Cut the high cost of health care in America.

Americans pay more for health care than Europeans pay for more or less the same services. Some of the difference can be attributed to the greater number of dysfunctional families in America. Rural communities have metamphetamine addicts and family violence. Inner cities in America have more crack cocaine addicts, and some of these are not yet born by the time they are addicted. Add alcoholism, dreadful housing conditions, gang violence, under and unemployment, chronic criminality, and very poor education and one has an evil brew with no (easy) remedy and with severe social repercussions and costs. A significant portion of the cost is for health care--often as not, too little and too late. And that means less effective and ultimately more expensive. The commonest form of malnutrition in America is overeating. This, too, is societal not medical. This form of malnutrition makes for rampant obesity, and it is particularly prevalent among urban poor. Unless they are addicted to heroin, in which case they are not obese. But might well have HIV/AIDS. All of these societal problems will end up being expenses sooner or later. And a large portion of the expenses will be charged against the health care system.

Americans are paid better in the health care industry than are European workers. From doctors and administrators on down, our group earns more. The industry is about the same size as the tourism/hospitality industry or the sum total of state and federal workers, whatever we call that industry. (Governance or government industry sounds oxymoronic to me.) This disproportionately high pay scale in American health care is either a drain on the economy or a boon to the economy depending upon whether this particular industry is viewed as adding to or subtracting from Americans in general. Considering the fact that no one really needs tourism but everyone needs health care, one might conclude that the health care industry is a positive. Considering that little or no work in health care is shipped overseas to India or Pakistan or Brazil, and that almost all of the wages paid are therefore cycled through the American economy, one might again conclude that health care in America is a boon to the economy. And, objective comparisons of such important parameters of health care industry performance as breast cancer patient survival, and prostate cancer patient survival are different and better in America than in Scotland, England, Wales, or Canada, despite the fact that these latter populations are similar in culture and language and affluence. The latters spend less and get less. Which gets me to a final point: do we get a choice in the matter? The town hall meetings of this summer are reminiscent of a trail ride when a really stubborn horse was assigned. It just should not be that hard, whether to be heard by our representatives in congress or to keep the horse from eating the understory. After all, we have the best congress money can buy. And the horse was full price.

If health care in America is paying a premium for costs that are societal and not essentially medical, and if health care in America is a boon to the general American economy, and if health care is more efficacious in ways that mean a lot to Americans, then why reform the goodness out of it. By patterning our health care system upon systems that are cheaper by one third but less effective by that much or more we will opt for a change all right. But is this the change we as a nation want? Yes, I know that our health care system is ranked low by some experts--below most European countries. Take a look at what parameters the experts are using for the comparison. See if things that are societal are held against a system that is medical. For example, look at the importance of prenatal care and infant mortality in setting up the ranking of the countries. Our inner cities are rife with crack addicted, alcoholic single mothers with crack addicted, alcoholic fetuses and infants that need health care but need other things even more. Family structure, belief systems, moral systems, education, housing, law abiding neighborhoods, honest employment are examples. Do you think our present social engineers are willing to admit that? Or more likely than face up to tough problems, they will just rob Peter to pay Paul. Peter is old and going to die soon anyway. Paul might vote social democratic tickets for the rest of his life.

In the long overdue column: comparisons of our present health care system with the social medical care systems in Canada and the UK that spell out exactly what parameters of care are being studied; enumeration of the societal ills that add measurably to health care costs in America with some attempt to display those costs; creative ways to finance health care for Americans without saddling employers and young people; workable ways to enhance good health and healthy life style and habits in all the diverse groups in America. (The old Chinese men and women out early in the morning doing Tai Chi in the park, kids who are not on the varsity but are playing basketball, football, baseball, and soccer, people with walking shoes on going to work in Manhattan, week end softball players and vegetable gardeners, late night hours in the gym, and so forth and so on.) And a congress not already bought and paid for by George Soros, et al.