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August 30, 1999 I keep hearing that the United States spends way too much per person on health care, especially when compared with other countries. But the more I learn about why that’s so, the less I think it really matters. First, the facts. We spend $4,090 a year per capita on health care as of 1997, the latest data available. Just for comparison, Canada spends $2,095 and the UK spends $1,347. So, at first glance it’s easy to think we’re wasteful. The money we spend per year amounts to 13.5 percent of the gross domestic product, a number which has been fairly level since 1992. Just to compare, after World War II, health care amounted to only 4 or 5 percent of the GDP. Part of the reason our cost per person is so high is that our country now spends a lot on research. For example, since 1988 we’ve invested $2 billion on the Human Genome Project, mapping almost 8,000 genes and already spurring development of more than 50 drugs or vaccines. Over the same period, the National Institutes of Health has spent more than $150 billion on health research, and pharmaceutical firms have spent about $155 billion on drug research. Much of this work ends up helping not just the United States—and other modern nations worldwide—but also Third World and underdeveloped countries that need the vaccines and the technology, yet don’t have the money to invest in the research. The good news is that, although this research is enormously expensive now, much of it promises to cut future health expenditures significantly. Finding the answers to genetically linked diseases, cutting the recuperation time for heart attack and stroke patients, and preventing hospitalizations for AIDS patients pays big dividends. Our expectations for body perfection are also increasing our national healthcare expenses. People are flocking to corrective laser eye surgery centers just so they can toss their contacts and glasses. Boomers and their parents are getting rid of wrinkles and folds, adding to their hairlines, removing those pesky C-section scars, and getting ligament reconstruction surgery so they can get back on the tennis courts or the slopes. We live in a society that expects a lot out of health care and a lot out of our bodies. Perpetual youth doesn’t come cheap. Sometimes, public policy increases healthcare costs, and it still isn’t necessarily a bad thing. For instance, experts think prescription drug spending will increase 11.2 percent between now and 2001, largely because the FDA accelerated the approval process for new drugs. Also contributing to the total increase in expenditures is improved prescription drug coverage, which means more people are getting more of the drugs they need. It’s a great example of how more options and more access can raise total healthcare costs. The trade-offs are tough. The more we increase access to care, offer more choices, raise prescription drug benefits, and improve technology in medications, the more we may be spending as a nation on health care. But the real issue is not whether we spend more than any other country—it’s what we get for the money and whether it’s good for society in the long run. The next time you hear people bemoan the fact that we spend so much on health care in this country, ask them where they’d rather go when they need an innovative new treatment. Canada? Great Britain? I don’t think so. Ask them how they measure the quality the other countries get for their dollars. And, bottom line, ask them what they’d rather we spend our money on. After all, what’s more important than health? Barbara
Bronson Gray, MN, RN |