Medical costs in the United States are higher than any other nation in the world. Yet, the life span of Americans is below that of all advanced nations. In addition, infant mortality is among the highest of advanced nations. These figures are contradictory. If we are paying more for health care, one would expect that our outcomes would be better than those countries that are spending less instead of the opposite. Why are our lifespans shorter than other developed countries and our infant mortality higher. There are a number of reasons for these disparities, some of which have to do with our society and some of which are due to the quality of our health care.
Deaths of despair as described by Case and Deaton is one major cause of decreased life span. Poor people who are unemployed mainly in rural areas and see no future for themselves do not avail themselves of much mental or physical health care. They also abuse drugs and alcohol and have a high rate of suicide. Government agencies are not aggressive enough in trying to help these individuals, and indeed health care outreach is being cut back by the Trump administration. In addition, vaccine protection is being avoided by large parts of our population, with vaccine skepticism being pushed by Robert Kennedy, Jr and HHS. Routine infant care is not being given to many newborns and young children, Trump reducing social workers who would be helping to oversee the care of these infants. Poor care is particularly prevalent in single parent families.
Surgical care represents almost 20 percent of yearly health care costs in the United States, with total health care costs responsible for one fifth of our GDP. Though cost containment of medical costs are imperative, there are no federal or state regulation of hospital costs. Increased costs are passed on by insurance companies to consumers. This is resulting in bankruptcy by people who cannot afford to pay the deductibles or co-pays for hospital care or for medical insurance itself.
A recent study in the Journal of the American Medical Association involved 1600 hospitals across the U.S. and four surgical procedures. Hospitals with the highest mark-up in cost for these procedures were found to be associated with the highest morbidity and rates for readmissions. The article concluded that high-cost hospitals were associated with significantly inferior quality and value of care, when one would have expected the opposite to be true.
Other studies have shown that the highest markup hospitals are three quarters owned by private equity firms that cut costs by cutting personnel and providing lower quality or fewer supplies. They are always looking for ways to cut costs. These hospitals tend to have the poorest outcomes for patients with higher morbidity and rates of readmission. More monitoring and government regulation is needed of high markup hospitals that may be more profitable but have poorer outcomes for their patients. There is really no role for private equity in ownership of hospitals or medical facilities where profit should not be a driver of medical care. But quality of medical care does not appear to be one of the Trump administration’s priorities
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Political junkie, Vietnam vet, neurologist- three books on aging and dementia. Book on health care reform in 2009- Shock Therapy for the American Health Care System. Book on the need for a centrist third party- Resurrecting Democracy- A Citizen’s Call for a Centrist Third Party published in 2011. Aging Wisely, published in August 2014 by Rowman and Littlefield. Latest book- The Uninformed Voter published May 2020