MY TURN By Julius Litman

‘Healther’ Skelter With the current health care debate now transferred from Washington to the heartland, some fact based discussion is both desirable and needed. We all know the health care system in the U.S. is broken. It is simply unreasonable to expect that a health care system designed in the 1960s and 1970s will continue to perform as it should in the 21st century. The baby boom generation is aging into that period of its life cycle when it will increasingly rely on the U.S. health care system, and there are many reasons to expect that that system will buckle and fail under the onslaught. The notion that we can afford to do nothing to recalibrate the U.S. health care system, or that there is no urgency to the problem, or that we should just leave it to the “invisible hand” of market place forces is nonsense. The facts are that the U.S. has the most expensive healthcare system in the world, and that despite its excessive cost, it underperforms. In 2006 per capita U.S. spending on health care was $6,993. The next highest was Norway at $4,507 per capita; or 36% less than what we spent, while Canada spent a mere $3,696 or nearly half as much (47%) per capita as we did. So what did this outsize expenditure buy us? In 2006, U.S. life expectancy at birth was 78.1 years. In Norway, it was 80.6 years; while in Canada it was 80.7 years. Nor does the U.S. healthcare system compare favorably on infant mortality rates. In 2006 the U.S. infant mortality rate was 6.7 infants per thousand live births. Norway’s was 3.2; or 52% better. Canada’s was 5.0 per thousand live births, or 25% better. Turning to how these healthcare systems are funded, we find in 2006 that 45.2% of total health care expenditures in the U.S. were from public or government funds. In Norway, on the other hand, 83.8% of total 2006 Norwegian health care expenditures were from public or government funds. While in Canada 69.8% of total 2006 Canadian health care expenditures were from public funds. Personally I don’t know which is more astonishing: that nearly half of all U.S. health card expenditures is already publicly funded; or that Norway’s and Canada’s public systems are so much cheaper and superior to our own. Disease and illness, whether heart attack, cancer, or stroke have no regard to country or social status. They afflict us all and can be vanquished only by a robust, equitable, accessible, evidence based health care system. That is what we owe ourselves, and it is what we must leave to our children after us. The notion that the American people cannot fix what ails its health care system is at best naive and at worst unpatriotic. For if there is anything for which the American public is known, it is for rising to a challenge no matter how profound or complex, whether it be landing on the moon, vanquishing polio, eliminating small pox, banishing lead in fuels and paints, or recalibrating a health care system we all know simply does not work as it should. In support of the debate on how to accomplish health care reform, there are at least two actions we can take immediately. Americans must insist that their health care providers prominently post their fees for health care services. There is no other sector of the U.S. economy where the cost, price, and amount actually paid for services, are so completely disconnected from each other and mysterious both before and after the service is rendered. The mere act of posting these fees will go a long way to reducing costs as patients gravitate to lower cost providers. In conjunction with the posting of fees, what’s needed too are measures of quality. Providers of health care services must be rated, so that in combination with a listing of fees, the public has the information it needs to meaningfully and comprehensively choose among providers. So far neither of these have figured prominently in the debate. Without them, recalibration of the U.S. health care system is doomed to failure; as it hardly makes sense to take something already broken, extend it to more people, and then call it fixed. Julius Litman is chairman of the Pike County Democratic Committee.