AMERICA’S WEIGHTIEST HEALTH ISSUE: NOT OBESITY, BUT BLOATED HEALTH CARE EXPENSES pp. 43-48
Authors: (George Everett, Orlando, Florida)
Abstract: The presidential campaign of 2008 has reawakened discussion of the rapidly rising costs of the United States of America (USA) health care system. Most of the political sparring has focused on how to cover the roughly 15% of Americans who are uninsured rather than how to deal with the far more troublesome and vexing problems of overwhelming total medical expenditures. After briefly stabilizing in the 1990’s, health care costs have soared to 16% of Gross Domestic Product (GDP) and are projected to approach 20% of GDP by 2017 . If the general trends of the last four decades continue, health expenditures will grow by 2 – 3 % of GDP per decade. Because the baby boom generation is nearing Medicare eligibility, federal outlays for medical costs are expected to grow exponentially. The Medicare Trustees recently reported that $432 billion was spent by Medicare in 2007 and that Medicare expects to owe $36 trillion over the next 75 years . While most developed countries have also faced rising health care costs, the USA has, by far, the highest costs in the world, whether measured by percent of GDP or by per capita spending . Furthermore, nearly all other developed countries have universal or nearly universal health coverage. If the uninsured in the USA are covered in the near future, an additional spike in total health care costs is likely  but with an improvement in subsequent health measures for the newly covered persons . If higher health care expenditures resulted in objective and subjective improvements in health measures, a strong argument could be made to let the costs rise to some maximally beneficial level. Unfortunately, there appears to be virtually no relationship between greater use of health services and improved health outcomes or patient satisfaction. In a pair of landmark studies, Fisher, et al  demonstrated that health care spending in different regions of the USA varied by more than 60%, after adjustment for price differences and other factors, with no difference in health outcomes or patient satisfaction .