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Health Care in Crisis: Where We Are, How We Got Here, What to Do by Mark Force, DC

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Health Care in Crisis: Where We Are, How We Got Here, What to Do by Mark Force, DC Mark Force, DC …functional & natural healthcare Ashland, Oregon, USA theelementsofhealth.com Health Care in Crisis: Where We Are, How We Got Here, What To Do by Mark Force, DC Intro “Let's face it we do have a health care cost challenge. We're spending about 16 to 17 percent of our GDP (gross domestic product) on health care and the sad truth is that there isn't universal access to quality care. You'll have a lot of people citing different people to fault for that including our industry for the price of medicine." The real honest truth is that we don't have a health care system; we have a sick care system. And that's not a play on words, that's a fact, because what's driving costs in our country is that we have now almost half of our country, including every woman, man and child, who has one or more chronic diseases and we don't start spending on you until you get sick. Forty five percent of Americans are living with one or more chronic diseases and the older we get the higher that percentage goes up. " "That 45 percent accounts for 75% of the now almost $2.4 trillion we spend on health care and in 2007 terms, that now averages almost $7,200 per person living in the U.S. and that is an astonishing number and that is just what we spend on treatment.”1 ~Robert Ingram, Vice Chairman Pharmaceuticals for GlaxoSmithKline2 “The U.S. has the resources that allow people to get fat and lazy. We have the luxury of choosing a bad lifestyle as opposed to having one imposed on us by hard times.” ~Paul Terry, assistant professor epidemiology, Emory University, Atlanta. 1 From “Sound Solutions to Rising Health Care Costs,” an address at the inaugural Distinguished CEO Lecture Series; April 1, 2008, Catawba College, Salisbury, North Carolina. 2 Also Chair for GlaxoSmithKline Foundation Board of Directors, national CEO Roundtable on Cancer, Chairman of the American Cancer Society Foundation, and member of the National Cancer Advisory Board. Mark Force, DC …functional & natural healthcare Ashland, Oregon, USA theelementsofhealth.com Table of Contents Healthcare Costs In The US....................................................................................... 3 Healthcare Outcomes In The US............................................................................... 4 Breakdown of Healthcare Costs In The US............................................................... 5 What Is Health?.......................................................................................................... 6 What Is Effective Healthcare?................................................................................... 7 What Drives Healthcare Costs?................................................................................. 7 High Longevity Populations: Clues To Lower Health Care Costs?......................... 18 Fundamental Solutions For The Healthcare Crisis.................................................. 20 Functional Medicine: Health Promotion In Healthcare........................................... 23 Selfcare As Healthcare Reform................................................................................ 28 Vital Aging As Healthcare Reform.......................................................................... 28 2 Mark Force, DC …functional & natural healthcare Ashland, Oregon, USA theelementsofhealth.com Healthcare Costs In The US US healthcare is the most expensive in the world. The U.S. health care system has been rated as the highest in cost and, yet, 72nd in overall level of health when compared to 191 member nations included in a study by The World Health Organization (WHO).3,4 The Committee on the Costs of Medical Care was formed in the 1920s as a result of concerns about the cost of medical care. In 1932, this committee gave the first estimate of national health care expenditures at $3.66 billion (4% of gross national income). In 1971, President Nixon announced a "crisis" in health care costs and said that the system was at risk of collapse from insolvency. In that year, national health care expenditures were $81 billion and represented 7.2% of the gross domestic product (GDP). We are in trouble. Our federally funded health care programs’ share of the budget has doubled in the last 20 years. It cost $717 billion and represented 26% of total federal spending in 2007.5 Spending on health care by individuals and the government is expected to increase from an average of $7,026 in 2006 to $13,101 in 2017. The total healthcare spending is then projected to reach $4.3 trillion.6 These costs have been considered to put the economic stability of the country at risk.7 We have promised entitlements through the federal government, primarily Medicare and Social Security, that are not funded and may be impossible to meet. “As 78 million baby boomers prepare to retire, the sum of America's unfunded entitlement promises (i.e., Medicare and Social Security) currently exceeds three times the size of the entire U.S. economy, and they are growing by over $2 trillion a year. Entitlement programs must be reformed to reflect current economic realities and longer life spans while also making them solvent, sustainable, secure and more savings oriented.8” 3 World Health Organization assessment of the world's health system. Press Release WHO/44 21 June 2000. 