U.S. health care is the most expensive in the world

The current cost of health care in the United States is the most expensive in the world.

by Dr. Mark Force — 

Editor’s Note: This is part one of a two-part article on our health care crisis. Part two will cover solutions to the problems.

The current cost of health care in the United States is the most expensive in the world. The U.S. health care system has been rated as the highest in cost and yet is 72nd in overall level of health when compared to 191 member nations included in a study by the World Health Organization (WHO).

Federal health care costs $717 billion and represented 26 percent of total federal spending in 2007. 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 health care spending is then projected to reach $4.3 trillion.

These costs have been considered to put the economic stability of the country at risk. Promised entitlements through the federal government, primarily Medicare and Social Security, are unfunded and may be impossible to meet.

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, but if we include promised future Social Security and Medicare benefits that are unfunded, this adds another $41 trillion. To understand the entitlements issue and how it relates to our national debt, read Running on Empty by Peter G. Peterson.

Yet, increased spending does not correlate with higher quality care. We are 45th in life expectancy (78.06) when compared to other nations, and we spend more than twice per capita than Japan, the industrialized nation with the longest life expectancy (82.07). And, life expectancies are expected to continue to decline in the United States due to diminished public health.

About one percent of the population with the highest spending accounted for 27 percent of health care spending, while the top five percent of costliest Medicare beneficiaries account for nearly half of spending. Advanced diagnostic and therapeutic technologies account for as much as half of the total health care dollar.

Health care costs

Lack of insurance — Those without health care insurance get less regular and preventive health care. They also tend to use more crisis care when sick and develop more chronic degenerative diseases (e.g., diabetes, heart disease, obesity, high blood pressure, etc.), both categories of which are more expensive than maintenance or preventive care.

Compromised infants — Five percent of infants account for 76 percent of total infant hospital costs. Low birth weight and very low birth weight infants had significantly longer hospital stays and accounted for a significantly higher proportion of total hospital costs. Maternal health has been shown to increase the risk for premature births. Some specific factors that increase premature birth risk, but are controllable through lifestyle in most cases, are high blood pressure, pre-eclampsia, diabetes, periodontal (gum) disease, and pregnancies before 18 or after 35 years of age.

Poor nutrition (most commonly seen in poor, inner city populations), smoking, excessive alcohol, drug use, teen pregnancies (especially younger than 15) and environmental stress are all well-known risk factors for low weight births. Simple public health practices to encourage improved lifestyle factors (i.e., improved diet, avoidance of smoking and alcohol) significantly decrease the risk of premature and low birth weight infants.

Low birth weight increases the risks for infants developing autism and psychiatric disorders. It is alarming to note that the incidence of bipolar disorder in those younger than 20 years of age has risen dramatically (25 cases per 100,000 in 1994-95 versus 1,003 per 100,000 in 2002-03) in recent years.

Low birth weight children are significantly more prone to a number of chronic health problems and disabilities that include cerebral palsy, asthma, impaired vision, IQ of less than 85, poor academic performance and poor motor skills.

Chronic, degenerative illnesses — Chronic diseases account for $3 of every $4 spent on health care. That’s nearly $7,900 per year for every American with a chronic disease. In most cases, the illness is caused by poor lifestyle habits that include diet, exercise, stress management and environmental stress (pollution, pesticides, etc.) which, barring the limitations of poverty and genetic factors, are under an individual’s control.

It has been estimated that someone who has one or more chronic conditions is five times more costly to the health care system than someone without any chronic conditions.

Obesity and diabetes — Obesity alone significantly increases health care costs to almost twice that of normal weight individuals. Diabetes is strongly linked to premature births and cardiovascular disease for the child later in life. And, one in three babies born today is projected to develop diabetes in their lifetime.

Poverty — Minority groups suffer more chronic degenerative diseases. When compared to Whites, the African American and Hispanic populations have about twice the risk of developing diabetes. Minorities also have higher rates of cardiovascular disease, HIV/AIDS and infant mortality. This most likely represents a higher prevalence of poverty in these groups and insufficient public health policies aimed at education, prevention and ongoing management for chronic degenerative illness.

Heroic end-of-life care — Mean medical costs for people aged 65 or older in their last year of life was $37,581 from 1992 to 1996. This represents around 28 percent of all Medicare expenses for a given year. Yet, providing more intense health care in the last two years of life to patients with severe chronic illnesses (more tests and procedures, along with longer hospital stays) is not associated with better patient outcomes.

Next issue, we will cover the solutions that have been proposed to solve the problems in our current health care system and argue their relative merit based on the evidence. From this I will propose a model that would likely give us better outcomes without breaking the bank.

Mark Force, D.C., is a chiropractic physician at The Elements of Health in north Scottsdale, Ariz. He practices functional and natural health care and is the author of Choosing Health: Dr. Force’s Functional Selfcare Workbook. 480-563-4256 or theelementsofhealth.com.

Reprinted from AzNetNews, Volume 28, Number 1, Feb/Mar 2009.