Is it unpatriotic to support continuity of the U.S. health system’s status quo, as many physicians and citizens seem to be comfortable advocating?  In answering this question, we need to consider how much health care is contributing to the debt, which itself threatens our economic vitality and national security. The accumulated national debt is currently well over $12 trillion, about 53% of the U.S. GDP for 2009. It’s about $4,000 per citizen.

As currently projected, it would grow to over 300% of GDP by 2050, and the vast majority of that growth will be the result of rising health care and Medicare costs, government economists estimate. The deficit number for this year will be $1.8 Trillion, and for the year 2011 the deficit would be $1.3 Trillion. If the SGR was to be eliminated, the number would likely be at least a half-trillion more. The dramatic growth of the deficit puts the nation’s future stability and security at great risk if not addressed. Deficit growth will be mainly related to unfunded health care costs to cover the 40 years it will take for the boomers to retire, vote en masse to demand the best health care, and die off, presumably after becoming part bionic and genetically-engineered beings. 

Tough Choices
The current partisan environment and resultant difficulty we will have to make the tough political choices needed to stabilize Medicare, health care, and Social Security represent a recipe for disaster. Without new thinking about health delivery system and payment reforms, for example, we will surely face accelerated price fixing and price cuts for doctors annually, like we have seen this and previous years for cardiology. The current SGR dilemma we face may look like a cake walk in the face of future pressures for cost containment. And doctors seem to be the easiest political victims for achieving such cuts.

Finally, it will be increasingly essential that patients bear a much larger share of their own health care costs in this future, potentially motivating more informed shopping. But, there is a finite amount of out-of-pocket spending that middle class and lower income families will be able to contribute, so political pressure for a bigger social support infrastructure for health costs will be demanded by aging boomers. Where will it come from? Probably from more cuts to health care providers. My crystal ball indicates we’re headed for a decade of tough fights like we are experiencing this year, unless we figure out how to ferret out the extensive waste in the current system to protect health care and the vitality of the profession.

There are ways this story could unfold in a more positive fashion. It would be nice if we as a species and a nation could dispense with war, for example, although this would seem to require ‘human nature’ transplants, or miracles, or both. We could tax the living heck out of everybody making more than minimum wage. But unfortunately that would kill off economic growth. 

Or, we could get engaged in preserving the profession and the patient-physician relationship, while still promoting continued innovation and scientific progress in health care. To accomplish this, we would need to figure out and refine ways to reduce health care spending increases to no more than a percent or two greater than the GDP. Could we accomplish this without killing off innovation and the vitality of the profession? I happen to think we could. I know some of you reading this are skeptical. That’s understandable. But what are the options here, folks? Leaving things to ‘evolve’ on their own in the political environment looks awfully risky.  Ironically, even if not yet realized, the nation needs for us to take these challenges on or solutions won’t likely be forthcoming. If we all allow the debt to explode, the entire economy -- including medicine -- will suffer greatly.

So, back to my original question: Is it unpatriotic to support continuity of the U.S. health system’s status quo, as many physicians and citizens seem to be comfortable advocating?   An informed answer is yes.

*** Image from morgueFile (jdurham). ***

< Back to Listings