Evans announces for Congressional seat

"One reason the United States has the highest level of health care in the world is that it's not run entirely by the government," he said. "I will vote to keep it that way."

The United States is the only G7 nation without universal health care coverage, yet the percentage of GDP to publicly insure 45% of the US population is very close to and in many cases higher than the percentage of GDP spent by other G7 nations to insure their entire populations. Americans spend more money on health care, private and public, than any other nation in the world, yet the United States has the highest adult mortality rate (the probability of dying between age 15-60) of all the G7 nations. Dave Evans' statement that the United States has the highest level of health care in the world is indeed true. We as Americans do in fact have the highest level of health care in the world because is it not run entirely by the government when one uses dollars spent as the indicator. However we if one uses indicators like the adult mortality rate of wealthy, comparable G7 nations a different picture emerges that shows that we are overpaying for health care in the United States.

Your comment raises an important question in my mind Tim. Why can we not have a form of both systems in the United States? It is a given that not everyone in the US can afford the most basic of health care. The alternative has become the emergency room, and those that do not pay, pass this burden to the rest of us anyway. Why can we not as a nation create a system to pay for treatment of the most common problems (broken bones, stiches, prescriptions for infections) through a public insurance available to all, and leave the more expensive, complex procedures (such as heart surgery) to private insurance? Would not a system of this nature create a healthier population due to increased detection rates for common diseases and problems, higher rates of immunization, and early diagnosis/treatment, while also easing the financial stress and overuse/abuse of resources that our hospitals unfairly face?

It's an interesting proposal Nathan. It probably would. Here's the rub. Insurance companies are never going to go for it. Essentially the government would get the "low hanging fruit" i.e. the cheapest outlay of capital. That would leave insurance companies to pay for the more complex (see-more expensive) procedures. The premiums for that would be outrageous. When you talk about expensive procedures you also have to throw in all the follow-up care. If someone say 65 comes in for bypass. They can probably expect to live another 15-20 years. During that time let's say they have 3 episodes of cardiac failure. The insurance companies would get those bills too. Each of those episodes would be 4-7 days in the hospital, at least 2 of which are going to require ICU monitoring. Add on top of that other diseases that are going to crop up like cancer, diverticular disease, peripheral artery disease and suddenly your actuary table is busted.

"Also, Americans that cannot afford expensive procedures are going to have to learn how to face reality and accept when their time comes. It is harsh, but the belief that everyone is entitled to the same level of care when facing death is simply false."

Ok, you're a young guy. You'll have kids someday. When you're middle aged (like me ...ugh) and your kid is in his 20's he starts getting headaches. Initial CT scan shows what appears to be a mass in his right frontal lobe. His follow-up MRI (delayed 4 weeks since we're now rationing healthcare) shows what appears to be a right frontal mass with edema extending across the midline consistent with a grade IV astrocytoma (glioblastoma multiforme). There is mass effect with early herniation. The 2 year survival in this scenario is less than 5%.

Now look at your child and tell him no.

Yes it's a gruesome example. Yes I get to see this every day. I spend a large portion of my time reading studies on cancer patients. Most are older, some aren't. If we're going to go down the road you propose we're going to have to make a distinction on who gets treated and who doesn't. If you want that job, you can have it. I'll go back to working at Josten's.

If we are going to, as a nation, decide that we want to provide the sick and dying with proper medical care because it is the ethical thing to do, then we must try to find a solution to this problem of how to structure the system, so that doctors and hospitals get paid while at the same time deciding who best to help with the limited resources that we have. For those that can afford expensive medical procedures, the scenario you describe does not exist. Unfortunately for the majority of Americans it is possible to end up in this situation. So which one is it going to be, help everyone because it is the ethical thing to do or keep the system as it exists today? Also, I feel that the people that resist change in America's health care system is the private companies and individuals in the health care industry. I could be wrong, but it seems to me that insurance companies would especially be big losers in a socialized health care system, and I am sure they are lobbying hard to keep things the way they are. But do we really need them? Do they gain their non-profit status because of the very ethical questions that we are talking about? I seriously know next to nothing about how health care in America works, but I have seen people's entire life savings and every thing they own disappear, because they wanted to help someone they care about. If we want to do what many would agree is an ethical move, then surely something can be done to distribute this burden across the entire population, perhaps through a federal sales tax.

Sharon you bring up an interesting paradigm shift. You are absolutely correct in that 60 years ago the vast majority of people died at home. One thing that has changed that is medicare/medicaid. There is now coverage for those people and most end up dying in a hospital bed, mostly from chronic illness. I have mixed feelings. It's true most people would choose to die at home but that is extremely taxing on the family, even with hospice care. Most people don't want to be a burden on the family.

Technology has contributed to the cost of healthcare, no doubt. It's the misuse of technology that has driven cost up faster than any other factor. It's been proven that if a physician owns a stake in imaging he will use it more frequently.

Here's my recommendations:

1) Require all licensed drivers to carry some type of basic coverage. We do it to insure autos in case of an accident, I can't understand why we wouldn't do it to insure the driver. Yes it's an out of pocket expense but it's pennies on the dollar compared to taxes that would be required to do this federally.

2) Apply Stark II laws across the board to all physicians. This would eliminate the "in-office" exception to imaging and would reduce needless exams and procedures.

3) Require every healthcare provider and facility to post their price list on the internet. Currently there is no true free market for healthcare since everyone hides their price list. All providers usually charge whatever the predominant insurer in the area will pay plus an unknown percentage. Market pressure will drive prices down.

4) It's going to sound hokey, but bring back 12 full years of health/physical education for the public schools. We've gotten away from teaching kids what is good for them and MAKING them exercise. This can be incorporated into a science curriculum in high school. Preventative medicine is the cheapest of all.

5) For the love Pete, get the federal government out of the healthcare business. This would take 25-30 years to complete our current obligations but could be done. When folks get to age say 35, they could buy a small policy that would address healthcare issues for later in life. By the time they reach 65, that policy is worth several million dollars and would cover most if not all issues.

Nathan I understand that you only want to do what is right and I appreciate and admire that. But whenever you allow the federal government to administer care you are begging for money to be wasted. As much as we all pay in to medicare, it's essentially insolvent, partly because of rising costs but also partly due to inherent inefficiencies in the system. You also allow outside influences (politics) to be the arbiter of what gets paid. That's a horrible way to run a system. This government just spent 900B to create 3M jobs. That's 300K per 30K per year job. With math like that running healthcare, we're doomed.