If I had a dollar for every time I heard the word crisis used to describe the healthcare system of one country or another, I would be rich. And with the '08 elections revving up,
we can expect to hear a crisis chorus from many presidential and congressional candidates wise to the fact that healthcare
often ranks as voters' No. 1 issue.
But the "crisis" is not limited to the United States. A January issue of The Economist, for example, reported that "the NHS [Britain's National Health Service] remains in a state of permanent crisis despite all
the money that has been lavished on it." A few years ago, Bernard Kouchner, former French minister of health, described how—at
the time when the WHO had rated the French healthcare system the world's best—there were demonstrations almost daily outside
his offices protesting something the healthcare system was or was not doing for patients or healthcare workers.
Of course, many of the criticisms—especially of our own system—are perfectly valid. Study after study has shown that America
has the least efficient and most inequitable system in the developed world, as well as the most expensive and one of the most
unpopular. It compares unfavorably with most other nations' on three key criteria: cost, quality, and access. However, even
if we were able to significantly upgrade our system, so many unmet needs and insoluble problems would remain that cries of
a healthcare crisis would be unlikely to lessen.
One problem is that our politicians don't level with us, and we may not even want them to. They suggest that they can fix
the healthcare system so that people will be generally satisfied with it. I believe that this is virtually impossible. Of
course, all systems can be improved, and many (if not our own) are in fact improving. But the public always wants more access
to better care at an affordable cost as well as the security of believing that the system will be there for them when they
and their families get sick in the future. Even significant improvements will never fully satisfy all their needs as they
And that is not all. The more light we shine on the quality of care, the more examples of poor care and poor providers we
will find. Drug safety will always be an issue, and new drugs will always have unpredicted and unpleasant side effects. Medical
care and pharmaceutical drugs may be better and safer than ever, but no system can ensure perfection.
As for rationing care—dirty words in the free-market USA—every system does it. Limits are placed on reimbursement and the
supply of physicians, hospitals, expensive diagnostic tools, and other technologies. Unfortunately, our politicians are loath
to admit this. A growing number of other countries' agencies (with NICE, the National Institute of Clinical Excellence in
Britain, being the best known) are starting to use research to determine which treatments are more or less cost-effective—and deserving of reimbursement. I call this rationing; our pols do not.
In the 1960s, British Minister of Health Enoch Powell said what most officials have been conspicuously unwilling to say: that
"there is virtually no limit to the amount of healthcare an individual is capable of consuming." In other words, finite resources cannot satisfy potentially infinite demand. Therefore, we will always have to ration care. Patients and their physicians will always want more treatments than governments
or employers are willing to pay for.
Healthcare spending has grown faster than GDP in every developed country in every decade for at least 60 years. The main drivers
of this growth remain the same: medical advances, a growing economy, and the aging of the population. In addition, the public
perceives that healthcare is "a superior good." Year after year, Harris Polls show that the public views healthcare as the
best way to spend new money generated by economic growth—better than spending more on education, defense, cars, food, clothing,
shelter, entertainment, or anything else. Increased spending on medical care is the logical response to public opinion, even
as we disagree about who should pay for it.