In the 21st century it is evident that the United States health care system faces a looming crisis. For the wealthy and well-insured it remains the best system in the world. Meanwhile, a growing number of Americans are becoming disenfranchised from the system.
A potential solution is to create a more simplified health care landscape. The government can do this, in effect, by “spending more to spend less”. A single-payer system would cost billions of taxpayer dollars to implement. It would also generate billions in savings by eliminating the complicated maze of health care payers.
Whether this system is adopted or not, government health care spending needs to be refocused. The single biggest expense of the health care system is administrative costs. As such it provides the single biggest opportunity for savings.
There are also several areas where spending increases could pay substantial financial and health dividends, such as prevention and early screening efforts. Increasing coverage for low-income, vulnerable populations will also be important.
A fully covered population could, in turn, be healthier and economically productive. As a result tax revenue would increase, further offsetting the cost of a single-payer system. For those already insured, the savings from reduced premiums could be pumped back into the economy.
The state of health care
Health care spending in America is at record levels, reaching 1.5 trillion in 2007. This, by comparison, is over four times the amount spent on national defense (National Coalition on Health Care, 2008). The irony in this is that a record number of Americans lack any health insurance coverage. According to author Jill Quadragno:
In 2003 45 million Americans – one out of every six had no healthinsurance…nearly 82 million – one out of every three Americans – went without health insurance for all or part of the years [2002-03].
In America the cost of health care is borne by a combination of the government, individuals and private insurers. Most private health insurance (73%) is supported by corporate employee insurance programs (Quadagno, 2005).
Expenditures for covered individuals are split almost evenly between publicly and privately financed policies. Total health care spending accounts for about 16% of GDP (gross domestic product). That figure has risen steadily since the mid 1960s and is expected to rise sharply through 2050.
A common perception is that the highest level of health care is available in America, at least for those who can afford it. This is not always the case, though. For example, America has “a system where six times as many people die from medical mistakes as die from HIV/AIDS” (Barlett, 2004). This is an alarming indication that medical professionals are being pressured by number of factors to either work too quickly or to cut corners.
Employer sponsored programs insure about 165 million Americans. Employer-based plans are hardly uniform or comprehensive. Most offer a very limited set of choices. “At least a third of workers have no choice of health plan” (Barlett, 2004).
These plans can often be at risk when the company is losing money, restructuring or negotiating new union contracts. Also, benefits are not always transferable to new jobs. This is one reason why the number of Americans without insurance for temporary periods (82 million) is nearly twice as high as the number permanently uninsured (45 million).