why do we spend so much on healthcare
DannyБs death this autumn wasnБt nearly as bad as the weeks before it. My husbandБs eldest brother died in November at age 71, just two months after entering a nursing home in apparent good health. Healthy physically, that is. Daniel Meyers had begun the slide into dementia by his early 60s. It wasnБt AlzheimerБs; his family suspects the decades he spent as a commercial deep-sea diver before his last, devastating case of the bends - brought up too fast in a diving bell - ended his career. In truth, it was a little hard to tell where БDanny being DannyБ left off and the dementia began. He was goodhearted and eager to help anyone with anything (whether they wanted help or not, as one funeral joke put it), a magnet for women and a gifted but quirky handyman who had trouble committing to both relationships and construction jobs. He left behind a string of broken hearts and half-tiled bathrooms. Invoicing was an occasional thing, and when his abilities to carry out even simple tasks failed him in later years, he moved from his apartment to a garage and to living in his van, until his family placed him in assisted living and, finally, in the nursing home. That last move was tough to pull off. He had Medi-Cal, which covers skilled nursing for the poor, but when nursing homes found out he was on the state program, they said they were full up, a common problem. He had to be transferred to a hospital so that a social worker could find him a bed in a San Jose nursing home. When he arrived, he did it walking and still able to talk.
But occasionally, if a staff member moved a hand in front of him, he would grab their wrist in the iron grip that came from a lifetime of physical labor. That led to chemical restraint - drugs that knocked him out so hard that he slept all day in a hunched knot. He was pulled to a sitting position for his meals, but ate little before falling asleep again. In no time, his lean, muscled frame grew gaunt. His deteriorating condition was obvious when my husband and I arrived for a lunch visit with a chocolate milkshake. Danny ate with maddening, drugged slowness. He would lose interest in his food until my husband gently guided his attention back to his tray. While weБd been told he had no appetite, he polished off his lunch and the milkshake - but it took 45 minutes. During that time, the aide who normally helped him eat came in three times to see if she could clear his tray, surprised that he was still eating. She was friendly and competent, and I could imagine her doing her best to provide good care. But she didnБt have 45 minutes to feed one man his lunch. Another brother who visited would make Danny rise from his bed and walk around a while. But family members couldnБt be there three times a day, so he spent most of his time sleeping. He couldnБt even take part in that other depressingly familiar scene in the memory wards of nursing homes - residents lined up in wheelchairs by the nurseБs station, chattering aimlessly or just sitting, slumped and wordless, for hours. Within two months, Danny had a serious bedsore, and the doctor noticed he had trouble breathing as well.
At the hospital, he was diagnosed with congestive heart failure. Given his wretched state and hopeless future, the family decided against treatment. He died two days later, a fate that seemed kinder than a return to nursing care. ItБs not that the facility was substandard or caused his death. Rather, societyБs lack of attention to the needs of the infirm elderly means that our collective standard for their quality of life is too low. ThereБs nothing high-tech about interacting with a mentally faded man, or sitting with him until he finishes a meal. But staffing is expensive, and weБve been spending our health care dollars on high-tech intervention more than on providing comfort in old age. Think it canБt happen to you? According to the legal site Nolo. com, Medi-Cal pays for the care of 65 percent of Californians in nursing homes. If we want things to be different for our aging generations, we canБt afford to turn a blind eye to where we might end up some day. Karin Klein is a freelance journalist in California who has covered education, science and food policy.
Health Reform: Any time there's a debate about health care reform, someone will invariably declare that the U. S. spends "too much" on health care. How do we know that? We don't, it turns out. It has become a long-standing cliche in the reform debate. "We spend more on health care than any other industrialized nation and we get worse health care outcomes. " Sen. Bernie Sanders uses this is a justification for his "Medicare for all" socialized medicine plan.
President Obama used it to justify ObamaCare. So does everyone pushing for a greater government role in health care. Other countries have government-run systems and spend less money and have better quality care. We should, too. The second part of that claim regarding health outcomes is based on highly unreliable international comparisons of infant mortality rates and longevity, which is a subject for another time. But what about the claim that we spend too much? There's no question that the U. S. devotes far more resources to health care than any other country. Health spending in the U. S. accounts for more than 17% of GDP. Among industrialized nations, the next closest is Sweden, where health care is 12% of its economy. In Canada, health care spending is less than 11% of GDP. In the U. K. , it's 9%, according to the World Health Organization. So what? The U. S. is a very rich country, and as a result, Americans spend more on just about anything than any other country in the world. The U. S. spends more per capita on advertising, more on national defense, more on information and communications technology, more on leisure activities. The country also gives far more to charities than any other nation in the world. According to the Charities Aid Foundation, charitable donations in the U. S. equals 1. 44% of GDP. The next closest country is New Zealand, at 0. 79%. Does that mean the U. S. spends "too much" on charity? After all, despite all those charitable donations, we still have poor people and distressed communities and a drug addiction crisis.
International health care spending comparisons fail to take into account one important fact: Once people take care of basic necessities, they're going to spend a bigger share of each additional dollar on things that improve their quality of life. Things like recreation, entertainment, education, and yes, health care. Take a look at spending growth rates within the U. S. As the accompanying chart shows, between 1990 and 2016, consumer spending on financial services, higher education, travel and accommodations, and spending by nonprofits, all climbed at a far higher rate than health care spending. And all of these categories climbed faster than overall GDP. But look at spending on the basics в household supplies, groceries, clothing, furnishings в these all climbed at a rate slower than overall GDP. The fact that the U. S. spends a bigger share of its GDP on health care than other countries tells us nothing, in and of itself, about our health care system, other than that the U. S. is a rich country. Plus, much of the money is going to finance breakthroughs in medical technology and treatments that far exceed what other countries are doing. Could health care delivery be more efficient? Could it better protect more people against catastrophic health costs? Sure. But as any doctor knows, you have to diagnose the problem first, before deciding on a treatment. Simply saying we spend a lot on health care isn't an adequate diagnosis. RELATED:
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