We’re Number Eleven…

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…


  1. For the “liberal left” – there are various options within the other 10 countries. For the “diehard Capitalist”- look at the Swiss System – https://en.wikipedia.org/wiki/Healthcare_in_Switzerland#:~:text=The%20healthcare%20in%20Switzerland%20is%20universal%20and%20is,up%20residence%20or%20being%20born%20in%20the%20country%29. – NO Government Health Insurance: from the link above: The healthcare in Switzerland is universal[3] and is regulated by the Swiss Federal Law on Health Insurance. There are no free state-provided health services, but private health insurance is compulsory for all persons residing in Switzerland (within three months of taking up residence or being born in the country).[4][5][6]

  2. And Indiana has some of the highest healthcare prices in the nation. Our private insurers are faced with healthcare prices that are well over 3 times what Medicare would have paid for the same services. See the ongoing RAND hospital price reports.

  3. Add to that endless list in Sheila’s first paragraph our individual personal problems attempting to keep up with the list, deal with the constant stress of dealing with the many changes in our own lives caused by that list which are resulting in health problems sending us into our chosen health care system for help which isn’t covered. No matter how high our premiums; the exemptions and co-pays wipe out much of health care. As for the “social safety net”; there are more exclusions than recipients due to petty issues denying applicants any assistance.

    Having been driven over the past five years to become a Conspiracy Theorist and believing that most Republicans do not believe “The Big Lie” but publicly support it to get donations and votes and stay in Trump’s good graces. I believe they had no intention of actually recalling CA Gov. Newsom but they succeeded in forcing the election and for CA to waste $276 MILLION to keep him. AOL is obviously right-leaning in their views but they do often print actual news items of interest. NBC report on September 15th titled “Paranoia drives many Trump supporters to avoid weekend ‘Justice for January 6 rally’ because extremist forums are claiming it is actually “a secret government plot to arrest more people involved in the riot.” As with the CA Newsom recall election I believe we might see a deliberately peaceful rally on September 18th because the extremist forums have planned it to debunk all valid reasons to investigate the January 6th insurrection we all watched as it happened. (I think I may be crazy; but if I think I’m crazy I must not be crazy.)

  4. Our broken healthcare system got votes for Barack Obama because he talked about a progressive fix or step one for universal healthcare. Instead, what he gave us while Dems were in control of Congress and the Senate was a Heritage Foundation project – a Koch-funded healthcare fix called RomneyCare from Mass. A major broken promise.

    What’s hilarious is the private sector wants to control workers by keeping the government from running healthcare, but the plans they offer workers are horrendous. Anybody with a pre-existing condition requiring meds has to literally pay $2.5 to $5.0 thousand to work at a company because of their high deductible plans. That’s pathetic!

    We spent over $20 trillion militarizing the USA after 9/11, not to mention the $19 trillion bailing out Wall Street banks.

    And, for what?

    Now, the Pentagon and POTUS have pivoted toward China. Really?

    Meanwhile, the media talks about how the progressives and moderate democrats are arguing over $3.5 trillion because moderates don’t think we can afford to spend that much on the American people.

    If you can’t see through the seriousness of our corruption, you’re refusing to see or blind. It is straight-up theft, all around Washington and New York.

  5. And that gap in healthcare expenses between USA and Switzerland is 5.6% of GDP, or nearly $1.2 TRILLION every year! And we worry so much about our competitiveness in world markets by cutting taxes and regulations.

  6. Instead of comparing our system to those of other high-income countries, why not point out that we rank one step above Bosnia for health care.

  7. I wonder how many corporations have looked at our healthcare industry and thought, “It would improve our bottom line if we had universal healthcare.” This is absolutely a part of the impact of universal healthcare, yet our corporate geniuses don’t seem to get it. They should be lobbying like crazy for it. I guess it’s not just the right wing wing nuts who vote against their self interest.

  8. “Exceptional” is what we are…exceptionally greedy, and short-term focused.
    The money we used to bail out the banks, from a problem they themselves created, would have gone a long way to deal with much other issues.

  9. Back in 2016 Bernie Sanders had Enhanced Medicare 4 All in his platform. His plan included Doctors, Hospital, Prescription Drugs, Dental, Eye Care and Mental Heath Care. The Corporate Democratic establishment attacked his plan.

    Since then the Progressive Wing of the Democratic Party has offered bills in the House for a similar plan. H.R.1976 This bill establishes a national health insurance program that is administered by the Department of Health and Human Services (HHS).

    Among other requirements, the program must (1) cover all U.S. residents; (2) provide for automatic enrollment of individuals upon birth or residency in the United States; and (3) cover items and services that are medically necessary or appropriate to maintain health or to diagnose, treat, or rehabilitate a health condition, including hospital services, prescription drugs, mental health and substance abuse treatment, dental and vision services, and long-term care.

