The Scientific Activist

From the archives:

(18 April 2006) If Massachusetts were a physician, I'd have mixed feelings about visiting him or her. Sure, Dr. Massachusetts would be incredibly persistent and would do its best to make sure I left its office feeling better than when I arrived, but on the other hand if I had any sort of serious condition, I'm skeptical about how far Dr. Mass. would go to treat the underlying causes, rather than just the immediate symptoms. Massachusetts would probably be an adept surgeon, but maybe not a great family doctor.

Last week, amid great fanfare, Massachusetts governor Mitt Romney signed a bill into law that would require all Massachusetts citizens to own at least a basic health insurance policy, in a program that has been likened to the standard requirement of mandatory liability insurance for all drivers. Massachusetts has been particularly proactive in health care requirements, making headlines in January when its legislature passed a law requiring Wal-Mart and other large employers to spend a minimum of 8% of payroll expenses on health benefits.

With over 40 million Americans currently without health insurance, surely mandatory insurance is a step in the right direction. Right?

Well, maybe. However, none of these regulations address any of the root causes of the U.S.'s glaring health disparities: the complex and confusing web of private insurance companies making up our market-based health care system. This legislation might provide a bit of temporary pain relief--and there's nothing wrong with that--but its not going to cure the cancer.

The seemingly insurmountable obstacle of the U.S.'s current health care system is its inefficiency. In 2003, for example, the U.S. spent $5,635 per person on health care, far more than the next highest spender, Norway, which only shelled out $3,807 per person (these and the ensuing figures come from the Organisation for Economic Co-operation and Development). This was 15% of the U.S.'s GDP, a far higher percentage than in any other industrialized country. This comes despite the U.S. paying for only 44.4% of these expenses with public funds, much less than its peers spent.

From this data, we can see two prominent qualities of the U.S. health care system: it's privatized, and it's expensive. So, does all of this money buy us a better health care system? Although in the U.S. we surely have access to some of the most state-of-the art medical care available in the world, most of the data does not paint a very optimistic picture. Compared with the world's other major industrialized powers, the U.S. has the lowest life expectancy and the highest infant mortality rate. When you combine these numbers with the high rate of the uninsured, it's clear that we're not getting anything that great for the extra money, at least in terms of the big picture.

Despite all of the talk about "inefficient government bureaucracy," the data demonstrates that government-funded health care is more efficient than the market-based system currently dominating American health care. One of the reasons for this is that, as I have written before, 13% of the income earned by private insurance companies goes to profit and overhead--meaning that this money does not go back into the system--compared with only 1-2% (for overhead) in government programs. Another reason is the built-in inefficiency of dealing with millions of different entities paying for health care rather than just one (the government in a single-payer system).

Not surprisingly, studies have shown that most physicians prefer a single-payer health care system. For example, a 2004 study in the Archives of Internal Medicine found that 63.5% of Massachusetts physicians believe that a single-payer system "would provide the best care for the most people for a fixed amount of money." Interestingly, these same physicians that overwhelmingly support a single-payer system apparently don't think their peers do the same, with only 51.9% of those surveyed believing that the majority of physicians support a single-payer system.

Clearly, there is a need for some activism here from the medical community. Our society gives a great amount of respect to physicians, as they deserve, and it is likely that the medical community will have to become more outspoken on this issue before true universal health care becomes a viable political possibility. If a perceived lack of support in the medical community is currently holding physicians back, hopefully more studies along these same lines will give them the courage to stand up for their beliefs. Clearly it won't be easy--especially in a political climate so hostile to anything resembling universal health care--but the need for an open and rational discussion on this issue is becoming increasingly pressing.

In the meantime, though, it looks like we can at least look forward to a steady dose of aspirin while we wait for a more substantial cure.