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Health and medical costs continue to rise faster than any other major segment of the U.S. economy. The cause is not insurance companies, drug companies, health-care providers, the uninsured or malpractice lawyers. It is us, you and I, and a broken system.Nationally, health care costs about $2 trillion annually or more than 15 percent of the Gross Domestic Product (GDP), our total output of goods and services. That’s an average of nearly $7,000 for each American.Health care is a larger segment of our economy than food, clothing or shelter. Prior to WWII, health care costs ran around 3 percent of GDP. As recently as 1965, they were less than 5 percent. They are expected to be 20-25 percent of GDP in 10-20 years when the post-war baby boom hits its peak years for consuming health-care products and services.We all pay the national health-care bill many ways: insurance premiums (paid directly or on our behalf by employers), taxes, out-of-pocket, and in the prices we pay for goods and services.Other developed countries spend typically half what we do on health care. It is frequently asserted that various forms of national health insurance can be credited with lower costs in other countries and that some form of it would lower costs here. The reasons our costs are so high and the paths to reducing them are more fundamental and personal.Of course, health-care costs are rising everywhere because of demographics; the post-war baby boomers are graying. Advances in medical technology are extending and improving our lives, but also add to the bill.Health care does not start at the doctor’s office. It begins with health; wellness it is usually called. A large part of our collective health care costs arise from so-called “lifestyle” conditions. Many common chronic maladies, including obesity, diabetes and coronary artery disease, are usually rooted in habitually poor diets and lack of physical exercise.Wellness begins at home with nothing more complex, magical, or expensive than good old-fashioned sound diet, reasonable physical exercise, and minimization of unhealthy vices.Another large but rarely discussed factor in health care is even more deeply personal: the way we approach death.Roughly half of all health-care expenditures in this country are on behalf of those in the last year or so of their lives. Most of these people are at or past the end of their natural lives with little realistic hope of true improvement in its quality.Few question using the full arsenal of modern medical technology to save or improve the lives of those who have some reasonable hope of recovery to meaningful existence. But millions of Americans every year try to postpone the inevitable at the cost of great physical and emotional suffering, loss of dignity and incredible burdens upon their caregivers, volunteer (usually family) and professional.Other countries have adopted health-care rationing, under various guises. Treatments likely to be ineffective in reestablishing a decent quality of life are often simply not available. We will be forced in that direction, too, if demand for health care services is not tempered It is time individuals, spiritual leaders, and society examine our acceptance of death and this common unnatural extension of the dying process. Employment of extraordinary means to prolong life should be a personal choice. But if everyone does it, the resources will not exist to allow us to make our own decisions. The health-care delivery system itself suffers from two fundamental problems. First, we have confused health care and health insurance. Second, we have not determined what level of health care is a right, supported by society in general, and what is a privilege, the responsibility of individuals who benefit. Insurance is a means to spread costs unlikely to be incurred but catastrophic if they are. True insurance has a vital role in health-care financing. Everyone should have major medical coverage to pay for the rare acute or protracted serious chronic condition for which care would otherwise be unaffordable or trigger financial ruin.Everyday health care is different. All of us need professional health care services and pharmaceuticals. Paying for routine services through private insurance or government programs gives the illusion that someone else is paying. That someone else is actually us, through insurance premiums and taxes. We do not insure our houses against peeling paint or broken door knobs. We do not insure our cars for oil changes or broken headlights. Yet, we expect health care insurance to pay for the routine preventive care and minor repairs we all need.The cost of that illusion is enormous. The U.S. health care financing system is a Byzantine combination of public and private institutions and programs, filled with disincentives to innovation, efficiency, and efficacy. Roughly a third of the U.S. health care dollar goes to administrative expenses, mostly for handling billions of claims for this false “insurance.” Most importantly, health care decisions are increasingly controlled by legions of bureaucrats in the government and health insurance industries rather than by individuals and their providers. Some truly cannot afford routine health care or premiums for major medical insurance. Society has developed means to provide other basic necessities to those unable to support themselves. We should be able to develop mechanisms to provide basic health care also, through vouchers, public health clinics and hospitals, etc.Politicians pander for votes by promoting more government-based health-care payment systems. Their “solution” to health care financing is always more government programs and control. If that were the answer, the old Soviet Union would have been a model of productivity. Large governments are not efficient and drag everyone down to a common level of mediocrity.Free markets, while far from perfect, ultimately find far more efficient ways to meet consumer needs. Government’s roles should be to regulate as necessary to curb abuses and to assure a safety net to those unable to provide for themselves. The legal system is often blamed for part of our high health-care costs. Malpractice insurance premiums and “defensive medicine” together account for only a few percent of the total U.S. health care bill. Comprehensive tort reform would help the U.S. many ways besides health care. But it won’t solve the basic problems.Improving our wellness and reducing our need for professional health care starts with reducing intake of junk food, sweets, pop, and unnecessary drugs and increasing our output of sweat. It means educating ourselves to better utilize nature’s marvelous preventive and curing mechanisms and when to engage appropriate professionals. And it means accepting that death is a part of life.Only part of the solution to rising health-care costs lies in Washington or Santa Fe. Governments and insurers have essential roles. But the root problems and solutions are much closer. We need only look in the mirror.We need to take care of ourselves. And we should not expect someone else to pay for the professionals we employ to help us do so. Our health will be better, our relationships with our providers will be better, and our costs will be much less.
Robert Gibson is a member of the Los Alamos County Council and a charter member of the Community Health Care Roundtable. These are strictly his personal views.