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Interviewer: What are the major issues facing health care right now in the United States? It seems like there are so many of them and it could be confusing and hard to sort out what exactly is going on. Well, we've got an expert that's going to help us do that next on The Scope.

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Interviewer: Dr. David Sundwall is a professor of public health at University of Utah School of Medicine. He's also a leader in health care policy and advocacy. So we all want quality health care that's affordable and available to all. What do you think we can do to achieve this?

Dr. Sundwall: Well, this is where I have to be careful because I start sounding like a socialist. I'm a Republican and would favor a single payer system. I think if we have something more like what they have then other enlightened countries, whether it be Canada or Germany or Switzerland, where they spend a lot less than we do for health care but somehow manage to cover all of their citizens, that's what we would ultimately like to get to.
That's a long time coming because there's such a reluctance in our country to have this uniformity. There's a belief that heath care ought to be private, it ought to be in the marketplace, and yet we have lots and lots of experience now showing marketplace doesn't make it more affordable, it doesn't lower the costs, and it doesn't make it more accessible. So we're moving in the right direction, I think, with what they're trying to do with the ACA and we're trying to do here in Utah with some Medicaid expansion if the governor is successful, but we've got a long way to go.

Interviewer: What do you think the three biggest challenges are to overcome in the health care arena that we face right now?

Dr. Sundwall: Its costs, primarily, its universal access which the ACA or the ObamaCare tried to get out by having it a mandate that people have insurance. And so I would say access to care, it would be cost of care, and how much care do we consume.
One of our sessions is how do we care for aging population. It's just a huge challenge for us when we have about 70% of health care costs are spent in the last six months of life. Now, forgive me for the details on that. The point I'm making is we spend way too much for what seems like futile care, not really extending quality of care but just a few months.

Interviewer: Not extending quality of life. Like, it's just all about keeping the person alive at that point.

Dr. Sundwall: It's been said that we delay death, not continue life.

Interviewer: That's interesting.

Dr. Sundwall: We're all going to die and that's a big thing. I just had a patient this week who I'm appalled that he's an 86-years-old from England, immigrated here recently to be with his children, he and his wife who are in their 80s. They discovered one of our fine big medical centers. He had an aortic aneurysm and they operated on him at 86 when he was already anemic, he already has diabetes, he has some COPD or lung disease, and why they took that risk, I don't know, but it must have cost many, many thousands of dollars. And now he is in a demented state because of the anesthesia. He's confused and in the psych ward at one of our hospitals, just because of his confusion that's totally related to his surgery. Anyway, it's unfortunate. He has a very, very poor quality of life but he's still with us. I guess that was the goal. I don't understand.

Interviewer: Yeah. Those are some tough questions.

Dr. Sundwall: Yep.

Interviewer: You've said, and it's been said, that we have kind of a strange dichotomy in the United States. We've got the best technology and medical science, yet when you look at how we rank among the developed nations in regard to health status, we're 42nd. We spend more money than anybody else. We've got better stuff than anybody else but we're not providing better. Why?

Dr. Sundwall: Well, like I say, that has grown up since Medicare and Medicaid were passed in 1965. A health economist in Washington named Lynn Etheridge, who was the head of the OMB for President Carter, said it as well as anyone I've ever heard. He said, "That passage of Medicare and Medicaid was a catalyst. We're shifting more money from one sector of an economy to another than has ever happened in the history of the world."
So now can you imagine just 50 years later we're now spending three trillion dollars on health care related services. That means that there's a whole lot of people doing very well about off of health care, meaning the providers of services, whether you be a hospital or a doctor, medical device maker, pharmaceutical company, there's just a whole lot of people that do well because we've shifted all these public money into health care and the private insurers followed suit with the levels of what they would pay.
So it's going to be a challenge. For us to fix our costs, it's going to hurt someone's pocket. We're going to have to redistribute that money. We should put more into public health, preventive medicine, those sorts of things that prevent illness in the first place, not just keep fixing an abdominal aortic aneurysm in an 86-year-old. And I'm always reluctant to cite an example because if it were me or a grandfather or maybe I'd want it done, but that's where you can see how hard this is. We want what we want when we want it, not what we can afford.

Interviewer: It's almost one-fifth of GDP, health care spending.

Dr. Sundwall: Yeah.

Interviewer: How does that get reversed? That's a lot of money.

Dr. Sundwall: Well, this is the challenge we're facing, and I for one don't think it can happen voluntarily because meaning for all the best efforts of, say, The University Hospital here to do more efficient services or to do things more appropriately, not to do duplication. Those are just really trimming at the edges. The only way to probably get a handle on this would be as in other countries where they have global budgets where they say, "This is what we'll spend for health care. Live within that. So be it." And that of course leads to some inconvenience. That leads to some delays in care, but it is what they can afford.
I mean, it is embarrassing, isn't it, when countries spend half as much as we do have better health? And so the figures are skewed because we don't cover everybody. So our bad outcomes relate to the fact that we have still several million people that don't have health insurance or access to care with they need it. That's what pulls us down. But you're right, our high-tech is the best.

Interviewer: Why is it so important making sure that we give people that don't have access to health care access?

Dr. Sundwall: You know, I think any economist or someone that knows this information believes that if everyone is covered it means that you don't have the degree of uncompensated care. People will get care sooner and more appropriately and in the right setting if they have health insurance. We've shown through so many studies that having health insurance certainly relates to health and that makes sense. However, one of our state legislators said it's a bad idea because then they'll go to the hospital and hospitals are dangerous places. I think that's a pretty fallacious argument.
I'll give you an example. I'm not bragging, but I've been fortunate to get to be 73-years-old and never been hospitalized. I don't have any chronic illness, I'm not diabetic or I don't have hypertension, and I'm grateful for my good health. But my employers over the decades of my life have been paying my health insurance so I float all boats. People like me have been paying for the care that other people need, and if everyone had coverage, you'd have a better pool to cover those people who are currently not covered and that means they'd likely be healthier and not be caught having this costly illnesses when they need medical care that they've delayed or put off for a long time. By the time they get it, it costs a lot and maybe they've been getting episodic care in emergency rooms. Isn't that silly? You go for a cold and you're charged $1000? That's just not right.

Interviewer: Yeah. It's truly now to prevention and a pound of cure. Keep people healthy, then they don't get those diseases and those conditions that cost a lot of money, then.

Dr. Sundwall: Don't get sick from them. Maybe they could get treated earlier and therefore a lot more appropriately.

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