The Global Context of the US Healthcare Debate

The solution to our healthcare fiasco is first to recognize its true nature and then to face down those who are consuming a fifth of our economic output while producing profoundly bad results. We need to take a much broader view in order to see that, compared to the rest of the developed countries, a) our current healthcare results are abysmal and b) our current healthcare costs are obscene.

This is the context that we need to apply to what the Republicans and Democrats must do to improve our health. Obamacare is an improvement because more people are covered, but very poor in responding to both the cost and quality issues. The Republicans seem hell bent on the most cynical vicious path that transfers money to the wealthy while casting millions back into healthcare hell.

US Healthcare Results

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The US ranks 56th in infant mortality out of 225 countries; 48th in maternal mortality out of 184; and 42nd in life expectancy at birth out of 224. ((Current CIA The World Factbook – accessed 5/113/2105)). This makes our healthcare near Third World and if you have the misfortune of being black, brown or rural poor white the results are significantly worse.

US Healthcare Costs

In 2014 the US spent $9,024 per person on healthcare. Japan, Canada, France, Australia and UK all spent between $3,900 and $4,500 per person. Switzerland, next closest to us in spending, was at $6,787. All but the latter spent less than half our spending. ALL of them had results far better than ours. ((data from Peter G. Peterson Foundation – Accessed 5/12/2017)) If we had great results, it might make sense to say that it is worth spending 19% of of our economic output on health, in contrast to the 8-10% spent by our developed country competitors. But the facts speak for themselves.

Every other developed country provides universal healthcare as a right. But they do not depend on a healthcare market to deliver it. They recognize that healthcare is not a commodity; it is not like corn, oil, automobiles or cell phones. And since healthcare is not a commodity, it can’t be subject to market controls. While their structures for providing healthcare differ in the details, every other developed country sets a national budget for healthcare and the doctors and hospitals work within the budget. Doctors and hospitals are incentivized to maintain people’s health because that is the only way they can be sure that they live within their budget. They have a larger focus on prevention and no incentive to produce more procedures and prescriptions to increase their income. The proof of the efficacy of this approach is in their results.

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In the US, we have a market focused health system that produces lots of procedures and prescriptions. The prices set by the providers for these procedures and prescriptions are across the board much higher than our developed country competitors. ((See 2015 Comparative Price Report – Variation in Medical and Hospital Prices by Country – accessed 5/14/2107)) This enriches doctors, administrators, drug companies and insurance executives but it does poorly at getting the health results we need and deserve.

There are plenty of healthcare models for us to study. We truly can learn from others’ experiences if we have the political will to do so.