Is it unpatriotic to support continuity of the U.S. health system’s status quo, as
many physicians and citizens seem to be comfortable advocating? In answering this question, we need to consider
how much health care is contributing to the debt, which itself threatens our
economic vitality and national security. The accumulated national debt is currently
well over $12 trillion, about 53% of the U.S. GDP for 2009. It’s about $4,000 per
As currently projected, it would grow to over 300% of GDP by 2050, and
the vast majority of that growth will be the result of rising health care and
Medicare costs, government economists estimate. The deficit number for this
year will be $1.8 Trillion, and for
the year 2011 the deficit would be $1.3 Trillion.
If the SGR was to be eliminated, the number would likely be at least a
half-trillion more. The dramatic growth
of the deficit puts the nation’s future stability and security at great risk
if not addressed. Deficit growth will be mainly related to unfunded health care
costs to cover the 40 years it will take for the boomers to retire, vote en
masse to demand the best health care, and die off, presumably after becoming
part bionic and genetically-engineered beings.
The current partisan environment and resultant difficulty we will have to
make the tough political choices needed to stabilize Medicare, health care, and
Social Security represent a recipe for disaster. Without new thinking about health
delivery system and payment reforms, for example, we will surely face
accelerated price fixing and price cuts for doctors annually, like we have seen
this and previous years for cardiology. The current SGR dilemma we face may
look like a cake walk in the face of future pressures for cost containment. And
doctors seem to be the easiest political victims for achieving such cuts.
Finally, it will be increasingly essential that patients bear a much
larger share of their own health care costs in this future, potentially motivating
more informed shopping. But, there is a finite amount of out-of-pocket spending
that middle class and lower income families will be able to contribute, so
political pressure for a bigger social support infrastructure for health costs will
be demanded by aging boomers. Where will it come from? Probably from more cuts
to health care providers. My crystal ball indicates we’re headed for a decade of
tough fights like we are experiencing this year, unless we figure out how to
ferret out the extensive waste in the current system to protect health care and
the vitality of the profession.
There are ways this story could unfold in a more positive fashion. It
would be nice if we as a species and a nation could dispense with war, for
example, although this would seem to require ‘human nature’ transplants, or
miracles, or both. We could tax the living heck out of everybody making more
than minimum wage. But unfortunately that would kill off economic growth.
Or, we could get engaged in preserving the profession and the
patient-physician relationship, while still promoting continued innovation and
scientific progress in health care. To accomplish this, we would need to figure
out and refine ways to reduce health care spending increases to no more than a
percent or two greater than the GDP. Could we accomplish this without killing
off innovation and the vitality of the profession? I happen to think we could. I know some of you reading this are skeptical. That’s
understandable. But what are the options here, folks? Leaving things to
‘evolve’ on their own in the political environment looks awfully risky. Ironically, even if not yet realized, the
nation needs for us to take these
challenges on or solutions won’t likely be forthcoming. If we all allow the
debt to explode, the entire economy -- including medicine -- will suffer greatly.
So, back to my original question: Is it unpatriotic to support continuity
of the U.S.
health system’s status quo, as many physicians and citizens seem to be
comfortable advocating? An informed
answer is yes.
*** Image from morgueFile (jdurham). ***