America spends $2.4 trillion each year on medical care.
Your head is probably full of facts and a few distortions thanks to the seemingly endless debate about how best to fix healthcare in the United States and what exactly the problem is with American medicine. In his new book Fractured, Ted Epperly, M.D., a former Army doctor and professor of community medicine at the University of Washinton (and Men’s Health‘s family medicine advisor), breaks it down for you. Here, Epperly cuts through the politics and explains just how big a hole we’ve dug for ourselves—and how you can make it out sooner than you think.
1. We live in a healthcare-based economy.
America spends $2.4 trillion each year on medical care, a figure that represents around 17 percent of our entire gross domestic product. It’s also been one of the few areas of the economy that continued to thrive during the latest recession. Projections by the U.S. Department of Health and Human Services estimate that proportion will increase to 25 percent by 2025, and 50 percent by 2082, if current trends continue. “Unless you understand how big of a fiscal cliff we face, you won’t understand why the country is experiencing so much angst over this,” Epperly says.
Your move: How much of your personal budget pays medical bills each year? While some healthcare expenses are sudden, most fall into the predictable category of prescription contact lenses and dentist checkups. When you’ve figured out your yearly costs, have that amount deducted from your annual salary and plunked into either a tax-free flexible spending account or health savings account, suggests certified financial planner Paula Boyer Kennedy, vice president of Cammack LaRhette Consulting in New York.
2. The United States does not have the best healthcare system in the world.
Despite the big price tag, we’re not even in the top 10 in terms of quality healthcare, or in the top 30 for that matter. A 2000 report by the World Health Organization put the United States in 37th place in healthcare outcomes—including mortality rates, immunization rates, and the number of people currently fighting disease—just behind Costa Rica. That’s because while well-off Americans can benefit from the truly outstanding medical facilities at, say, the Mayo Clinic or Johns Hopkins, the rest of us simply can’t afford the top-quality treatments. “We basically have a third-world healthcare system for many people in our own country,” Epperly says.
Your move: Finding the best doctor for you takes a little research. When a doctor gives you a referral, ask for two to three specialists your doc likes, then ask who their favorite is and why, Epperly says. That way, you can tease out whether your doc is just sending business to his or her buddies. Before your first visit, look up your new doctor by name on your state medical board’s website to see if they’ve had any complaints.
3. American healthcare is focused on treating illness instead of preventing it.
You probably already knew that, but it’s staggering to see just how little cash goes into keeping the doctor away: Between 92 and 95 percent of all healthcare dollars are spent on surgeries, imaging, emergency room care, and intensive care, according to a study in the Journal of the American Medical Association. At the same time, 40 percent of deaths in the United States are due to entirely preventable factors like not exercising enough, smoking, and not wearing a seat belt. “There’s some pushback against a nanny state, but at a minimum we need to educate people with the right information about how their choices affect their lives, and they can make their own decisions,” Epperly says.
Your move: As if we don’t say it enough: Obesity has been linked to numerous medical conditions from heart disease to Alzheimer’s (not to mention erectile dysfunction), and it’s 100 percent preventable. Need a starting point? Melt fat, torch calories, and sculpt every muscle on your body with Speed Shred, the brand-new, cutting-edge fitness program from the experts at Men’s Health.
4. You’re already paying for someone else’s hospital bills.
Hospitals and insurance companies pass the cost of treating uninsured and under-insured patients on to everyone else. “When someone can’t pay, doctors raise prices on medical services for patients who can afford it, and then insurance companies raise their premiums to keep ahead,” says Epperly. But as insurance companies raise premiums, less people can afford coverage, or the high co-pays and deductibles. And that means more people can’t pay their bills, resulting in an upward spiraling cycle of increasing costs, Epperly says.
Your move: If you’re relatively healthy, you probably don’t need an expensive insurance plan. “Consider a high deductible insurance plan with a health savings account,” Kennedy says. Unlike a use-it-or-lose-it flex spending account, health savings lets you keep adding year after year until you need it. The only drawback: Your insurance plan must have at least a $1,250 deductible if you’re single or $2,500 on a family plan.
5. Insurance doesn’t protect you from bankruptcy.
In fact, a full 78 percent of people who file for medical bankruptcy had medical insurance, according to a 2009 Harvard University study. So what happened? “Most insurance plans in the United States have a yearly or lifetime cap, and it might be $10,000 or $1,000,000, but if you go over it, then you’re on the hook for the rest of your medical expenses,” says Epperly. Under the Affordable Care Act, insurance companies can no longer set those caps, but before that the United States was the only industrialized nation that allowed its citizens to go broke just by trying to stay alive.
Your move: You know who wants your insurance company to pay the bill just as much as you do? Your doctor. “Choose a doctor who has a dedicated billing staff with plenty of expertise in dealing with insurance companies,” says Kennedy. They can explain the ins and outs of your cryptic hospital bills and point you in the right direction to get help if it seems like your insurer is trying to bail on their part of the deal.
