CHICAGO, IL (September 24, 2008) – Americans’ expectations for health care are too high, and the will of politicians to avert an exploding health care crisis is too little, Dr. G. Timothy Johnson told an audience at North Park University on Tuesday night.
If action isn’t taken soon, the rising cost of health care could provoke a financial crisis as great as the current banking crisis, said Johnson, the longtime medical editor for ABC News and an ordained minister in the Evangelical Covenant Church.
“There really is no way to fix the American health care system,” Johnson began. “The reason is we don’t have a health care system in this country.”
What does exist is fragmented, inefficient, inadequate, and even dangerous, Johnson said. It also potentially poses a greater threat to the economy than the current banking crisis.
Americans will spend more than $2 trillion on health care this year and that amount could go to $3 trillion by 2020, Johnson predicts. One-sixth of all jobs in the country are related to health care, Johnson notes. A shock to the health care system would send shockwaves throughout the economy.
Major changes in approaches to providing health care have led to the current crisis, he maintains. Health care went from being low-tech, personal, and having a simple payment structure to being highly focused on high-tech solutions, impersonal, and burdened by a complicated payment system.
Employer-based health insurance was an “historical accident,” Johnson said. Companies could not afford increasing salaries after WWII, so they began adding health benefits.
Today, companies are looking to control costs by reducing or eliminating coverage, Johnson said. He noted that 80 percent of uninsured Americans have jobs.
Johnson says part of the problem with finding a solution relates to four major expectations Americans have for health care:
• Convenience – People want appointments immediately and don’t want to wait for anything.
• Curative – “We expect that whatever comes up, American medical science will be able to solve the problem.” The latest technology or drug is not always the best treatment.
• Coordinated and compassionate – Any system should be easy to navigate.
• Cheap – People don’t even like co-payments.
“You can’t have it all,” Johnson told the audience. The cost is too great.
“Just spending more money will not solve the problems.”
Just spending more money will not solve the problems, he suggests. Americans spend $6,100 a year per person on health care – more than twice the $2,500 per person spent by the rest of the industrialized world combined.
“If we got health care that was twice as good, I guess that would be acceptable,” Johnson said. But the World Health Organization ranks the United States 32nd in terms of quality, he added.
The system can even be dangerous Johnson said, explaining that 100,000 deaths last year were attributed to medical errors. He asked people to consider what would happen if the same could be said of the airline industry.
Americans with insurance – who know how to navigate the system – still have access to excellent care, but the gap between them and those who do not have access continues to grow, Johnson observes.
A worsening shortage of general practitioners also is contributing to rising health care costs. Only 20 percent of graduating medical students are choosing general practices because specialties offer higher financial rewards.
The Mayo Clinic opened its own internal system of general care after realizing its employees were using the emergency room for health care because they could not find a general practitioner, Johnson said.
Given Jesus’ imperative to care for the least, Johnson said, Christians have a moral imperative to push for universal access. The United States is the only industrialized country that does not offer universal access, Johnson said.
People actually have access to universal care – if they get sick enough. Ultimately, “We won’t let you die in the street,” Johnson said. That ultimately is more costly, however. Instead, providing systemic universal access to people would enable them to be treated earlier and at a lower cost.
Johnson differentiated between universal access and universal financing. Universal access enables health care coverage for everyone, but universal financing means the government pays all the bills.
Johnson says he favors some form of public-private partnership, as is done in most industrialized nations. Government would set standards and regulations and then allow private companies to compete.
The plan for federal employees can serve as an example, Johnson said. Each year, employees receive a list of health insurance companies in their area that have been vetted by the Office of Personnel Management, which makes certain the companies are solid and are offering fair prices. Employees can then choose based upon the plan and price that best meets their needs.
Medicare is a public-private partnership that Americans approve of, Johnson said. “Try taking Medicare from people over 65 and you’ll have a fight on your hands.”
Johnson said he expects Medicare to be expanded to all people, if the crisis worsens.
The money it costs to provide care for those who can’t afford it would cost hundreds of millions of dollars more than the current proposed banking system bailout, he predicts.
Opponents of universal access argue that people will abuse the system. Johnson said that is not the case in other countries and encouraged the audience to read “The Moral Hazard,” an article by Malcom Gladwell in The New Yorker, saying it is the best on the subject.
Despite pledges by both candidates to reform the system, Johnson does not expect Congress to make major changes soon. He recalled the unlikely alliance several years ago involving Democratic Sen. Hillary Clinton and Republicans Newt Gingrich and Sen. Bill Frist, noting they were unable to influence passage of a widely desired bill that would enable electronic recordkeeping. Patients often switch doctors, and electronic recordkeeping would enable physicians to access a patient’s previous medical history.
Each of the presidential candidates has proposed changes, but no one will get all they want. Intense negotiations will be needed, but the White House still will have to lead the discussion, he believes.
As medical editor for ABC News, Johnson provides analysis for World News Tonight, Nightline, Good Morning America, and 20/20. Johnson’s programs and feature reports have won several awards, including a national Emmy Award and two local Emmys. He also received the 1998 Bradford Washburn Award bestowed by the Museum of Science, Boston, Massachusetts, an honor also conferred upon Jacques Cousteau, Walter Cronkite, and Dr. Jane Goodall.
Johnson serves on the faculty of Harvard Medical School and is on the medical staff of Massachusetts General Hospital. He also serves as assisting minister of the Community Covenant Church in West Peabody, Massachusetts.
Editor’s note: The accompanying photograph is used courtesy of Eric Staswick, ©2008.
