Understanding Health Care

A young reporter once set out to explain the American health care system to his editor.

After many minutes of earnest conversation, the editor smiled brightly. "I get it now," he said. "It makes perfect sense."

"Well then, I must have left something out," the reporter replied.

The bottom line on the American health care system is that it makes absolutely no sense.

No one — not conservatives or liberals, doctors or patients, businessmen or humanitarians — would design such a system starting from scratch.

It's paradoxical, pricey and porous. If President Barack Obama has his way, it's about to get a significant overhaul.

Senate Democrats already have released several draft proposals that they hope will expand insurance coverage and control costs. That's no mean feat. Even many who wish them well doubt that it's possible.

House Republicans, meanwhile, last week trotted out a competing, though far less detailed, proposal containing their vision for reform.

Interest groups on all sides have begun advertising and "Astroturf" advocacy (fake grassroots) to shape the debate. It promises to be a confusing summer.

Even to those who know it best, the health system is complex and, at times, inscrutable.

One reason is the jargon. It can make the reform debate even more baffling than it otherwise would be.

You want "mandates?" We've got employer mandates and individual mandates.

"Models" or "systems?" We've got socialized, government-controlled, single payer and free market.

There's the "Massachusetts" model and the "Canadian" model; health benefits tax and congressional "scoring," which estimates a bill's price tag.

Don't forget "rationing;" you'll be hearing that word a lot.

In the coming weeks, we'll explore what's brought us to this point and explain what those terms mean.

This stuff is hard, but it really matters.

We all pay, directly or indirectly, for the health system we have. Sooner or later, we're all going to use it.

No system is perfect. But in recent years, three very real problems built into the U.S. system have become too big to ignore.

The first is coverage, which is porous. About 50 million Americans now are uninsured. Millions more have inadequate coverage for serious illness.

That's not true in any other industrialized country. About 22,000 Americans die each year as a direct result of being uninsured.

The second big problem is cost, which is ridiculously expensive. The United States spends roughly twice as much per person as the average in other developed nations. And those costs are growing fast.

U.S. health care spending doubled between 1997 and 2007, from $1.1 to $2.2 trillion. It's expected to reach $4.3 trillion by 2018.

The third is quality, which is paradoxical. You'll often hear that we have the world's finest health care. That's true some of the time, for some people, particularly for costly and intensive treatments.

But only about half the time do Americans — even those with good insurance — receive the care doctors say they should get.

The best measure of quality of care is whether people get better, what doctors call health "outcomes." For example:

— Average life expectancy in the United States is three years less than in Canada, four years less than in Switzerland or Australia.

— The chance that an American baby will die before its first birthday is 40 percent greater than for a baby in the United Kingdom. It's 75 percent greater than for babies in France or Germany.

— The U.S. adult mortality rate — the odds that someone will die between the ages of 15 and 60 — is 36 percent higher than England's; 51 percent higher than Canada's and 73 percent higher Switzerland's. The U.S. rate is on par with Panama.

Everyone — doctors' groups, the insurance industry, hospitals, lawyers, patient advocates, Democrats and Republicans — agrees: The U.S. system needs to be changed.

The question is how to do it.

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