It is well worth reviewing the Commonwealth article on the actual state of US healthcare to grasp the totality of the unsustainable health system that we must use right now.
While there are many problems with the US healthcare system, the most profound problem of the current one is the unsustainable cost, 30-60% higher than any other developed society. While we tend to think of this cost as related to individual high-cost parts of the system (say, prescription drugs), it is truly a system problem. At 18% of the GDP, it is approaching $1 in $5 of our national economy. When you combine that with entertainment, our economy is more than one-third in these 2 categories.
The next time you see an article on the stagnant American economy and the future of work, remember that we are rapidly becoming a society of entertainment and healthcare.
Also, ask yourself about reducing our costs to equal, say, the next highest cost healthcare system, which is, like all the other systems in major countries, single payer in one form or another. We do a worse job of health support than other developed countries, and we need to understand that reducing costs to any real extent in our current system will worsen our healthcare significantly.
Since a major cost in our system is wage and benefits costs, we will also be reducing both jobs and the spending power of the replacement jobs, if there are any. This wouldn’t mean all that much in most areas of employment, but because healthcare is so large, any significant decrease in jobs is a big deal for the whole economy.
Remember that for the most part, those individuals working in healthcare have invested a lot of money, time, and a good bit of their personal and family future in the health system. If they end up failing to contribute this substantial investment to the national economy, we will all suffer, and not just in our health.
This creeping system failure is the definition of a Catch-22. All the approaches that might reduce the cost of the system compete poorly right now with the existing system in resources, institutional infrastructure, and political power.
There is no obvious system level solution to this. Single payer would help, but it wouldn’t magically eliminate all the system effects in our health behemoth. But there are trends we can support and ones we can fight.
More in future posts.