    There are now 117 Co-Sponsors, as usual with prior bills similar to HR 1976, Nancy Pelosi is not a Co-Sponsor.

    This is not about racism – High premiums, high deductibles and co-pays effect all Americans. This about Corporate Power and Profits to the Healthcare Industry.

  10. Todd and others nail it today. Whichever Republican message maker created the false meme, “socialized medicine” along with the inherent fear of anything socialized by corporate/banking America is the root of the problem. Who sponsors Republicans and a few Democrats like the egregious Joe Manchin? Corporations. Why can’t the Congress get a grip on lowering drug prices? Corporation-fueled bribes.

    Money and capitalism does not care a whit about doing the right thing by the people who make them rich. All profits all the time is what Marx railed against almost two centuries ago. He knew this would happen, and the United States has maximized the chances for its own collapse by its utter, unregulated greed.

    Yes. Why are we all staying here?

  11. We don’t really have health care. We have crisis intervention care. There are many corporations that would hate to see us turn to universal health care i.e. health insurance and pharmaceutical companies. The people running our health care system are not health care providers but MBA’s. They are more focused on profit and share holders not the patients or the nursing / medical staff, nor all the supportive services doctors and nurses need to be able to provide competent, safe care at the bedsid.

    I still believe that the best way to reduce health care costs is to move toward preventative care. In order for that to be effective there would need to be no inequities in health care. The education of health care maintenance would have to be required in every public and charter school. Corporations could experience less sick pay and more productivity if they also invested in preventative care and health maintenance for their employees. The big task would be incentivizing people to stay healthy by eating healthy and exercising. Too many of us enjoy being a couch potato while snacking on cheetos or other unhealthy snacks while streaming shows on our TV’s and/or computers. On top of that, food stamps would have to increase so that those in need of them could actually buy healthy produce instead of cheap processed food full of corn syrup and other ingredients that add weight, help create diabetes 2, and cardiomyopathy. Even if we go to universal health care, we will have to ensure that there is no disparity in its supply chain and distribution for each and every citizen regardless of his/her socioeconomic status. Perhaps then the homeless would get better health care, people of color, and other minorities.

    The pandemic has shown the terrible disparity we have in health care. It has also shown that some people no longer believe the information of health care institutions. When you have people refusing to wear masks and take vaccines health care prices inflate and ICU’s become inaccesible to people infected with COVID. Their refusal to follow public health guidelines has also led to health care provider burn out and exacerbated the nursing shortage.

    I believe that the high insurance premiums keep us from being globally competitive with other countries. If we could go to universal health care, then maybe corporations would stop out sourcing jobs.

    Last but not least, the only way to boycott the health care system we have is to STAY HEALTHY AS BEST YOU CAN! GET ON YOUR FEET AND DANCE OR RIDE A BIKE. Go to sleep and wake up at the same time. ( I now that’s hard for parents with kids.) And EAT HEALTHY!

  12. When profit is the main aim of US health care industry the outcomes measured in health benefits is ailing. Too bad it doesn’t have to be this way. I agree with Robin, we have to learn to keep ourselves healthy as much as possible.
    I’ve heard Joe Biden say he wants to expand medicare for seniors; full coverage for eyeglasses, hearing aids and dental, along with letting medicare use negotiating power with Pharma. We hope he does, and it’s just his first step toward universal coverage.

  13. Back in 2000 I went on a mission trip to El Salvador. One of the most striking things that I heard was that FOUR students could be educated for medical school in CUBA for the same amount of money that ONE student could be educated in a medical school in the USA. Why do doctors need to earn big dollars here? To pay off their student debt and for many of them, to have a particular lifestyle that includes the “good life” – country clubs, a stay-at-home parent, private schools for their children. The list goes on. Exactly how many doctors do each of us know that practice medicine for the simple act of practicing medicine? It’s far too few. And this is another (HUGE) factor in escalating medical costs.

  14. We are already paying higher health cost due to the people who can’t pay. Pay now or pay later. The later cost are much higher

  15. As Mr. Marx indicated in the first comment, Switzerland has universal mandatory healthcare. My husband and I have separate policies. His policy has a 2500 deductible and I have 500 since I see the doctors about every other month. There’s no family plan as your own policy is based on your age and deductibles. It’s close to 1,000 a month for both policies and we pay about 10% of the excess after the insurance company pays. The only reason the cost is so high is because EVERYTHING in Switzerland is expensive, not just real estate, going out to eat and purchasing food. My thyroid drugs are made here and for 100 day supply, I pay about 30 bucks. That medicine in the states cost me 280 bucks for 28 days!

    Unfortunately, the Swiss are money hungry idiots like the states and they have introduced nationwide a policy that charges all ER visits a flat 50 bucks fee on top of your other charges. The UK, where we will probably move to next, is having the same conversations about universal healthcare over their single payer system. That’s just the facts, m’am.

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