Op-ed: How Does the U.S. Healthcare System Fare Compared to that of Nine Other Countries?
Op-ed: How Does the U.S. Healthcare System Fare Compared to that of Nine Other Countries?
Hint: not well.
By Jay Brock
GUEST WRITER
The Commonwealth Fund, the healthcare think tank, last month came out with a report comparing healthcare in the United States with nine other advanced nations, and it’s a stunner.
According to the report, “the U.S. continues to be in a class by itself in the underperformance of its healthcare sector…the only clear outlier…” where the other nine nations, unlike the U.S., “have all found a way to meet their residents’ most basic health care needs, including universal coverage.”
Unfortunately, this report is not in the least surprising, since the results detailing the failures of the American healthcare system tell the same old sorry story that goes back decades: the United States spends far more on healthcare, and gets much less in return, than all other advanced nations.
The countries we’re compared to are Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom.
The areas where we lag include affordability; lack of primary care services; administrative burdens for both patients and providers in dealing with insurance company billing issues; shorter life expectancy; and more avoidable deaths.
We do rank high in the quality of our care—the problem is that too many people have difficulty accessing it.
Health insurance in America is about half government-based and half employer-based. There are thousands of plans, and they vary in cost and coverage. It’s a vastly complicated system, and it’s very expensive to run—we could soon be wasting a trillion healthcare dollars per year on costs that have little or nothing to do with healthcare.
How did we get here? During World War II, when there were wage and price controls to keep the American economy stable, private employers were allowed to offer health insurance as a benefit rather than increasing wages. Over the years, these health insurance plans grew in size, and then Washington said they could transition into for-profit companies. So rather than a health insurance system being a public good supplied by the government on behalf of every citizen, it became a hugely profitable industry run largely by (and for the benefit of) the private sector. The health insurance industry business model is to make a profit, not ensure that everyone gets affordable healthcare.
The result is that nearly 30 million Americans have no health insurance, another 60+ million are “underinsured”—meaning they can’t afford to use their insurance—and 3/4 of Americans worry they won’t be able to afford to pay their medical bills if they get sick. The number of people here who die prematurely each year because they cannot afford timely medical care is in the 70,000 range. This is the opposite of every other advanced nation, where the emphasis is on making healthcare both affordable and universal.
Who is accountable for the health insurance quandary affecting too many Americans? Look no further than the people in Washington we elect to serve on our behalf. They are the folks who make the rules that we all live by. It’s tempting to blame the health insurance industry for these problems, but they’re mostly just playing the game by the rules set out by Washington politicians. And the for-profit health insurance company has a fiduciary responsibility to its stockholders to enhance profit. Making healthcare affordable and universal is up to Washington, not industry CEOs.
What’s the answer? Certainly not perpetuating the current failed profit-based health insurance system. Forget about “increased competition” or “building on the Affordable Care Act” (Obamacare).
What we need is a system that accomplishes what every other advanced nation already has: healthcare that is both affordable and universal. One that puts the interests of patients first. One that is easy (and much less costly) to administer. A system that pays 100% of the cost for all necessary medical care (so there are no out-of-pocket expenses). A system where healthcare contributions are based mostly on income—so they are truly affordable for everyone. One where the paperwork for individuals is minimal. One where there’s no need to fight over prior authorizations or outright denials of care that harm patients but improve the bottom line of a for-profit health insurance company.
A single payer system such as Medicare for All would work best. Canadians love their SPS—despite some significant drawbacks, it’s even more popular than hockey.
Polls here show real support for such a system—7/10 Americans approve.
The problem? 7/10 Washington politicians don’t approve.
Until the folks in Washington start representing our best interests rather than those of wealthy industries that pack a huge political punch, we will just have to put up with care that is too unaffordable for too many— and the tens of thousands of unnecessary deaths each year.
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And Trump will do nothing about this. "The fault, dear Brutus, lies not in our stars but in ourselves".
Dr Brock, as always, insightful. Thank you.
And though, after a second reading, my objection is more muted, because I think we are basically saying the same thing, in our own way, I do want to point out a distinction that to me is important.
I think your analysis of this issue applies to a multitude of the base problems in our government. On gun control, civil liberties, gerrymandering, money in politics, immigration, fiscal responsibility, tax policy, Pretty much all of it.
But when you say Washington politicians - you act like they are there without our consent.
They are not.
They are there because we as a nation have chosen, for good or for ill, thru ignorance, greed, self interest, or indifference, to have them there.
They reflect us. We should not pretend otherwise.
Much like our recent choice as a nation to elect Donald Trump. We can no longer claim that Trump is everything loathsome that he is; yet pretend that he doesn't reflect us as a nation.
He does.
We are no longer a nation of honor, nor of integrity.
We should acknowledge, though not accept that our rights are now considered malleable, and our purpose as directionless as a fibrillating heart.
They say Ben Franklin was once asked what kind of government our Founders were creating for our country. To which he replied, "A Republic, if you can keep it."
Which now, after 200 some odd years, we now know the answer.
We cannot.
Not taken from us by an enemy without.
But meekly given away, in hopes that it will help our 401K. Puts me to mind of Henry Fonda, in the Grapes of Wrath, in his conversation with John Carradine when he explained no matter how injust it was, his father liked his hamburger. Though I can understand a starving man seeing things that way more than I can a fat people worried about whether they get a 5% or 10% return on their dividend.
We've sold ourselves into bondage rather cheaply, I'm afraid.
So though there are many of us, nay - most of us, who still are people of honor, who value truth, and are invested in the betterment of our people - as a nation, we are not.
We the people have clearly chosen to be represented by a dishonest, dishonorable, ignorant, loathsome man.
He truly represents us, no matter how often a Derrick Anderson claims that although he'll stand with his party, but he's not happy about it - or a Martin Davis rationalizes that's okay - there is no way we cannot say that is us.
We made a choice.
What nation should trust our word, as we are led by a liar of epic proportions? What cop should be willing to give his life to hold the line fast in service of the law, as we are led by a 30 time felon with pending sentences by our own choice? Or soldier lay down his life to protect a Constitution that its citizens choose to ignore?
Admittedly, like many others, on a certain level I'm having trouble processing this.
Good article in the WaPo the day after the election talking about Michael Fanone's reaction to the nation's rejection of all he held dear.
I'm not in as bad a place as him, because I do have family, purpose, and happiness that sustain me. For that, I thank God. Though, like Camelot, I realize that we've lost something we will never regain. Not in my life time anyway.
It's gone.
And yet I realize, as I did even when I thought it wasn't true, that even if I am the only person left on this Earth that believes that truth matters, billionaires don't need welfare, nor children tortured because of who their parents are - those are still things I believe.
I will never bend a knee to such a loathsome god.
So be it.
As someone who has also bled, fought, and had friends die defending these things that I offered my life for; in flood, fire, blizzard - day after day, night after night, year after year; it is admittedly hard to realize your country does not share your values.
But just like with your comment regarding Washington being the problem, it's not. From what I've seen, the vast majority of people working in government on every level are honorable people who are the ones willing to put others first.
When you say Washington politicians, it is not some faraway "other" that we should blame for our troubles. Nor Russian dictators, faceless corporations, manipulative lawyers or lobbyists. Though they've all played their part.
As that great 20th century philosopher Pogo once said, "We have met the enemy, and he is us."
And that's what hurts the most.
Start there.
Still, I thank you and keep the faith. Best wishes.