What I'd Ask Obama and Romney

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If I were the moderator of Wednesday night's first presidential debate – scheduled to be devoted to domestic issues including health care – the single question I would most want to ask of both candidates is this one: How is it possible that the U.S., which is the richest country in the world, is the only developed country on this planet that has not figured out how to provide basic health insurance to all its citizens?

It certainly is NOT because we don't spend enough money on healthcare.

Believe it or not, we already spend about twice as much per person as the average per-person cost of all other developed countries! This year we will spend over $8,000 per person versus the over $4,000 per-person average of all other countries.

So the question really becomes: How is it possible that we spend so much money on healthcare and we still have 40 to 50 million Americans uninsured at any given time?

As you might expect, the answers to that question are complicated – and I will spend the next several months in this column trying to answer them. Once we understand those answers, I will outline what I think are the four essential ingredients necessary for true reform in this country.

But right up front, here is a big part of the problem: Approximately a third of what we spend on healthcare is "unnecessary."

Now that word "unnecessary" covers everything from criminals who commit fraud by billing Medicare and other insurance providers for care never delivered to a lot of care given in "good faith" for which there is no proof of any benefit.

Consider a recent report from the Institute of Medicine.

They looked at healthcare costs in the year 2009 and concluded that 30% of the money spent in that year was wasted on things such as unnecessary services and excessive administrative costs. In 2009, 30% was $750 billion; today it would be over $800 billion!

And the tragedy behind that cold number is that it would be enough to provide basic insurance to all of our citizens.

So now the question I started with could be restated this way: Why do we Americans spend so much money on unnecessary healthcare when so many of us have no health insurance at all?

More questions: Who is responsible for all this foolish spending? Why haven't we done something about this travesty? What will it take to get this spending under control – without compromising patient outcomes?

Those are the kind of questions I will be addressing over the next several months and I welcome you to join me as I wrestle with these truly life and death issues.

Timothy Johnson, MD, MPH, trained as an emergency room physician but switched careers in 1984 when he joined ABC News as its first full time Medical Editor. Although he retired from that role in 2010, he continues as Senior Medical Contributor. Johnson is the author of a new book on healthcare reform, The Truth About Getting Sick in America: The Real Problems with Health Care and What We can Do.

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