Even as economic inequity and inequality fuel a nationwide plague of “deaths of despair,” a runaway and inefficient health system hits Americans hard in their pocketbooks, in effect imposing an $8,000 annual tax on every household, a pair of leading economists say.
The crushing cost of the U.S. health system, exceeding $1 trillion a year, forces all Americans to pay this “tribute,” as if it were going to a foreign power, except this is a toll on themselves that we tolerate and allow, say Anne Case and Angus Deaton. The Princeton economists have reached this conclusion, as part of their research for their upcoming book, “Deaths of Despair and the Future of Capitalism.”
Case told economists at a San Diego conference: “A few people are getting very rich at the expense of the rest of us.”
The couple already have made a compelling case — a Nobel Prize-winning one for Deaton — on how unchecked capitalism has harmed Americans, finding soaring deaths among those ages 25 to 64. As the Washington Post reported of those in this group:
“They discovered Americans … have been committing suicide, overdosing on opioids or dying from alcohol-related problems like liver disease at skyrocketing rates since 2000. These ‘deaths of despair’ have been especially large among white Americans without college degrees as job options have rapidly declined for them.”
Three years of reported declines in Americans’ life expectancy rates have increased the concerns raised by Case and Deaton, as well as causing serious second-guessing among health care experts about the nation’s expensive and ever more costly medical services.
The economists have unkind thoughts and words about the American health system, of which the Washington Post quoted Case saying: “We can brag we have the most expensive health care. We can also now brag that it delivers the worst health of any rich country.” As the newspaper reported:
“The U.S. health-care system is the most expensive in the world, costing about $1 trillion more per year than the next-most-expensive system — Switzerland’s. That means U.S. households pay an extra $8,000 per year, compared with what Swiss families pay. Case and Deaton view this extra cost as a ‘poll tax,’ meaning it is levied on every individual regardless of their ability to pay. (Most Americans think of a poll tax as money people once had to pay to register to vote, but polle was an archaic German word for ‘head.’ The idea behind a poll tax is that it falls on every head.)”
Deaton told the newspaper in an interview that an economic indictment of the health system would fall hard on doctors, who are 16% of people in the top 1% of income earners in this country, according to others’ studies. As Deaton argued: “We have half as many physicians per head as most European countries, yet they get paid two times as much, on average. Physicians are a giant rent-seeking conspiracy that’s taking money away from the rest of us, and yet everybody loves physicians. You can’t touch them.”
For now, the couple are staying out of the political mire about potential fixes for the U.S. health care system, offering limited prescriptions, instead, as the newspaper reported:
“After looking at other health systems around the world that deliver better health outcomes, the academics say it’s clear that two things need to happen in the United States: Everyone needs to be in the health system (via insurance or a government-run system like Medicare-for-all), and there must be cost controls, including price caps on drugs and government decisions not to cover some procedures. The economists say they understand it will be difficult to alter the health-care system, with so many powerful interests lobbying to keep it intact.”
Indeed. In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of therapies and prescription medications, too many of which turn out to be dangerous drugs.
As voters make up their minds in the crucial 2020 elections, they may be well served to ask themselves if, for example, the Trump Administration has acted with the needed alacrity to end the opioid and overdose crisis? Which party has acted to deal with not only health insurance for millions of poor, working, poor, and middle class Americans, but also to help us all with sky-high prices and costs for prescription drugs and medical bills, especially of the surprise variety (those that occur, notably in emergency situations, when patients receive “out-of-network” treatment that their insurers may not cover)?
The evidence abounds that significant problems exist in the health care system: Why is ours four times more costly to run than that of our neighbors to the north? Why can a Finnish mom deliver a baby for on average $60 but her American counterpart pays $4,500 — that’s out of her own pocket, after insurance?
If Case and Deaton haven’t made the case for you, too, about the profound economic nightmares occurring for so many working class Americans, it may be worth the time to read the recent New York Times essay by Nicholas Kristof and Sheryl WuDunn, adapted from their book “Tightrope: Americans Reaching for Hope.” They take the talents they amply displayed as Pulitzer Prize-winning foreign correspondents to ask what happened to a generation of Americans left behind, in this case columnist Kristof’s friends in Oregon. It’s grim reading.
It also affirms that health care also is swayed, big time, by “social determinants,” economic concerns like whether raising the minimum wage by as little as $1 an hour reduces suicides among poorer workers or whether closures of manufacturing plants are linked to increases in overdose deaths.
We’ve got a lot of work to do to improve our society and health care system, and our votes this fall could not be more important.
