The Washington Post has an editorial today about US pandemic preparedness, or lack thereof. It noted, in particular, that a big obstacle to developing and administering a vaccine for avian influenza is that "American pharmaceutical companies, scared off by liability issues and low profits, no longer make vaccines at all." Additionally, it notes that the country will need to provide "help for US hospitals, which are filled to capacity."
It would be well for editorial writers to ponder why a country that spends more than $1 trillion on health care a year is unable to produce any vaccines, and does not have enough hospital beds to respond to natural disasters.
In general, despite our immense spending, the US has decreasing capacity to provide primary care, to provide acute care, and to provide for public health. Although millions of words have doubtless been written about our ever-rising health care costs, there has been too little enquiry about where all that money is going.
I hardly have all the answers. Yet perusal of Health Care Renewal would suggest that much of the money is not being wisely spent, and far too much fails to provide health care on the ground.
For example, we have put up numerous posts on how we over-pay for some drugs, devices, and procedures, especially those that are new and apparently high-tech, or once were. Most recent examples range from $1600 screws used for spinal surgery (see post here) to currently marketed brand-name prescription drugs whose yearly price increases are far greater than inflation (see post here).
We seem to spend inordinate amounts on management, administration, and bureaucracy, on marketing, and on legal expenses. Regarding the former, the number of health care managers grew over 700% from 1983 to 2000, and there are now more managers in the US than doctors (see post here). The CEO of a not-for-profit health care system can command more than $500,000 in total compensation (see post here), of a not-for-profit managed care company, over $1 million (see post here), and of a for-profit managed care organization, over $100 million (see post here).
All too often, those who run US health care organizations have conflicts of interest. Recent examples include those alleged about the board of the University of Medicine and Dentistry of New Jersey (see post here), advisory panels of the US Food and Drug Administration (FDA) (see post here), top leaders of the US National Institutes of Health (NIH) (see posts here and here), etc., ect. Some have wound up convicted, e.g., recently, the former CEO of the Fletcher Allen health care system (see post here).
Thus, it seems that the excess power concentrated in ever-larger US health care organizations, and mismanagement, conflicts of interest, and even corruption at the tops of these organizations have diverted resources away from actually providing health care to those who need it. We spend more and more on hospital management, but have fewer acute care hospital beds. We have endless supplies of drugs for erectile dysfunction and restless leg syndrome, but not of influenza vaccine.
But we won't be able to address this problem until enough people become aware of it.
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