Health care system is failing our country

The U.S. health care system is a failure, failing to extend lives, failing to prevent chronic disease, failing to protect infants and failing to spend our money wisely.

Our system fails because it focuses on health care instead of health. One is an industry; the other is quality of life.

The U.S. spends $3.3 trillion a year — twice as much per person as the average wealthy nation — and leads the world in medical research, breakthrough drugs and ingenious devices. It has the best medical schools.

Sixteen percent of the U.S. gross domestic product goes to health care, the highest of any developed country, according to the Organization for Economic Cooperation and Development.

Yet we have one of the unhealthiest populations in the developed world. We have the highest infant mortality rate, the highest chronic disease rate among the elderly, and the lowest life expectancy at birth.

U.S. life expectancy is going down, despite employing the best emergency medical services, the most high-tech hospitals and the best-trained physicians. The businesses and individuals who finance our system, almost all of us, should be outraged by the poor value we get for our money.

Theories for this disconnect abound. Our system is wasteful, some providers are overpaid, insurance companies skim too much and too many Americans don’t take care of themselves. All of those things are true, but there is more.

Elena Marks, CEO of Houston’s Episcopal Health Foundation, suggests that Americans confuse health with health care, and if we focus on the former, we won’t need as much of the latter.

“Health is a state of complete physical, mental and social well-being, and not just the absence of disease,” Marks said in a lecture last week at Rice University’s Baker Institute, where she is a fellow. “What if the health care industry were responsible for health, not just medical services?”

Researchers at the University of Wisconsin and the Robert Wood Johnson Foundation have studied the healthiest counties in America and discovered which factors contribute to health: 40 percent is attributable to wealth and social status, 30 percent to behavior, 20 percent to clinical care and 10 percent to the environment.

The U.S. spends 97 percent of its health funds on clinical care, and only 3 percent on public health, which addresses health problems caused by poverty, behavioral issues and environmental factors. Evidence from other countries and U.S. pilot programs shows we could spend less overall if we focused more on the other factors.

This reality, though, collides with ideology. While most Americans find it acceptable to provide emergency care, conservatives who value self-sufficiency oppose providing a helping hand for people who struggle to meet their basic needs, even if it saves money in the long run.

For example, U.S. law requires hospitals and doctors to provide emergency treatment without regard for the patient’s ability to pay. The U.S. also socializes the cost of care, requiring large companies to offer insurance, encouraging people to enroll and collecting taxes to pay for those without coverage.

This money collected from healthy people goes to care for the ill and injured.

Opposition grows, though, if you suggest spending money to keep people from getting ill or injured in the first place. Such as guaranteeing access to enough food, a safe place to live or offering help for behavioral problems.

The Episcopal Health Foundation wants to focus on improving health, not paying for care.

For example, if a child from a low-income family is suffering frequent asthma attacks, Marks sends someone to check for problems at home. If black mold is growing on the walls, or the house is infected with pests, fixing those problems is cheaper than recurrent visits to the emergency room for asthma attacks, Marks said.

Doctors can’t prescribe a home repair, even if it would save money.

When a homeless man kept showing up in the ER, Episcopal Health paid for a social worker to help him for a year to get his life straight. His ER visits dropped 68 percent, cost of care fell 86 percent, and he reported a 144 percent increase in his quality of life based on a self-assessment before and after the program.

Sending people to teach people with diabetes how to cook healthier meals, free gym memberships and better public parks have all shown great success changing behavior. Opening a greengrocer in a food desert improves the health of entire communities.

These interventions are cheaper than providing care. And they are routine in the countries that have healthier populations and spend half as much on health care.

We don’t need to spend a penny more; we need to spend our trillions more wisely. But that will require us to focus on outcomes rather than ideology.

Chris Tomlinson is the Chronicle’s business columnist.chris.tomlinson@chron.com twitter.com/cltomlinson