Health Care Reform is confusing and scary. Will the proposed changes make costs go up or come down? How will the quality of service be effected? Will treatment improve or worsen? And who will make the decisions that determine how cases and patients are handled? An unknown bureaucrat in Washington or one of the ten federal regions, or an unknown bureaucrat at the end of an 800 number who works for a private insurer and turns down a request for treatment as being outside of standard protocol? And who will pay for the changes? Can the nation afford to cover the 44 million uninsured? What loopholes are unforeseen?
Perlo doesn’t have a crystal ball, juju beads, or oracle bones, but it clicked through Google and Bing and discovered an already massive, invisible system of government health care that no one is talking about and that your tax dollars pay for.
The federal government is already deeply, deeply involved in health care in a myriad of ways, from the labels on packages to manufacturing standards to expanding markets to building roads and buying ambulances to operating clinics and subsiding nutrition to funding training to reimbursing service providers for minor treatment and major operations.
A good way to assess future performance is to look at past results. There is a huge amount of data and performance reports available that can guide the national conversation about health care priorities, costs, and potential savings, and can help identify needs and a sensible path to new policies.
As Booker T. Washington, the Virginia-born founder of Alabama’s Tuskegee Institute, said in his 1896 Atlanta Exposition speech, “cast down your buckets where you are.” To gain a fuller picture of the dollars the federal government is currently spending, examine the annual budgets of only a few programs and departments from the government’s invisible empire of health services.
In 2009, there were 1,961 mentions of “health” in 181 federal budget documents .
- Among these “mentions,” the FDA (Food and Drug Administration) charged with keeping the nation’s food and drug supply safe, requested $2.4 billion.
- The National Institutes of Health were appropriated a combined $30.3 billion. The Center for Disease Control and Prevention requested discretionary authority budget of $6.35 billion. The CDCP monitors and tracks infectious diseases, chronic diseases, environmental and occupational health illness, and state and federal bio-terrorism preparations.
- The Health Resources and Services Administration which funds clinics and health centers, rural health care, funds training and scholarships, some organ transplant services, among other services, asked $6.8 billion.
- In 2009, for legislated mandates, Indian Health Services was expected to receive $4.08 billion.
- In the 2008 budget, the WIC (Women, Infants, and Children) program, which provides nutrition assistance to women with infants and services 45 percent of all US born infants, was budgeted at $5.5 billion.
- So far, in 2009, the US government has purchased $3 billion of flu vaccine components-which may prevent an epidemic of H1N1, currently the biggest threat to cause a global pandemic.
- The newly passed Children’s Health Insurance Program (CHIP), for children of families caught in the income gap between private insurance and medicaid, is requesting $6.9 billion to spend this year.
Examine the invisible government health care expenses by several themes: treatment, costs for specific illness, drug prices, public payer, public health care providers, breath and scope of federal health services in all departments.
- One out of eight federal dollars-nearly $80 billion-is spent on services and treatment for Americans with diabetes. In fact, one study, (http://bit.ly/nE00G), reports 18 out of the 21 federal departments spend money on diabetes. Annual federal diabetes expenses exceed the entire annual budget of the Department of Education. While diabetes is preventable or manageable through diet and exercise, the government spent only $4 billion on prevention.
- Overall spending is a theme with staggering implications. Without any reform, for 2009, the federal government plans to spend $2.24 trillion on health care with 1.84 trillion of that total funded by deficit spending.(http://www.usgovernmentspending.com/) .
- $602 billion in 2004, 44% of all monies spent covered emergency room treatments. Still, more than half of all visits went unpaid.
- American drug prices are the highest in the world, and account for 13 percent of all costs, or $202.24 billion in 2007.
- By class, cardio-vascular drug purchases reached $31.5 billion, central nervous system agents accounted for $23.7 billion, hormones, $24.5 billion, and psycho-therapeutic drugs for $17.9 billion.
- Current health care annual rates of spending increase are a whooping 8.6 percent.
- The US as a whole spends $4.33 billion on health care in corrections.
- The US has the highest infant morality rates of any developed country.
- Medical debt is the number reason cited in the US for personal bankruptcies.
- Non-profit hospitals represent 70 percent of US hospital capacity.
- Currently, no nationwide system federally owned health facilities are open to the public (e.g., the Veterans Administration system only accepts veterans).
