How have healthcare costs become so high?

First, let’s get a little historical perspective on the US healthcare system. To do that, we go back to the American Civil War era. In that war, outdated tactics and the carnage wreaked by modern weapons of the era produced terrible results. Most of the deaths on both sides of that war were not the result of actual combat, but of what happened after a battlefield wound was inflicted. To begin with, the evacuation of the wounded proceeded at a snail’s pace in most cases, causing serious delays in the treatment of the wounded. Second, most wounds were subjected to wound-related surgeries and amputations, often resulting in massive infection. So you could survive a blow wound only to die at the hands of medical providers whose well-intentioned interventions were often quite deadly. High death tolls can also be attributed to everyday illnesses and conditions in a time when antibiotics did not exist. In all, there were approximately 600,000 deaths from all causes, over 2% of the US population at the time!

Let’s go to the first half of the 20th century for some extra perspective and to take us to more modern times. After the Civil War, there were steady improvements in American medicine in both the understanding and treatment of certain diseases, new surgical techniques, and in the education and training of physicians. But for the most part, the best doctors could offer their patients was to wait and see. Medicines could treat broken bones and perform risky surgeries and the like (now increasingly used in sterile surgical settings), but medicines were not yet available to deal with serious illnesses. The majority of deaths continued to be due to untreatable conditions such as tuberculosis, pneumonia, scarlet fever and measles and/or related complications. Doctors were increasingly aware of cardiovascular disease and cancer, but they had almost nothing to treat these conditions with.

This very basic understanding of American medical history helps us understand that until recently (around the 1950s) we had virtually no technologies to treat serious or even minor ailments. Nothing to treat you with meant that visits to the doctor, if any, were relegated to emergencies, so obviously the cost was miniscule in that scenario. A second factor that has become a major driver of current health care costs is that medical treatments that were provided were paid for out of pocket. There was no health insurance and certainly no health insurance paid for by someone else such as an employer. The cost was the responsibility of the individual and perhaps a few charities that supported charitable hospitals for the poor and needy, among other things.

What does health insurance have to do with health care costs? The impact on healthcare costs is enormous. When health insurance for individuals and families emerged as a means for businesses to escape wage freezes and to attract and retain workers after World War II, a large amount of money was available for health care almost overnight. Money, as a result of the availability of billions of dollars from health insurance pools, encouraged an innovative America to ramp up medical research efforts. As more and more Americans became insured, not only through private employer-sponsored health insurance, but also through increased government funding that created Medicare, Medicaid, and comprehensive veterans’ health care, finding a cure for almost anything has become very lucrative. This is also the main reason for the wide range of treatments we have available today. I’m not saying this is a bad thing. Think of the tens of millions of lives saved, extended and made more productive as a result. But with a funding source that has grown to its current size (hundreds of billions of dollars a year), upward pressure on health care costs is inevitable. A doctor’s supply and most of us demand and get access to the latest healthcare technology, medicines and surgical procedures available. So there is more health care to spend our money on and until recently most of us were insured and the costs were largely covered by a third party (government, employers). This is the “perfect storm” for ever-increasing healthcare costs and, in general, the storm is increasing.

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Now let’s look at a key question. Is the current trajectory of US health care spending sustainable? Can America maintain its global competitiveness if 16%, on its way to 20% of our gross national product, is spent on health care? What do the other industrialized countries spend on health care and is it even close to these figures? Add in politics and an election year and the whole issue becomes very confused and misrepresented.

I believe we need a revolutionary change in the way we think about health care, its availability, costs and who pays for it. And if you think I’m going to say we should cut health care arbitrarily and drastically, you’re wrong. Here it is fellow citizens – health care expenditure must be preserved and protected for those who need it. And to free up these dollars, those of us who don’t need it or can put it off or avoid it need to act. First, we must convince our politicians that this country needs continued public education regarding the value of preventive health strategies. This should be a top priority and it has worked to reduce the number of smokers in the US, for example. If prevention were to gain a foothold, it is reasonable to assume that the number of people needing health care for the myriad lifestyles that cause chronic disease would drop dramatically. Millions of Americans are experiencing these diseases much earlier than in decades past and much of this is due to poor lifestyle choices. This change alone would free up a lot of money to cover the health care costs of people who need urgent treatment, whether due to an acute emergency or a chronic condition.

Let’s take a closer look at the first problem. Most of us refuse to do anything about implementing basic health strategies in our daily lives. We don’t exercise, but we make a lot of excuses. We don’t eat well, but we make a lot of excuses. We smoke and/or drink alcohol to excess and make many excuses as to why we can’t help it. We don’t use preventive health checks that look at blood pressure, cholesterol readings, and body weight, but we make a lot of excuses. In short, we neglect these things and as a result, we succumb to chronic diseases such as heart problems, diabetes and high blood pressure much sooner than necessary. In the end, we go to doctors for these and more routine things because “health care is there” and somehow we think we are not responsible for reducing our demand for it.

It’s hard for us to listen to these truths, but it’s easy to blame the sick. Maybe they should take better care of themselves! Well, that could be true or maybe they have a genetic condition and are among the unlucky ones through no fault of their own. But the point is that you and I can implement personalized preventative disease measures as a way to dramatically improve access to health care for others while reducing costs. It’s much better to be productive by doing something we can control than by shifting the blame.

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There are a large number of free websites available that can lead us to a healthier lifestyle. “Google” “preventive health care strategies,” look up your local hospital’s website, and you’ll find more than enough help to get you started. Let’s go to America – we can do this!