Why US Healthcare Policy Needs Radical Change

[Note: This blog uses HIV to illustrate broader issues in US healthcare.]

The “war” on HIV in the US has been stalled for several years.  While there have been improvements in treatments and outcomes for people getting the disease, there has been no progress in reducing the incidence of infection.  How come?

“Every picture tells a story” and this one isn’t a particularly good one.


We would expect major population centers to have issues with AIDS, but how does that explain Mississippi?  In fact, virtually the entire “Old South” is high risk for HIV.

Total spending on healthcare doesn’t necessarily tell the story.  The US now spends 17.8% of GDP on healthcare — the highest level of spending on Earth and it’s continuing to increase each year.  By comparison, the EU spends 10% of GDP on healthcare — with more of its population receiving healthcare and more funds available for other uses, and longer life expectancy for its residents.

How dollars are spent matters.  One of the key points lost in the debate about the Affordable Care Act is that it’s much less costly to treat disease in early stages than later.  Prevention is even less costly.  As a matter of policy, we want people to have checkups and screenings expressly for the purpose of improving outcomes and reducing costs.

A team of researchers at Yale reported earlier this year on a statistical analysis that links spending on social services and public health with AIDS  deaths.  More spending on social services appears to reduce deaths.  (See reference to Talbert-Slagle et al in Sources, below.)

Another report (Bradley et. al.) links greater spending on social services with reductions in obesity, Type II diabetes, heart issues, lung cancer deaths and depression.

Social services include education and jobs programs.  The message seems to be that people who are focused, busy and hopeful are less likely to have theses issues or to engage in risky behavior than those who are not.  Sitting on a couch with a beer watching TV is a problem.

The next chart seems to illustrate the point that AIDS is most rampant where spending on social services and public health is low.  (Maine — an exception — is low in both AIDS and social services spending, but has a shrinking population with most people in the 20-40 age range leaving for other locations.)


Conversely, states that are low on social services and public health spending often require more Federal funds for AIDS testing.  The chart below (CDC, 2010) shows the relative allocation of Federal funds for HIV testing and prevention.   hivtesting

Even with this chart, there are anomalies.  Idaho and Montana spend a lot on testing while having a low incidence of the disease.  Is that excess caution or paranoia at work?  Or is it the ability of its Congressional delegation to shift spending to where it is less needed?

Bottom line: the US does need a complete rethinking on how it spends money on health.  Right now, policies are designed to treat illnesses after the occur and enrich drug companies and health insurers.  Prevention and early detection is a lot less expensive and produces better results.

It really is time for a change.





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