This is the text of a speech I delivered at my Toastmasters group today. I have looked for a long time for a succinct description of the problems with our health-care system, couldn’t find one, and so I wrote this. It’s based in large part on T.R. Reid’s book, The Healing of America, but is also informed by numerous newspaper and magazine articles and other sources.
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I donated blood yesterday, as millions of Americans regularly do. As I lay there sharing my blood, I thought about the irony of our situation here in America. We are generous, kind people and the world’s leading nation in many ways, yet we have created a health-care system that ranks 37th in the world, according to a survey by the World Health Organization.
I have taken a long, hard look at our health-care system, and I have concluded that it is barbaric. That’s a strong word, I know. I spent a lot of time thinking about it and reviewing dictionary definitions before I decided to use it. I’m not accusing anyone of being a barbarian, but I believe we have a health care system that is demonstrably barbaric.
One definition of barbaric is: crude, uncivilized, and brutal.
Our health care system is truly crude – unrefined. It is marked by logical inconsistencies and financial inefficiencies.
Unlike every other major industrialized nation, we have a piecemeal collection of different systems that treats vast swaths of our citizenry differently. Every other modern nation puts all of its citizens in the same system (by the way, this is how insurance is designed to work – by having everyone in the same pool, risk is spread equitably across the population). Here we have 4 pools: if you’re employed or able to buy your own health insurance, then you are covered much like folks in Germany, in a multi-payer, multi-provider system; if you are a veteran or a Native American on a reservation, then you are covered much like folks in the UK’s National Health Service, a single-payer system in which the doctors work for the government; if you are over age 65, then you are covered like folks in Canada’s system (from which we also got the name Medicare), a single-payer, multiple-provider system; if you are not covered, then you are in the heaven-help-us, please-don’t-let-me-get-sick, pay-as-you-go non-system. Every other modern country has one system for everyone.
Our system is incredibly inefficient. All you have to do is think about your last encounter with your insurance company to see this. But the data also show how inefficient our system is. The U.S. spends vastly more on health care than other countries – in both absolute and relative terms. More refined systems in other countries waste many fewer dollars on bureaucracy and administrative overhead and – more importantly – they deliver better health results. That #37 ranking in the WHO survey is just the tip of the iceberg – we rank poorly in virtually all comparisons of health-care outcomes.
Our awkwardly assembled and poorly managed health-care system is indeed crude.
Our health care system is also demonstrably uncivilized. It is simply uncivil to treat each other the way we do.
We leave tens of millions of our fellow citizens uncovered (and this will remain true even after the current health-care reform bill is fully implemented). Universal coverage is the ideal in the modern world, and every other modern industrialized nation except ours has figured out a way to cover all of their citizens.
And here in the U.S., those who are covered have to fight their way through armies of insurance-industry minions who try to rescind coverage and deny care.
Leaving millions of our fellow citizens exposed to the whims of illness and injury, and then denying us care even when we are covered – that is truly uncivilized.
Finally, our health-care system is brutal.
The upshot of our crude and uncivilized system is that tens of thousands of Americans die every year for lack of medical care (25,000 to 40,000, depending on the source). That’s like having a travesty on the scale of the 9/11 attacks unfolding each and every month. That shouldn’t happen anywhere at any time. And it simply doesn’t happen in other modern countries.
Also, about a million Americans are driven into bankruptcy every year due to unpaid medical bills, a situation that is also unheard of in other modern countries.
Killing tens of thousands and bankrupting a million people every year, our health care system is definitely brutal.
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I’m not happy to deliver this news. Nor do I know how to fix this situation. Believe me, I would if I could.
Americans are not Barbarians. It’s a shame that we are saddled with such a barbaric system.
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