20,000 Americans killed by invisible healthcare rationing every year

The United States healthcare system is #1 in costs and #37 in outcomes, according to The World Health Organisation (WHO). A primary reason we waste so much money is because we’re the only advanced economy on Earth that denies basic medical treatment to millions of our citizens, something even many poor countries — like Cuba — provide.

Now that we’re attempting to take a baby step toward healthcare sanity, health insurance companies are scaring people with the threat that faceless government bureaucrats will “ration” healthcare if government creates a public health insurance option. Scaring people about the creation of an additional option that anyone can ignore in favor of whatever health insurance they already possess is disingenuous. Further, our private health insurance system already rations healthcare. 45,000,000 to 50,000,000 Americans already have no health insurance. That’s rationing by wealth and social class. And tens of millions of “insured” Americans — most unknowingly — are in danger that some day, if they’re unfortunate enough to become very sick, their insurer will refuse to cover them or will charge them unaffordable amounts. (Michael Moore profiled this latter group — who believed they were insured… until they were dropped by their “insurer” — in the outstanding movie “Sicko.”)

Solving the twin problems of out-of-control U.S. healthcare spending and shockingly poor health outcomes will require taking money away from astonishingly expensive drugs and procedures keeping terminal patients alive a bit longer (often in agony) during their last year of life and re-directing that money toward cheaper treatments that allow younger, healthier patients live much longer, healthier lives. Why? According to Harvard professor David Cutler:

Spending in the last year of life is about 10 times [higher than] spending outside the last year of life.

Strangely, American government allows 45+ million Americans to risk death-by-lack-of-health-insurance even while it pays (via Medicare) for super-expensive treatments that slightly extend the (often painful) lives of terminally ill elderly. Even more astonishingly, we’re spending hundreds of billions on terminally ill old people, many/most of whom would be happier in a low-cost hospice setting, like the one recently profiled in The New York Times, than an uncaring, unloving hospital room. This makes no sense!

Princeton University bioethics professor (and all-around thoughtful, caring guy) Peter Singer raises this hugely important question (“Who should receive what treatment?”) that many, if not most, Americans never consider. We must answer it as a society, if we hope to prevent skyrocketing healthcare spending — which buys consistently lousy health outcomes for average Americans — from becoming 1/3 of the U.S. economy, as some project it’s on course to. (It’s already 1/6th of the U.S. economy… a much larger fraction than in any other country.) Professor Singer writes that even U.S. emergency rooms — which are required by law to treat everyone — ration healthcare, with deadly consequences:

[E]ven in emergency rooms, people without health insurance may receive less health care than those with insurance. Joseph Doyle, a professor of economics at the Sloan School of Management at M.I.T., studied the records of people in Wisconsin who were injured in severe automobile accidents and had no choice but to go to the hospital. He estimated that those who had no health insurance received 20 percent less care and had a death rate 37 percent higher than those with health insurance. This difference held up even when those without health insurance were compared with those without automobile insurance, and with those on Medicaid — groups with whom they share some characteristics that might affect treatment. The lack of insurance seems to be what caused the greater number of deaths.

When the media feature someone like Bruce Hardy (whom Britain’s health system initially denied a kidney cancer medication that would likely add six months to his life at a cost of $54,000) or Jack Rosser (also initially denied the $54,000 medicine by Britain’s health system), we readily relate to individuals who are harmed by a government agency’s decision to limit the cost of health care. But we tend not to hear about — and thus don’t identify with — the particular individuals who die in emergency rooms because they have no health insurance. This “identifiable victim” effect, well documented by psychologists, creates a dangerous bias in our thinking. Doyle’s figures suggest that if those Wisconsin accident victims without health insurance had received equivalent care to those with it, the additional health care would have cost about $220,000 for each life saved. Those who died were on average around 30 years old and could have been expected to live for at least another 40 years; this means that had they survived their accidents, the cost per extra year of life would have been no more than $5,500 — a small fraction of the $49,000 that NICE recommends the British National Health Service should be ready to pay to give a patient an extra year of life. If the U.S. system spent less on expensive treatments for those who, with or without the drugs, have at most a few months to live, it would be better able to save the lives of more people who, if they get the treatment they need, might live for several decades.

Estimates of the number of U.S. deaths caused annually by the absence of universal health insurance go as high as 20,000…

[T]he U.S. system also results in people going without life-saving treatment — it just does so less visibly. Pharmaceutical manufacturers often charge much more for drugs in the United States than they charge for the same drugs in Britain, where they know that a higher price would put the drug outside the cost-effectiveness limits set by NICE. American patients, even if they are covered by Medicare or Medicaid, often cannot afford the copayments for drugs. That’s rationing too, by ability to pay.

Posted by James on Wednesday, July 15, 2009