January 17, 2012 | Posted By David Lemberg, M.S., D.C.

The United States spent $2.5 trillion on health care in 2009. That's "trillion". With a "T". This expenditure represents outlays of $8100 per person and 17.6% of our gross domestic product (GDP).1 The U.S. spends more per person on health care than any of the 39 other nations in the Organization for Economic Cooperation and Development. The next closest nation, France, spends 11.2% of its GDP. U.S. expenditures have been rising rapidly, tripling from 1990 to 2009, and will likely rise to 19.6% of the GDP by 2019. In other words, by 2019 one out of every five dollars produced in the U.S. will go to health care.

Exactly what are we getting for these prodigious sums? Not very much. Infant mortality, for example, is a key marker of how wisely a nation is spending its health care dollars. The U.S. ranks a dismal 41st, ranking worse than countries such as Malaysia, Cuba, and Poland. What about life expectancy? Again, the U.S. ranks far down on the list at 36th, tied with Cuba and worse than South Korea, Chile, Costa Rica, Ireland, and Greece.

These statistics tell a very sad tale. Despite spending huge amounts of ever-scarcer personal dollars on health care, the key metrics for U.S. residents continue to demonstrate how badly America is underperforming. Compared to the U.S. payout of $8100 per person, citizens in Norway spend $5003. In Switzerland citizens spend $4627, and United KIngdom citizens spend $3129.3 Of course, Norway and Switerland can be considered wealthy countries. The U.S.? Not so much these days. Where are the U.S. monies actually going, if not to effective means of health care delivery (implying effective health care outcomes)?

One main receiving station for a substantial slice of the $2.5 trillion pie is big pharma. Retail prescription drugs account for approximately 10% of health care dollars in 2009.4 That's 250 billion dollars to global corporations which spend 25% of annual revenues on advertising. Doing the math, each year Americans spend more than $62 billion to pay for broadcast and print ads for global pharmaceutical corporations. This is waste on a huge scale. Consider that approximately $60 billion would cover the annual costs of providing clean water, sanitation, education, and family planning services to all the people in all the developing nations of the world. U.S. citizens must throw away this money every year to pay for the means by which pharmaceutical companies maintain their profit margins. Something is very wrong here.

But instead of standing up for the welfare and well-being of those people whom they were elected to protect and support, members of Congress prefer to not only dither, but actively obstruct meaningful legislation. This should come as no surprise. In 2000, the drug industry employed more than 625 lobbyists.5 This is excessive by any measure, particularly when we recall that there are only 535 members of Congress. And who exactly pays the lobbyists' salaries. Americans do, as part of the ever-increasing costs of retail drugs.

Reiterating, the annual cost to provide clean water, sanitation, education, and family planning services in developing nations is approximately equal to the annual advertising budget of big pharma in the U.S. Comparable waste could easily be discerned in the $2.5 trillion spent annually on U.S. health care. Investing a similar fraction of the found money on a decent minimum of health care for every American would go far toward improving health care outcomes overall. And obviously, improved health would lead to reduced expenditures in the next year, and the next, and so on. Our problems are solvable. We need the will to solve them.

1Martin A, et al: Recession contributes to slowest annual rate of increase in health spending in five decades. Health Aff (MIllwood) 30(1):11-22, 2011

2Sisko AM, et al: National health spending projections. The estimated impact of reform through 2019. Health Aff (Millwood) 20(10):1933-1941, 2010

3Organization for Economic Co-operation and Development: OECD Health Data. OECD Health Statistics (database), 2010

4Big pharma spends more on advertising than research and development, study finds. ScienceDaily, 1/5/2008

5Relman A, Angell M: America’s other drug problem. The New Republic, 12/16/2002, p 38

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.