By Glenn Ellis
COVID-19 is still with us and will be here for some time to come. But what is clear is that our health care system leaves much to be desired. It’s way past time for us to take a close look at what we have, what we really need, and the human toll of not examining our healthcare system.
Given the amount of money that is spent each year, you would think that the United States should be doing much better on health indicators such as infant mortality rates and life expectancy.
Here are a few points from a recent study conducted by the Commonwealth Fund in 2020:
- The U.S. spends more on health care as a share of the economy — nearly twice as much as the average developed country — yet has the lowest life expectancy and highest suicide rates among the 11 nations.
- The U.S. has the highest chronic disease burden and an obesity rate that is two times higher than the developed country average.
- Americans had fewer physician visits than peers in most countries, which may be related to a low supply of physicians in the U.S.
- Americans use some expensive technologies, such as MRIs, and specialized procedures, such as hip replacements, more often than our peers.
- Compared to peer nations, the U.S. has among the highest number of hospitalizations from preventable causes and the highest rate of avoidable deaths.
In spite of being the most expensive health care system in the world, the U.S. outperforms its peers in terms of preventive measures. Go figure.
The Patient Protection and Affordable Care Act (known as the ACA or Obamacare) of 2010 was proclaimed by some as a landmark in health care reform that would transform the US health care delivery system into a program that provides “health care as a right.” Although the ACA does much to reduce major gaps in coverage for many Americans, it does not provide health care as a right. Passage of the ACA has created substantial public debate on what should be covered and who should pay.
The fight to make health care a right, has been going on for over 100 years in this country. Since the early 1900s, the United States has periodically considered the need for a nationalized health care program, but each time, this type of reform has been defeated. Instead of a single-payer system, the United States has a mix of public sector and private sector programs.
The public sector programs include Medicare, Medicaid, health care delivery to underserved populations (such as the Indian Health Service and Community Health Centers), and other government-sponsored health care (in prisons, public clinics, and hospitals). The private sector includes most community hospitals, professional services (physician, dental, and other), nursing facilities, retail outlets selling medical products (e.g., prescription drugs, durable medical equipment), health insurance companies, and managed care providers.
Until recently, public health activities such as health prevention activities have been poorly funded (between 1 percent and 3 percent of national health expenditures), but in 2010 they received a significant boost with passage of the ACA.
Overall, the largest spending category is for hospital care (32.1 percent), followed by physician services (20.1 percent), and prescription drugs (9.3 percent).
It might be expected that these high costs would result in the best health outcomes in the world; however, such is not the case. The lobbying groups, combined with Americans’ fear of “big government” and “socialized medicine”, tend to limit meaningful movement toward a single-payer system or another type of health care reform. The average U.S. resident paid $1,122 out-of-pocket for health care, which includes expenses like copayments for doctor’s visits and prescription drugs or health insurance deductibles.
Despite the highest spending, Americans experience worse health outcomes than their international peers. For example, life expectancy at birth in the U.S. was 78.6 years in 2017 — more than two years lower than the average of all developed countries and five years lower than Switzerland, which has the longest lifespan. In the U.S., life expectancy masks racial and ethnic disparities.
The National Institutes of Health (NIH) defines health disparities as differences that exist among specific population groups in the United States in the attainment of full health potential that can be measured by differences in incidence, prevalence, mortality, burden of disease, and other adverse health conditions. More than one-quarter of U.S. adults report they have ever been diagnosed with two or more chronic conditions such as asthma, diabetes, heart disease, or hypertension during their lifetime.
These conditions impact Blacks, and other marginalized communities in a negative way, and they carry a disproportionate burden of these diseases. Racial and ethnic disparities are arguably the most glaring inequities in health over this country’s history, despite the many strides that have been made to improve health in the United States for others.
It’s time for this country to live up to its Constitutional creed: “We hold these truths to be self-evident, that all men (and Women) are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men (and Women), deriving their just powers from the consent of the governed…”
Glenn Ellis, MPH is a Visiting Scholar at The National Bioethics Center at Tuskegee University and a Harvard Medical School Bioethics Fellow. He is author of Which Doctor? and Information is the Best Medicine. For more good health information visit: www.glennellis.com.