The health care discussion perennially dominates America's agenda. Rarely can we listen to political conversations without hearing concerns about the health care crisis. Needless to say, it is an escalating problem requiring prompt attention. Therefore, now is the time to tackle the health care problem of uncontrolled costs.

Since the 1970s, American health care expenditure has grown exponentially. According to Thomas Bodenheimer and Kevin Grumbach, a pair of health policy experts and authors, spending per person grew approximately 700 percent over the past 30 years, from $1,110 in 1980 to $8,086 in 2009. We spent about 9.2 percent of our gross domestic product on health care in 1980, but in 2009, we spent about 17.6 percent of GDP on health care, which equals $2.5 trillion. Bodenheimer adds that by 2019, expenditure will grow to equal 19.6 percent of the GDP.

Such high costs are unsustainable. They prevent care access and devastate our national budgets, which already suffer high debts. Moreover, the more we spend on health care, the less money we will have for other investments, such as education and defense.
Care quality is only partially dependent on our spending. According to Bodenheimer, while the United States spent $7,538 per capita for health care in 2008, Canada and the United Kingdom only had per capita costs of $4,079 and $3,129, respectively.

This example demonstrates that it is possible to provide care without bankrupting budgets.
While there are many factors driving health care costs, the most serious ones relate to the way we use health care. If we want effective and lasting cost-reduction, we need to address these cost-drivers.

Most American health care providers operate on a fee-for-service system. Under this setup, a provider receives a payment for each service  a patient receives.

In FFS health care, a patient is billed for every vaccination, MRI scan and procedure that he gets.  

This delivery system has greatly escalated expenditure over the past decades, because under FFS,  providers have incentive to administer extra  services  in return for  higher reimbursement.

Since patients are not generally knowledgeable about their needs, they tend to unquestioningly accept the provider's recommendations. This acceptance is only fueled by the lack of financial concerns that normally comes with receiving extra treatments because of health insurance.

Unfortunately, many of these extra services are both expensive and counterproductive. For instance, Bodenheimer cites that during the late 1990s, there was a 77 percent increase in spinal fusion surgeries in the United States, despite medical experts' doubts regarding the wisdom of this procedure. For many patients, this costly surgery often worsened their conditions, with surgical side effects commonly leading to prolonged hospitalization.  
A second reason for America's high costs rests on our desire to use every medical innovation that is released into the market. There is a common belief that a new method will always function more effectively and efficiently.

Unfortunately, this is not always true in health care; the costs are often greater than the benefits provided.  The new technology may perform the same procedures as the older technology did, but it may result in more negative side effects and higher costs.
 Innovators continuously promote new medical technology, but it is rarely tested for cost-effectiveness before it is released for public use.  An example is the recently developed da Vinci robot, a four-armed machine that innovators have touted as a breakthrough  for  prostate surgery.

However, oncologist Ezekiel J. Emanuel  explains that while it appears to be an advance, the robot has yet to show true improvements in surgery, and some patients actually suffered negative side effects such as incontinence and erectile dysfunction after using this machine.
Moreover, the robot costs more than $1 million dollars to build, a price that is passed on to the patients.

While there are other reasons for America's high care expenditures, these problems alone are quite daunting. Cuts in spending will be necessary, but policymakers cannot reduce necessary care in the process, so reforms need to be gradual. We can start, however, by moving away from the FFS system, and implementing a system in which care quality, rather than financial gain, is the incentive for service.  

Both patients and providers also need to be more prudent and ensure that selected treatments will yield benefits and are worth their cost.

We can also observe how Canada and the U.K. operate their health care systems and model some of our practices after theirs.  Both countries use fewer pricey procedures than the United States does, and Bodenheimer says this reduced usage plays a major role in reducing their spending.

Simultaneously, many Canadian and British providers operate on limited-budget systems, which pressure providers to give only the necessary and beneficial services since their resources are limited.  

Furthermore, despite their reduced spending, both countries still maintain near-universal care coverage for their citizens.  

Our generation will decide the fate of American health care. The longer we wait to change our practices, the harder it will be to slow cost growth and undo its damages.

Today, we are already making difficult decisions on how to use our limited budgets. If we keep ignoring the problem, it will eventually deplete our ability to invest in the future and in health care itself.            
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