The problem with living at a time when there are so many problems–and so many truly major ones, at that–is that our focus gets splintered. Climate change. Vote suppression. White Supremicists. Rightwing domestic terrorism. Guns. Government gridlock. The pandemic. Continual wars and the growth of the military-industrial complex …The list is endless.
But a recent report in the Washington Post reminded me of one of our most long-term and shameful problems–America’s perverse refusal to follow the lead of other wealthy (and plenty of non-wealthy) countries and provide universal access to health care. The negative consequences of our refusal to allow anyone to opt in to Medicare (Medicare for those who want it), or just to broaden the scope of the Affordable Care Act, have receded from prominence.
We may be distracted by other policy failures, but the problem remains–and it is as acute as ever, if not more so.
Researchers at the Commonwealth Fund compared the health-care systems of 11 high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.
The United States has the worst health-care system overall among 11 high-income countries, even though it spends the highest proportion of its gross domestic product on health care, according to research by the Commonwealth Fund.
“We’ve set up a system where we spend quite a bit of money on health care but we have significant financial barriers, which tend to dissuade people from getting care,” said Eric Schneider, the lead author behind the findings and senior vice president for policy and research at the Commonwealth Fund, which conducts independent research on health-care issues.
The researchers identified five metrics of a well-functioning health care system: access to care, the care process itself, administrative efficiency, equity and overall health-care outcomes.Norway, the Netherlands and Australia were judged to be the top-performing countries overall.
The high performers stand apart from the United States in providing universal coverage and removing cost barriers, investing in primary care systems to reduce inequities, minimizing administrative burdens, and investing in social services among children and working-age adults, the Commonwealth Fund found.
The latter is particularly important for easing the burdens on health systems created by older populations, according to Schneider. “These sort of basic supports throughout younger age groups reduce, we think, the chronic disease burden that’s higher in the U.S.,” he said.
Since I have a son who lives in Amsterdam, I was particularly interested in the description of the Netherland’s high-performing system. The researchers found that it was a “well-organized system of locally placed primary care doctors and nurses who provide care on a 24/7 basis”–a system that keeps minor problems from turning into major ones.
The U.S. doesn’t come close. (As a former graduate student, a hospital administrator, told me years ago, we don’t have a healthcare system in the U.S.; we have a healthcare Industry.)
The United States was rated last overall, researchers found, ranking “well below” the average of the other countries overall and “far below” Switzerland and Canada, the two countries ranked above it. In particular, the United States fell at the end of the pack on access to care, administrative efficiency, equity and health-care outcomes.
The article noted that the inequities in America’s healthcare, together with our inadequate primary care, put the country in a much weaker position when it came to confronting the pandemic. That fact–together with the GOP’s advocacy of vaccine denial–may account for the fact that the U.S. has the second-highest COVID death rate among the eleven countries in the study.
America’s healthcare industry is costly in both lives and dollars.
Spending on health care as a share of GDP had grown in all of the countries the Commonwealth Fund surveyed, even before the pandemic. But the increase in the United States has “greatly exceeded” those of other nations. The United States spent 16.8 percent of its GDP on health care in 2019; the next highest country on the list was Switzerland, at 11.3 percent of GDP. The lowest was New Zealand, which spent roughly 9 percent of its GDP on health care in 2019.
Meanwhile, health care in the United States is the least affordable.
I hate sounding like a broken record, but this is what happens when racism drives decisions about the social safety net. Political scientists and sociologists confirm that–in addition to the profit motives/special interests of insurance companies and Big Pharma–the fact that White Americans don’t want “their” tax dollars spent on medical care or other social benefits for “those people” has prevented us from installing a less-costly and vastly more effective medical system.
We keep filling in that swimming pool…