4 WHO health system attainment and performance in all member states, estimates for 1997 5 The State of the Union's Finances: A Citizen's Guide available fro download as a PDF from the Peter G. Peterson Foundation (http://www.pgpf.org/) 6 Keehan, S., et al., "Health Spending Projections Through 2017: The Baby-Boom Generation is Coming to Medicare," Health Affairs Web Exclusive, February 26, 2008, W-145. http:// content.healthaffairs.org/cgi/reprint/hlthaff.27.2.w145v1 7 CBO Testimony, Statement of Peter R. Orszag, "Growth in Health Care Costs," before the Committee on the Budget, United States Senate, January 31, 2008, http://www.cbo.gov/ ftpdocs/89xx/doc8948/01-31-HealthTestimony.pdf 8 from the Peter G. Peterson Foundation website (http://www.pgpf.org/) 3 Mark Force, DC …functional & natural healthcare Ashland, Oregon, USA theelementsofhealth.com In 1980, we were the largest lender nation in the world. Now we are the largest debtor nation in the world. Our current “on the books” debt is $10.8 trillion as of September 30, 2007, but if we include promised future Social Security and Medicare benefits that are unfunded that adds another $41 trillion! And, if you break this figure down, the Social Security benefits add up to $6.7 trillion while the Medicare benefits total $34.1 trillion! This puts our nation at risk in a scary and long list of ways that is outside of the scope of this paper. I have mentioned these issues because it puts into context the grave and pressing realities of Medicare and health costs. We have to fix these problems for our individual and national health. To understand the entitlements issue and how it relates to our national debt, read “Running On Empty” by Peter G. Peterson.9 We are paying an incredible amount of money for health care in this country through health insurance premiums, tax dollars going to government health care programs, and in direct costs for uncovered services. Yet it looks like we’re not really getting a good return in terms of improved health, longevity, quality of life, and well-being. In fact, increased spending is not correlated with higher quality care.10 Healthcare Outcomes In The US The stats on our health status are pretty dismal. We are 45th in life expectancy (78.06) when compared to other nations.11 If we compare ourselves to Japan, the industrialized nation with the longest life expectancy (82.07), we spend more than twice as much per capita on health care.12 Life expectancies are expected to decline in the future according to current health trends. This reverses a long multigenerational trend in life expectancy increasing with succeeding generations.13 Yet, with all of the money spent and with the intensive use of healthcare in the US, the relationship between doctors and patients is deteriorating.14 9 Also available from the Peter G. Peterson Foundation website (http://www.pgpf.org). 10 Geographic Variation in Health Care Spending, CBO Paper, Peter R. Orszag, February 2008, http://www.cbo.gov/ftpdocs/89xx/doc8972/02-15-GeogHealth.pdf 11 CIA World Factbook (2008 estimates) 12 Snapshots: Health Care Spending in the United States and OECD Countries, Kaiser Family Foundation, http://www.kff.org/insurance/snapshot/chcm010307oth.cfm (USA, $6,711; Japan, $2,249; 2003) 13 A Potential Decline in Life Expectancy in the United States in the 21st Century, Jay Olshansky, Ph.D., et al, NEJM, Volume 352:1138-1145, March 17 , 2005. 14 Well: Doctor and Patient, Now at Odds, Tare Parker-Pople, The New York Times, July 29, 2008. 4 Mark Force, DC …functional & natural healthcare Ashland, Oregon, USA theelementsofhealth.com Breakdown of Healthcare Costs In The US Some of the factors that have been cited to drive up healthcare costs are inappropriate use or over-utilization of medical care, regional variation in recommended services and their costs, wasteful or inefficient administration, uninsured populations, a lack of preventive services, an aging population, a lack of free market price controls because of patient’s often indirect relationship to fees, “defensive” testing and referrals due to the prevalence of malpractice claims, marketing of sophisticated and expensive tests, treatments, and drugs, and poor lifestyle choices leading to chronic degenerative diseases. Approximately 1% of the population with the highest spending accounted for 27% of aggregate health care spending. The top five percent of costliest Medicare beneficiaries account for nearly half of Medicare spending.15 Advanced diagnostic and therapeutic technologies have been proposed to account for as much as half of the health care costs in the last few decades.16 Those without healthcare insurance are less likely to get regular and preventive health care and to seek immediate care when necessary. The decreased and delayed use of ongoing health maintenance care results in more crisis care which is significantly more expensive than regular and ongoing treatment for chronic degenerative conditions (i.e.
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