Leading the Elephant Out of the Corner

Abstract

I will break with tradition and address a topic that is more political and social than scientific—the future of health care. Although I will focus initially on the growing healthcare crisis in this country, I will cite similar concerns and trends elsewhere in the world and suggest fundamental principles for change that are relevant throughout our global society. Of the 192 member states of the World Health Organization in 2003 (Figure 1), 85 countries spent less than $100 per capita each year on health care.1 Another 85 countries spent between $100 and $2000 per capita. Only 22 countries, or 11.5%, spent more than $2000 per capita. Most of us are privileged, as we work in one of these 22 countries (Table 1). Figure 1. Pie diagram showing the distribution of the 192 member states of the World Health Organization based on per capita health spending in 2003. Only 22 countries, or 11.5%, spent more than $2000 per capita. Based on data from the World Health Organization.1 View this table: TABLE 1. World Health Organization Member Statistics With Per Capita Health Spending Greater Than $2000 The recent growth in healthcare expenditures is an issue in many of these countries, including the United States. In the United States, federal government spending on Medicare and Medicaid continues to accelerate (Figure 2). These 2 items now comprise almost 21% of the budget, equal to Social Security.2 Along with other mandatory items and interest payments, these nondiscretionary expenditures now approach 61% of the total federal budget (Figure 3). Of the remaining 39%, 20% goes to defense, leaving 19% of the federal budget for all other discretionary spending. Figure 2. Growth in federal government spending on Medicare and Medicaid from 2003 to 2006. The Medicaid spending does not include the contribution from the states. Based on …