- Hospital care accounts for 31 percent of all current health care costs.
- In 1996, one percent of those receiving public treatment funds accounted for 27 percent of total costs.
- Government health care programs currently cover 28 percent of Americans, 83 million people.
- The US operates the largest national public health unit in the world, the US Public Health Service Commissioned Corps, one of America’s seven uniformed services.
- Every department of the federal government is involved in funding health care as a public activity, including Agriculture, Defense, Education, HUD, Commerce, Interior, the Department of Justice an the others. The departments offer initiatives, trade mission, program goals, funding, outreach, treatment services, state grants, consumer protection against malpractice and fraud, transport, research, safety certification, guidelines and standards, and planning, both long term and contingency.
At first reaction, the numbers from every corner are staggering. Health care, clearly, has created a “giant sucking sound,” that tax dollars are flying into, inside and outside of treatment care. Reform is necessary, if only to stop the rapidly increasing flow of dollars.
The Director of the Congressional Budget Office wrote these powerful words on his blog, about his recent testimony before Congress:
” Under current law, the federal budget is on an unsustainable path, because federal debt will continue to grow much faster than the economy over the long run. . . Unless revenues increase just as rapidly, the rise in spending will produce growing budget deficits. Large budget deficits would reduce national saving, leading to more borrowing from abroad and less domestic investment, which in turn would depress economic growth in the United States.
Measured relative to GDP, almost all of the projected growth in federal spending other than interest payments on the debt stems from the three programs–Medicare, Medicaid, and Social Security. For decades, spending on Medicare and Medicaid has been growing faster than the economy. CBO projects that if current laws do not change, federal spending on Medicare and Medicaid combined will grow from roughly 5 percent of GDP today to almost 10 percent by 2035. By 2080, the government would be spending almost as much, as a share of the economy, on just its two major health care programs as it has spent on all of its programs and services in recent years.
In CBO’s estimates, the increase in spending for Medicare and Medicaid will account for 80 percent of spending increases for the three entitlement programs between now and 2035 and 90 percent of spending growth between now and 2080.”
Clearly, the first goal of reform must be to cut costs, reduce expenses, save money. Do any of the current plans meet this goal?
Secondly, waste, duplications, inefficiencies, and hidden costs abound throughout the systems and much of the real costs are off the books and are deeply embedded in each federal department. Critical and close oversight of these widely disbursed costs must be achieved. Through coordination, cooperation, and consolidation, it appears that real, significant savings in administration, services, and support can be achieved. The expenses connected to diabetes hidden in the system are a screaming poster child for theneed for teamwork. Grouping all health care expenses on a spread sheet that cuts across cabinet lines must be a high priority.
Thirdly, costs must be matched to measurable targets. How do only one percent of all users of the system account for 27 percent of the costs? Strategies for chronic users must be developed, better profiles created, alternatives explored. Name the top three creative ideas in the current reform plans. Without new ideas, how can there be reform?
Fourthly, drug costs must be severely curtailed.
Fifth, the cost of routine procedures must be reduced. Child birth is an example of a procedures whose costs have skyrocketed. Why?
Sixth, the government does efficiently provide medicaid, medicare, veteran health care, public immunization, disease mapping, research, and large grants to communities and individuals.
Seventh, so does the private sector. But in both cases, costs are raising to rapidly.
Lastly, future fears are being used to shield the maladies, malaprops, and out of control spending of the present. The US territories, Guam, American Samoa, Puerto Rico, for example absorb a large percent of health care funding. How exactly will reform affect the territories? And why are the current bankruptcies, unfathomable bills, and budget-breaking proscription costs not a part of the public debate?
Oh, watch carefully the special interests that suggest the government will enact forms of euthanasia for the elderly, or develop a plan with cracks so wide that legions will fall through, or increase private costs more rapidly. Having chased answers for treatment and services from the smallest detail to major conditions (a few years ago, my father suffered pulmonary edema over a weekend while in the hospital and it took five days for the family to get an assessment from the primary physician-while the consulting cardiac physician refused to speak at all to a family member despite repeated requests), I believe the answer to improved care lies in better values. The culture of American medicine must be reformed, along with its cost and payment structures, and the culture of its stake holders, the unions, medical/hospital/pharma/insurance associations who tremble and fear change, and resist it even worse than the American public.
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