The New Health Dialogue

Over the next few days, we’re going to post on our New America Foundation colleague Phil Longman’s revised and updated book on the Veterans Affairs health system,  “Best Care Anywhere.” His book, which recounted how the VA went from basket case to beacon, first came out in 2007, and the new version brings us into the era of national health reform. It's an era in which we can learn a lot from the VA about meaningful use of health information technology, accountability, doctors who collaborate and communicate, chronic disease management -- all of which adds up to good care.

But before we get into the gist of the book's message, we just wanted to share a bit of math he used to set the stage. We are used to reading about health care’s impact on the national economy, and we see those reports every spring about how long you have to work to pay off your tax bill. How about how long it takes to pay off the health bill? Longman did some math to uncover a "little known but diabolical fact."

Back in 1955...the average worker had to labor 1,638 hours to earn enough to buy a brand new Ford Fairlane. By 1997, the average American worker earned enough in just 1,365 hours to buy a brand new Ford Taurus, which, unlike the Fairlane, came with such standard features as air conditioning, airbags, cruise control, and power windows, steering, and brakes, and it got much better mileage.

That pattern of lower real cost, higher quality held for most big ticket items. But when Phil took a look at how it applied to health care, he had one of those "Aha" moments: so this is why the economy can grow (most years) but people don’t feel richer.

Let’s travel back to 1964, for example. Most Americans were feeling prosperous. Suburbia was burgeoning. Record numbers of American youth were becoming the first in their families to go to college...Health-care spending in the United States was just $197 per person per year. This low cost meant that with a mere 78 hours of labor (or by the end of the second work week in January, for those working full time), the average worker earned enough to cover the per capita cost of health care, including that of all children and retirees.

Zoom ahead to 2007. A average worker had to put in 411 hours -- 40 hours a week, well into March -- before earning enough to cover the average per capita burden of medical expenses –- which had hit $6,300.

If current trends continue by 2054, the average American worker will need to devote 2,970 hours a year to cover the cost of health care. That would mean working at least 8 hours a day, every day of the year,from January to December, with all of life’s needs outside of health care somehow financed by still more exertion

Of course, present trends won't continue unchanged over the next 40 years -- those numbers show why they can't. Health reform will bring about some changes -- and Longman believes the VA's story or reinvention and improvement can help. As he told another health blog Gooznews, the new health reform law focuses on insurance coverage, but there are delivery system provisions that "could provide the ground work for something like a civilian VA system." Whether this actually happens depends heavily on people at the local and state level taking advantage of the opportunity the new health reform law gives them. It's kind of like getting just the toy you want for Christmas, only it says on the box 'some assembly required.'"