic illness.
The difficulty is that nobody wants to relinquish what they have if their insurance appears to be okay, especially since the government tends to screw up almost anything it touches. The opposition to any change capitalizes on this fear by warning how bureaucrats will be deciding your healthcare, and how you will wait months for an operation and will usually die before treatment. Obviously, these options wouldn't be a step forward either, especially if they bore any resemblance to real proposals.
So Dean outlines the current ideas which can be boiled down to this:
- Americans can keep whatever coverage they have but will have an additional option to choose government insurance if needed (which denies nobody, essentially providing a base-level safety net if the worst happens or your unexpected tumor becomes a pre-existing non-qualified condition).
- Much of this government policy will be paid for by eliminating waste, improving IT and focusing more on preventative medicine (eg. encouraging women to have annual mammograms without fear of cost saves a boatload on the avoidable cancer treatment).
- Integrating the existing network of insurers, hospitals and providers rather than starting from scratch and providing the European-style "socialized medicine" that everyone fears.
He elaborates on how other nations provide healthcare to all their citizens (the US is the only industralized country in the world without some form of catch-all healthcare for its people). He also addresses some of the concerns ("myths" as he calls them) around the reforms, especially given the long-standing record of failure in attempting to fix the growing problem. He delves into many of the cost issues, especially around some of the soon-to-be-bankrupt Medicare and Medicaid programs, which in themselves illustrate how doing nothing is no longer an option.
Overall, I found the book to be accessible and provides a reasonable overview of the Obama plan. While I'm not entirely convinced about the reform that's being shaped in Congress right now, I understand more than ever that the existing model is broken and only serves to enrich the wealthy rather than provide care to people. Somehow the Hippocratic oath got lost to the money machine somewhere along the way, but the average person really has little to fear and a lot to gain from many of these ideas.
PS - I lived in England until I was 25 and had no problems with their version of universal healthcare. I am increasingly shocked at what I pay for health insurance, especially since our provider won't cover asthma as a 'pre-existing condition', and won't pay for an ambulance ride that's not "pre-approved".