CARVILLE: Financial fitness |

CARVILLE: Financial fitness

Phil Carville
Fitness Columnist

I usually write about physical fitness, which is part of a broader topic called preventative care — the benefits of diet, exercise, screening, immunizations and other actions to help you stay healthy.

However, last week two members of my extended family were diagnosed with severe health issues: one with cancer and one with heart disease. Now the discussion moves from preventative care to curative care.

Curative Care

Curative Care refers to medical practices used to treat patients with the intent of curing them, not just reducing stress or pain. Examples are chemotherapy to treat cancer and bypass surgery to reduce the symptoms caused by clogged arteries.

But curative care is very expensive … often running into hundreds of thousands of dollars. For persons who do not have huge savings and excellent health insurance, this can mean personal bankruptcy.

Since 78% of U.S. workers are living paycheck to paycheck, any health problems dramatically increase the likelihood of bankruptcy and financial ruin — which brings me to the topic of financial fitness.

Financial Fitness

I am not talking about stocks or investment strategies. I am talking about health insurance and the cost of medical care in America. The situation is a disgrace and a travesty for its citizens.

According to the World Health Organization, the United States is rated 37th in the world regarding health services … behind Costa Rica, rated 36th. Canada is rated 30th while France and Italy are rated No. 1 and No. 2, respectively.

Health Ratings

These ratings are based upon four factors: access to health care, administrative efficiency, equity and health care outcomes. This can be translated as: Do people really have access to health care? How efficient are the institutions providing health care? Is the health-care system equitable (i.e. only for the rich)? Are people actually cured?

These are excellent criteria and when applied to the developed countries of the Western world, the United States comes out last. Yes, last. Surely something is wrong here.

Per Capital Costs

The United States spends more per person on health care than any of the top 11 developed countries yet comes out last in health-care performance. We spend more than three times Sweden, Germany or Japan, yet we have poorer results.

As a nation, in 2017 we spent $10,739/person/year on health care. France, which is No. 1, spent $4,902/person/year or 54% less per person than we do, but with better results.

GDP Costs

Let’s look at health care costs as a percentage of Gross Domestic Product (GDP).

France spends about 12% of GDP on health care. The United States spent 18% on health care in 2017. Estimates are that it will be 20% in 2020. Looking at it in another way — in 2020 one of every $5 spent in America will be spent on health care.

The means that there will be fewer dollars available for education, science, food, clothing and housing. The pinch will really begin to show in the next few years. It will be dire and could destabilize our democracy and our country.

It is estimated that in 2050 health care costs will be 28% of GDP, leaving even less for national security, education, housing, food et cetera. What kind of a nation will we have then?

Behind the Curtain

Remember the movie “The Wizard of Oz?”

“The great and powerful Oz was trying to intimidate Dorothy and her friends with scare tactics that seemed to be working. But right when all hope seemed lost, Dorothy’s dog, Toto, pulled back the curtain behind which Oz was hiding. It turned out that despite all the smoke, sound effects and bombast, the mighty Oz was actually just a feeble old man,” — Jim Buchan.

When the Wizard was exposed, he famously said “pay no attention to that man behind the curtain.” This is much the same situation we have today with the discussion of our health-care system.

When our disgraceful health care outcomes are compared to the better performance and lower costs of the other developed countries in the western world, vested interests try to change the debate. Petty politicians, lobbyists and narrow-minded political extremists (i.e. feeble old men) will say, “Pay no attention to the man behind the curtain.”

We must turn the debate around from the narcissistic “We are the greatest” to the practical “How can we do better?”

Silliness or Science

It is beyond silly to allow short-sighted, biased corporate interests and pill pushers to frame the debate. We have a national health care problem … and it is growing greater each year. Tens of millions of American citizens cannot afford and do not have health care. Millions more have health care insurance that is insufficient to cover major medical problems. The results are: financial ruin, broken families, homelessness, children who will not be educated and an overwhelming burden on society.

Let’s take a scientific approach. Let’s study the health-care systems of the top 30 developed countries in the world. How do they operate? How do they achieve the results they have? Why do they have superior results and at lower costs?


The arguments such as “It’s socialism,” or “We can’t afford it,” or “It can’t be done,” or “We have the greatest health care in the world,” are all bogus. They are syllogisms which do not lend themselves to clear thinking and real solutions.

There are 35 countries in the world which have higher rated health-care systems than we have. Some are “single payer” but most have a combination of national health-care coverage and some form of private insurance. France, for example, has a national health insurance program, but the physicians are in private practice. Supplemental coverage may be purchased from private insurers.

Germany has a universal, multi-payer system which is a combination of 77% government funded and 23% private insurance. The German health-care system has a record reserve of 18 billion Euros which makes it one of the “healthiest” health systems in the world.

Come on, America, let’s study the obvious and just find some solutions.

We should follow the advice of the great sage Yogi Berra who said, “You can observe a lot by just watching”.

Phil Carville is a co-owner of the South Yuba Club. He is happy to answer questions or respond to comments. He can be reached at

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