Let’s start out with one indisputable fact: The United States has the most expensive health care system in the world. But that’s OK because we get the best care in the world, don’t we? If you believe that “fact,” read on.
In 2010, the US spent $2.6 trillion on health care, averaging $8,402 per person, and health care spending accounted for 17 percent of total economic activity (GDP). Other wealthy countries spend far less. In Germany, the country with the second highest rate of spending, health care costs accounted for 11 percent of GDP. The United Kingdom spent 9 percent, and France and Canada spent around 10.5 percent, as did most of the other European countries.
Why does the U.S. spend so much on health care? Is it because of Obamacare? The answer is clearly no. Prior to the passage of the Affordable Care Act, the U.S. was already spending more than any other country in the world. Since Obamacare passed in 2010, the rate of cost increases has been cut in half, according to a report by the Kaiser Family Foundation.
So the United States has the most expensive system in the world. Does that mean that we also get the best health care? Unfortunately, it doesn’t. In terms of some important measures of overall health, the U.S. ranks far below other industrialized countries. The Organization for Economic and Development publishes health statistics for industrialized and semi-industrialized countries. For the 44 countries included in its 2010 report on infant mortality, the U.S. ranked 32nd. In fact, the U.S. infant mortality rate was worse than the rates in the Slovak Republic, Lithuania and Poland. In terms of overall life expectancy, the United States ranks 29th for women and 27th for men. Even poorer countries outperform us: Men in Chile, Slovenia and Portugal have slightly longer life expectancies than men in the U.S.
In the U.S., we spend a huge amount on health care but don’t do very well on measures of health performance. Still, it’s widely believed that we have the best health care system because — unlike the rest of the world — we can choose our own doctors and we don’t have to wait years for doctor appointments. This view assumes that there are two kinds of health care systems: the free enterprise system like we have in the U.S. and socialized medicine, like all the other wealthy countries. In reality, there are big differences among the countries that offer universal health coverage. Some of these countries, like the UK and New Zealand, deliver health care in government-run facilities. Other countries, like Canada, use a system of national health insurance to pay private-sector doctors and hospitals. Still others, like Germany and Switzerland, rely on private doctors, private hospitals and private insurance plans.
With a few exceptions, most of the countries that offer universal health coverage allow patients to choose their own doctors, and the national health insurance pays the provider. It is true that in other countries, waiting times for appointments with specialists are often longer than in the U.S., but this isn’t always the case. In Canada, patients may wait months for non-emergency care. In other countries — such as the Netherlands, the UK and Switzerland — waiting times are shorter than they are in the U.S.
But there’s another measure of health care quality that should be noted, and that is the extent to which affordability affects health. Do patients skip doctor visits or prescribed medications because they can’t afford them? On these measures, the U.S. performs very poorly. In the U.S., over 20 percent of patients reported that they had skipped consultations or prescribed medications because of cost. In comparison, in countries with universal health care plans, the rates were far lower (under 10 percent).
It is widely assumed that a national health insurance system would create a huge, unwieldy, expensive bureaucracy and drive up health care costs. But what do we have now? The administrative costs for U.S. health insurance are the highest in the world. Twenty cents of every health dollar is spent on non-medical costs. In contrast, most of the countries with universal health care plans spend less than 5 percent of health care dollars on administration.
Obamacare isn’t perfect, but at least it was a big step in the right direction. The American Health Care Act — the Obamacare “replacement” that is currently struggling for passage in the Senate — is clearly a step in the wrong direction. Twenty-three million Americans would lose health care coverage, according to the Congressional Budget Office.
Elise Stefanik voted for the passage of the AHCA. Stefanik’s office issued a statement saying that “this legislation will lower taxes, reduce our deficits and lower premiums.” But according to the data from the Congressional Budget Office, it’s clear that many people would be priced out of coverage. A 64-year-old who earns $27,000 per year would have to pay over $16,000, or about 60 percent of income. Of course, many people wouldn’t be able to afford health insurance and would have to fall back on Medicaid. The Republicans want to slash the Medicaid budget and shift the burden to state and local governments. Slashing federal expenditures on Medicaid would enable the Republicans to give huge tax breaks to corporations and very wealthy Americans.
It’s outrageous that Stefanik supported this awful bill, and it’s outrageous that she continues trying to put lipstick on this pig. The AHCA would have terrible effects on the North Country, not just for the people who lose their health insurance but for everyone else, too, as local and state governments scramble to cover Medicaid costs by increasing taxes.
Are you counting on Republicans to “fix” your health care insurance? Unless you are young and healthy or very wealthy, it’s a better bet they’ll fix your wagon instead.
Susan Hahn lives in Ray Brook and has a master’s degree in sociology from the University of California. Prior to retiring, she was a vice president at iVillage, an NBC/Universal company. Sources and data for this article are available on request.