The performance of health care systems interests me greatly, as it is my job to help my local health care system be the best. Recent evidence suggests we are not getting better. In fact, one study suggests the disparity in health outcomes is getting worse. That is, some people benefit more than others from our health care system in the US. The income inequalities translate directly into health outcome inequalities. And racial differences also are getting worse. How can we tolerate a society where we apply our resources so unfairly?
The researchers in this study looked at health outcomes by county in the USA and then looked at race, gender, and socioeconomic class. The results are very disturbing. “If you look at the extremes in 2000, men in the most deprived counties had 10 years’ shorter life expectancy than women in the most affluent counties (71.5 years versus 81.3 years).” The difference between poor black men and affluent white women was more than 14 years (66.9 years vs. 81.1 years).
Of course people with lower incomes have less access to health insurance. I don’t think this is fair or reasonable, but even more disturbing is that among people with health insurance, there are still racial disparities. I cannot help facing the terrible likelihood in all this — that racism persists in health care workers.
There is some hope here. Between 1966 and 1980, disparities in health outcomes actually got better in the US. It’s since 1980 that the gap is widening. What really worries me now is that the economy is in tough shape and government will have trouble finding the resources to do the right thing. What homeowner and voter will support more taxes this year? What politician would suggest it?
But health care needs to be like education- we should all have access to a basic set of benefits. So where do we get the funding? I have a simple idea — we are now spending $5,000 a second in Iraq. We can’t afford to further mortgage our kid’s future, so we better figure out a way to pay as we go. According to forensic psychiatrist Marc Sageman's book Leaderless Jihad: Terror Networks in the Twenty-First Century, our current policy is likely creating more terrorists anyway. We could fund a lot of health care for the uninsured with $5,000 a second.
This week I had an interesting conversation with my son. A college senior, he’s considering job options in his field of environmental science. Possibilities include various types of nonprofits, research, and environmental education organizations. 
As we talked about his ideas, and he does job interviews and gets offers, he is asking about health insurance.
Notably most organizations tell him that’s up to him. So here is the son of a physician executive, successfully launching into the workplace, with the strong prospect of not having health insurance.
As you know, I believe that we need to take a hard look at how health care is managed and funded in this country. The current system is way too complex, saddled with very high administrative costs, delivers care in uneven and illogical patterns, and leaves some 47 million Americans not covered. Here are three key problems I see:
- Government promises more benefits than it is willing to pay for, and passes the uncovered costs to private health insurance
- The health care payment structure is set up to reward visits to multiple doctors and lots of tests rather than coordinated and planned care, especially for chronic illness.
- Access to care is different depending on where you live and what kind of insurance you have, if you have any.
A recent New York Times has a great essay illustrating the problems of multiple tests and doctors http://www.nytimes.com/2008/03/11/health/views/11essa.html?ref=health
And if you're following politics and would like to read some outside analysis of each presidential candidate's health care reform policies, check out the Commonwealth Fund, a private non-profit that works on health care policy analysis. http://www.commonwealthfund.org/
You can also access information on this site about the health of populations in the United states, by individual state http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=494551
The information on Vermont is very up to date, identifies Vermont as the third healthiest state in the country. It also confirms the clear evidence that the most cost effective health systems in the world and in the US are primary care based with high levels of generalists and low numbers of specialists. By US standards Vermont is high in generalists, low in cost, and has excellent outcomes. By international standards we have a long way to go.