Is this the future of health care in the United States? From an Economist report on health care in Spain:
Health spending makes up 30-40% of regional governments’ budgets. Long-lived Spaniards are rightly proud that they enjoy free health care from cradle to grave. But soaring drug bills, an ageing population, slack cost controls and reduced tax revenues are testing the system to breaking point. One estimate is that health costs will double in the decade to 2018…In the past health budgets have overrun by up to 15%, according to one former regional health boss. When tax revenues were growing, that could be handled. Now much of the debt is passed on to drug companies and health-care technology suppliers. They are jointly owed €9.5 billion ($13 billion) and have to wait an average of 430 days to be paid for hospital drugs, says Humberto Arnés of Farmaindustria, a trade body. “Basically we are financing the system,” he says.
The American health care debate needs to focus on one inescapable fact: unless we make major, deep changes in the way health care is delivered in this country, there is no way we can pay for the health care we want and need as the population goes up, gets older — and as new, expensive treatments continue to appear.Ultimately we must either ration health care (death panels and all) or restructure it top to bottom so that it is able to deliver the same or, preferably, much higher levels of care much less expensively. Proponents of a single payer health care system (basically, the kind many European countries and Canada have where the government collects premiums for everyone, sets prices, and pays bills) argue that it is cheaper than our current hybrid (and grossly inefficient and excessively) pricey system.I agree with the single payer crowd there, but a single payer system only really makes sense under two conditions. The first, as the Spanish are discovering in a very unpleasant way, is that single payer only works if the single payer has plenty of money. If you count on the government to cover your health care, and the cost of health care bankrupts your government so that the health care system goes down as well, it’s hard to call that a success.The second problem is related to it: single payer would be more feasible if the technology of health care has frozen. That is, if we already knew the best way to treat all diseases, manage hospitals, divide up responsibilities between different types of health care professionals and so on, a single payer approach might make sense.But in fact health care is not a frozen field. New treatments and new technologies appear all the time, and I suspect that as new scientific breakthroughs appear that process will continue and even accelerate. (I certainly hope so; there are plenty of conditions we don’t know how to treat, and plenty of treatments that are risky, or have grave side effects.) The organization of health care is at a very primitive state, in the sense that most hospitals and medical practices in the country could benefit from serious reform — but it is far from obvious how an ideal system would work. We are only in the earliest stages of seeing how collecting detailed information across the health care system and analyzing this data with powerful software could improve treatments and delivery.Our health care system needs to experiment, try different things, compare the results of different strategies. Sweeping, continuous and sometimes radical innovation is the only way that health care costs can be contained long term even as the quality and quantity of care demanded goes up. No centrally run health care system works that way; too many lobbies and interest groups distort the priorities of a single payer system.