Dr. Richard Cain on Healthcare

(08/05/2014)

Dear Editor,

I read your 8/1/14 commentary on healthcare. In my opinion there were several incorrect conclusions in your article. In regards to the higher infant mortality rate in the US; we record that any infant showing any sign of life is considered a live birth. In Europe before a certain gestational age or unless they live at a certain time after birth they are not reported as a live birth. USA today reported that this probably falsely elevates the US infant mortality rate in relation to other western nations by 17%. It also contributes to the shortened life expectancy numbers. If you take a child that died at birth and average them with 100-year-old you get a fifty-year life span. It is shown that premature infants have a higher survival rate in the US, this adds to healthcare costs in relation to other western nations.

The US does have a higher rate of teenage pregnancy and drug use during pregnancy compared to other western nations, which does increase infant mortality and healthcare costs; I would argue these are social problems, not a failure of the medical system. I would recommend to decrease healthcare costs in this area, one need to look at the social issues which increase them, and the government policies that may encourage and sometimes reward these behaviors. The rates of chronic illnesses are related to lifestyle, surviving previous illnesses or injuries, and other factors. Again, I would argue that lifestyle is not a medical system failure. The US does have a higher obesity rate, which increases chronic illnesses. Sadly the rest of the western world is catching up with us. Cancer survival rates are higher in the US. It is shown that people with more advanced cancers live longer in the US, which does increase costs in relation to other western nations as well.

I agree that the high cost of healthcare is a burden for many families. Obamacare does very little to address this as several families now have an $8,000-$10,000 deductible, which I would argue is the same as no insurance at all for most working families. This, like mandating no prior conditions, could have been addressed by our politicians. They could have said that all medical expenses are tax deductible. If you owed me a bill of $100 and said you didn't have the money to pay I could take it off my taxes, and notify the IRS of such and they could evaluate your ability to pay. Our tax code does not allow the tax deductible part unless certain rare circumstances are met. The IRS can go into your banking account and remove the money they determine you owe under Obamacare. Allowing individuals to get tax relief has never been explored as the government is already spending 1/3 more than it makes. Politicians have restricted further what you can buy tax free with your medical benefits card.

I have recommended going to copyright system instead of a patent system for drugs, which evidently goes against centuries of legal precedents and won't gain traction, so I don't have a solution for the high cost of drugs. I am not sure what meaning the return on investment has in regards to healthcare, so can't comment on that either.

Obamacare does not fundamentally address any of these problems; it primarily says that the government will only pay so much for something, no matter what it costs. Obama argued that he would pay for it with savings. There are not enough savings available to pay for it. There are two logical choices, either start "fixing" the current law, which no Democratic politician has shown willingness to do, or repeal it. So it is up to the electorate to decide where we go from here. If we actually had a sensible plan I think everyone would benefit.

Sincerely,

Richard E Cain MD
Marietta, OH