Keystone Essay – the US Healthcare System
Americans are regularly sold a story of the world-class healthcare available in the US. Certainly for the rich and those with top-level corporate health insurance such care is available. The facts for most Americans are so enormously out of line with this persistent mythology that “delusion” barely touches the gap.
As the graph to the left demonstrates the outspends all of our developed country cohort while providing much worse health outcomes.
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. 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. If we had great results, it might make sense to say that it is worth spending 19% 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.
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. 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.