Paperwork at South Central Family Health Center in South Los Angeles. Health care spending is through the roof in the U.S. because it operates as a business, says one expert – but it should be viewed completely differently, says another health advocate. (Mae Ryan/KPCC)
$2.15 trillion.
According to a study appearing in the Archives of Internal Medicine, that's how much the United States would have saved had it implemented cost-saving measures from the Canadian health care system beginning in 1980.
Of course, there are plenty of caveats: One critic, Professor Stuart Altman, told HealthDay that the comparison doesn't work, because the U.S. medical care system is more expensive to run, and that people who work in U.S. medicine make more than their Canadian counterparts.
But criticisms and systematic differences aside, U.S. spending on health care does eclipse Canadian spending – by a lot. But Altman said part of the reason for that is that in other countries, health care is a "social service." But in the United States? He says it's "big business."
Just look at California, where the Los Angeles Times reports health insurers are preparing to spar with each other to gain a spot in the state-run health insurance exchange set to open in Fall 2013. The exchange, which is a result of a provision in the Affordable Care Act, will negotiate with different insurers for the best rates, and then will help both consumers and small businesses choose a plan based on those negotiations.
The exchange's tagline – "Your destination for affordable healthcare" – emphasizes its goal to be easy on your wallet, and part of what will theoretically make that happen is the increased competition among insurers. That's Business 101.
Nina Vaccaro, the executive director of South Los Angeles' Southside Coalition of Community Health Clinics, agrees with Altman that health care is a "big business" – and she doesn't like it at all.
"I don't think it should be that way, but the reality is that in the U.S., people profit off the illness of others," she said.
Heath care is profitable for a lot of people, said Vaccaro, and the people who pay the price are the "most marginalized in our communities, particularly those that can't afford to pay out-of-pocket for their care."
"So you have people that may not go to see a doctor for fear of the cost," Vaccaro said. "One of the challenges that we see with our uninsured population is when they're referred to go see a specialist, their first concern is, 'How much is this going to cost me?' and 'Can I afford this?'"
When health care is viewed through a business lens, she said, it's the people who can't afford it "that are left with extremely high medical bills." And that's not to say it doesn't affect your average middle-class American – most people are "one health care incident away from going bankrupt," she said.
"I think the Affordable Care Act made some strides, but at the end of the day, it's not regulating health care access," Vaccaro said. "It's a step in the right direction. But until we're able to fully regulate the pharmaceutical industry and other areas that are really driving he high cost, it's going to be difficult."
Vaccaro pointed to Canada, Cuba and England as places with successful, socialized universal health care systems – depending on who you talk to, of course. Some may say the care isn't as good in those places, she acknowledged, but that isn't a reason to dismiss the system entirely.
"There are problems with our system too, and we're not providing care to everybody who needs it here," she said. She believes that, from a "human rights perspective," those three countries have done "quite a good job" changing their health care delivery system so folks aren't excluded.
Vaccaro knows of patients who go to Mexico because the cost of health care is cheaper there, and calls it a "shame" that U.S. residents leave the country to receive care. But she doesn't see that changing anytime soon.
"We are built as a capitalistic society, and people want to be able to make profitable businesses," she said. "And until people let go of the idea that we should be making money off the ill health of our fellow citizens, it's going to be very difficult."
Added Vaccaro: "I don't think I'm going to see that happen in my lifetime."
