COLUMBIA — If the U.S. health care system were a patient, a physician would hardly know where to begin treating its various ailments.
That was the gist of what an MU health policy expert had to say about the U.S. health care system Wednesday at a forum held at the MU School of Medicine. About 100 students, faculty and staff came and participated in the question and answer session, which was broadcast to medical professionals through the Missouri Telehealth Network.
The keynote speaker was Karen Edison, director of the Center for Health Policy and chairwoman of the dermatology department at MU, who addressed the politics, economics and conflicting philosophies of the debate. She called it "arguably one of the most important policy debates in our time."
"One of the fundamental questions is: Is health care a right or a privilege?" Edison said. The question was followed by a long silence. "I won't ask you ... you can ask yourself."
Edison talked about Americans with chronic diseases and the effects health care costs have had on treatment.
"These are adults who are chronically ill who have reported access problems due to costs in the past two years," she said. "They didn't fill a prescription or they skipped a dose, they didn't visit a doctor when they had a medical problem, get a recommended test, treatment or follow up."
The Centers for Disease Control and Prevention show chronic disease as the leading cause of death and disability in the United States, including heart disease, cancer and diabetes. The CDC shows seven out of 10 American deaths each year are attributed to chronic diseases.
But it would help if patients understood what their doctors were saying to them. That's an issue of health literacy, which Edison described as a "huge" problem in the U.S.; patients often can't understand the information their health care providers give them, so they can't put it to use to make smarter health decisions.
"The average American reads at a seventh- to eighth-grade level. ... The average person over the age of 65 reads at a fifth- to sixth-grade level," she said. "Most of what we say and most of what we hand out in our clinics is not."
Edison said medical technologies, pharmaceutical drug prices, defensive medicine and fraud and abuse in the Medicare and Medicaid systems are "cost drivers" of health care.
"We recently heard about a $65 million case of fraud and abuse in the Medicaid program," Edison said. "So we need to figure it out ... wherever they exist."
Policies aimed at reducing costs are included in each of the three main reform bills to come out of committees in Washington recently, specifically the Senate Health, Education, Labor and Pensions Committee's plan, which is estimated to cost roughly $600 billion over 10 years. President Barack Obama told Congress in September that his health reform initiative would be paid for by savings within the existing system, particularly fraud in Medicaid and Medicare.
William G. Little, president of the Quam-Nichols Company in Chicago, was in the audience and asked Edison how realistic that prospect is.
"It seems to me that they are talking about a huge amount of the cost of the $600 billion over 10 years coming from efficiencies provided by the medical community," he said. "Are $600 billion of cost-reductions possible? Do you think that is a reasonable objective?"
"Nobody really believes they are going to save a lot of money in the short term," Edison replied. "What they're trying to do is get a balance where everybody gives up a little bit."
Edison talked about the 739,000 Missourians without health insurance — an estimate made by the U.S. Census Bureau — and the economic discrepancies that might cause this.
According to a report by Families USA, a consumer advocacy group, health insurance premiums for Missouri workers increased 4.4 percent faster than median incomes from 2000 to 2007.
The report shows that annual family health insurance premiums have gone up $3,833 for employers and $1,289 for workers. And for individual health insurance, annual premiums have risen $1,153 for employers and $383 for workers.
Edison also said that more than 70 percent of Missouri's uninsured families are employed, but many find the insurance premiums unaffordable and are earning too much income to receive coverage through Missouri's Medicaid program: Missouri HealthNet.
"So we have a safety net, but it's not a safety net for everybody," she said. "It's a safety net for people who fit into certain categories, such as being pregnant, blind or disabled."
MU senior Megan Wagoner, who studies nutrition and fitness, said that her professor canceled class so that her students could attend the forum.
"We're going to have to have a good plan in order to take care of everyone," she said.
The stakes are high, and everyone is "trying desperately to stay at the table," Edison said. "Because everybody in Washington knows if you're not at the table, you're on the menu."