The Obama's speech on health care reform on last Wednesday was somewhat compelling. There should be counterarguments on the policy level, but no one can deny the necessity of the change itself. Basically I second to his opinions. And I always want him to be the last President to discuss uninsured people.
However, as I read and hear about the reform, I cannot help but thinking that this reform does not have any concrete ideas to curve the sky-rocketing US health expenditure.
Covering uninsured is a very important issue, but it would not bring huge cost saving since the US people have already paid the "hidden" costs throug paying their ER visits. By reducing uninsured, we can "shift" this cost, but we cannot reduce it. The problem of uninsured is a purely moral and social justice issue.
Obama expects the positive impacts of health IT, but it is not a silver bullet. Certainly, CPOE (Computerized Physician Order Entry) has cumulative evidence in prevention of medical malpractices, but other technologies such as EMR (Electronic Medical Record) still have huge issues on their pros and cons.
So, my point is that Obama's focus is too myopic. Without changing the population's basic health status, the US cannot change anything. The problems in health care systems are very superficial.
Let's look at some basic stats. Among developled countries, the highest life expectancy is achieved by Japan. They live 4 years longer than American, while their expenditure on health per capita is just 39% of the US's.
Of course, there are lots of differences. Japan has an universal coverage, salaries of doctors and nurses are not as high as US, and more than 70% of hospitals with >400 beds have CPOE systems*. Still, these differences are superficial and seem to play very small roles.
Rather, I would say that the biggest difference between Japan and the US is brought by the difference in thier population's basic health status. In comparison with Japan, the US has... 70% higher cancer incidence (a 10 fold difference in male prostate cancer and a 3 fold difference in female breast cancer), and a 9 fold difference in obesity prevalence. The deaths caused by ischaemic heart diseases among standardized population is 3.7 times higher than that of Japan.
Some would attribute these discrepancies to genetics, and I do not deny the possibility of the explanation, but we need to be reminded that the longevity of Japanese is a post-war phenomenon. They had shorter life than American a century ago.
What the US needs to do to handle with the health care cost is to shift the population toward healthier status. Without doing this, the US would continue to face the difficulty of paying for healthcare.
The "true" health care reform should be a more comprehensive combination of changes in lifestyles and behaviors, public transportation, agricultural policies, social inequity and inequality, cultural values, and so on, "including" health care system changes.
