Multiple culprits blamed for U.S. healthcare crisis.

A noted health care professional once lamented, "Whereas once, health care and health insurance were understood as activities related to acute injuries and illnesses, they have expanded to include preventive and mental health services, long-term care, complementary medicine, and the ability to maintain psychological, social, spiritual, and sexual performance far into the golden years."

One of our great American philosophers, Pogo Possum said it another way: "We have met the enemy--and he is us."

There are many, many "culprits" to blame for the crisis in health care. None, however, are as easily identifiable as the public's complacency.

Over the past several decades, Americans have managed to ingrain a seemingly permanent sense of entitlement into, not only employees, but management as well. Somehow, the public has coddled itself into a fiscal corner from which escape will be very, very difficult.

Aside from the failure to recognize this problem as though it snuck up and magically appeared overnight, behavior that serves to do little more than make an already untenable situation worse--continues.

In spite of clear warnings of both impending and present danger, Americans eat too much, eat the wrong things, over-medicate, under-exercise and--maybe the greatest foible of all--sit passively by while children continue in their parents' same unfortunate ways.

In addition to all of this (or, perhaps, because of all of this), the public sector has managed to convince itself that these actions are the responsibility of others--in the form of employers, government and the neighbors.

Do I have your attention, dear readers? Before you convince yourselves that I am about to lead you down the unpleasant path of self-loathing, please permit me to arm you with some facts.

In 1944, President Roosevelt implemented the World War II Factory Workers' Health Plan which provided assistance to those at home who served to support the war effort. At the end of the war, the program was disbanded. In 1946, President Truman attempted to institute a National Health Care Plan based upon Roosevelt's matrix. His effort failed.

In 1965, President Johnson spearheaded the Medicare and Medicaid systems that still exist to today albeit in a markedly different form. The Nixon administration in 1973 mapped out the rudiments of a Health Care Reform proposal as did the Clintons in 1991. Neither plan got off the ground.

As recently as the second President Bush's tenure, further analysis has been performed in an endeavor to revise, reform, amend and improve the ailing health care system. The results have not been stellar to say the least.

For the past 50 years, personal out-of-pocket health care expense has plummeted while those ever-increasing expenses have been methodically shifted to public and third-party payers.

This spending "party" has yet to come to an abrupt halt as the annual health care bill is now close to 15% of our gross domestic product. Among the industrialized countries of the world, the United States stands head and shoulders above the rest in paid per capita medical expense. No other country comes close.

The best?

But, one may protest, our system is the best and--after all--"you get what you pay for." Then why is our mortality rate amenable to health care among the highest in the industrialized world? Our infant mortality rate is the highest; our waiting time to see a doctor when sick or in need of medical attention is the longest with the exception of Canada's; our medication and laboratory error rates are the highest; and--most telling of all--our life expectancy at birth is the lowest? Something doesn't add up.

Inflation? Increasing wages? Could these financial realities come into play? Good question--bad answer. The cumulative change in both workers' earnings and inflation over the last sixteen years reflects an increase of approximately 19 percent. During that same period of time, health care costs have escalated close to 96 percent.

OK, then--that's not it. So, who let the "dogs" out?

Putting entitlement attitudes and lifestyle habits aside for a moment, several factors can be identified that contribute to the "crisis" as it has been dubbed by the media. At the end of the day, each of these dynamics is visible as a "driver" of health care cost. Be clear, though none of them are "causes." They are:

Medical Consumer Price Index

Drugs and Treatments

Provider Expense

Government Mandates

Fraud

Litigation 

Consumer Demand

The Uninsured

The Failure of Managed Care

So, as Mick Jagger eloquently pondered in these lyrics, "... What's a poor boy to do, 'cept to sing in a rock 'n' roll band?"

To be continued.

Arthur "Art" Singer has been an employee benefits professional since 1980. currently serving as the Director of Field Advisory Services for USI Insurance Services. Among his professional designations are Chartered Life Underwriter, Chartered Financial Consultant, Registered Health Underwriter, Registered Employee Benefits Specialist and Chartered Advisor for Senior Living. Singer has served on the Advisory Boards of Blue Cross of California, PacifiCare, Kaiser Permanente, UNUM/Provident, Chubb and Ohio National Financial. He is frequently retained by the California legal community as an expert.