The US health care system is complicated, for sure. But in some essential and profoundly consequential ways, it’s not complicated at all.
A few related truths about health care in the US:
The US health care system is (and has long been) wildly inefficient, inequitable and ineffective. The depth of its dysfunction is quite shocking (more on this below). The Affordable Care Act (ACA) made the US health care system better. The Republicans’ repeal and the ACA would make dramatically worse.
Health care for profit—a system that treats health care as a commodity—is bound to fail in a few predictable ways. A health care system driven by profit will not meet the health care needs of lower income people (who can’t afford insurance at the “market price”—the price at which insurers can profit), nor will it meet the needs of those most desperately in need of health care—people who are unwell are not profitable. A market based health care system—one that is driven by profit, not the health care needs of human beings—works for healthy people and rich people, but not for the people who need it most.
The US does not have a healthy health care system because a powerful minority will not allow it. The US health care system is a dysfunctional nexus of arrangements imposed on the rest of us by ideologues and those who profit from our health care system’s dysfunction. GOP senators composed their most recent health care bill behind closed doors because they know that it is unpopular and indefensible. But it serves their patrons.
The US spends more on health care than other country in the world, by far. The US spent $9,237 per person on health care in 2014—about 18 cents of every dollar spent in the US in 2014. The US spends more than twice as much on health care per capita as the UK, France, Japan, Canada, Italy, Australia, New Zealand and Iceland. And yet, in study after study, the US health care system is ranked as one of the least effective among rich countries. Among the world’s rich countries, the US is last in life expectancy and infant mortality. Infant mortality in the US is three times that of Japan and the UK.
In a 2014 report, the National Research Council compared the US health care system to those of 16 other rich countries. The report concludes that “Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries… The health disadvantage is pervasive—it affects all age groups up to age 75 and is observed for multiple diseases, biological and behavioral risk factors, and injuries.” Drs. Christopher Murray and Julio Frenk, writing in the New England Journal of Medicine, note that “(i)t is hard to ignore that… the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy.”
The US is the only wealthy country without universal health coverage. In total, 58 countries—some “rich,” many not—have universal coverage. In 2016, 27 million Americans had no health insurance—a dramatic improvement from 2013 (thanks to the ACA) when 57 million Americans (one in six) were uninsured. The Commonwealth Fund estimates that, in 2016, an additional 31 million Americans were “under-insured,” and thus likely to forego medically necessary treatment because of high out of pocket costs. The Congressional Budget Office (CBO) estimates that the House’s proposed “replacement” of the ACA would strip 24 million Americans of their health insurance.
Sixty percent of personal bankruptcies in the US have unpaid medical bills as a major cause—a total of more than 600,000 bankruptcies in 2015 alone. In dramatic contrast, the number of households in Canada, France, Germany, Japan, Switzerland, the Netherlands and the UK combined who were forced to declare bankruptcy because of medical bills? Zero. They have universal health care.
The US health care system’s failures are felt especially acutely by people of color. Infant mortality among African American children is twice that of whites. Life expectancy for white Americans exceeds that for African Americans by four years. And African Americans are much more likely to be uninsured than whites.
So, the US spends much more on health care than any other country, and tens of millions of US residence have inadequate access to health care. That is the dreadful, appalling status quo in US health care.
The GOP is hell bent on making this bad situation much worse. The GOP's American Health Care Act (AHCA), passed by the House last month, would include $800 billion in tax cuts over 10 years, two thirds of which would go to the top 20% of earners. 40% of this tax cuts would go to the top 1%. The GOP bill also calls for dramatic cuts in Medicaid, and draconian caps on its growth going forward. And the GOP continues to block the US government from negotiating for lower prescription drug prices – because, clearly, the profits of their patrons are more important than decent, affordable health care for their constituents.
Meanwhile, the CEOs of America's five largest health insurance companies, collectively, earned over $200 million last year, and Big Pharma’s profits are at an all-time high.
The US is the most unequal of the world's rich countries. For four decades, the incomes of the 1% have soared, while those with a high school education or less have seen their wages and economic security erode. In this context, the GOP’s determination to pass legislation that will make the rich richer and the poor more vulnerable is especially appalling. The Republicans have concluded—as they always do—that the super-rich are getting too little while children, the elderly, the middle class, the poor, women, and people of color are getting too much.
The GOP’s approach to health care is clear: blame the victims. Rep. Jason Chaffetz (R-Utah) contends that health care is a matter of personal responsibility. “Americans have choices, and they’ve got to make a choice,” he said earlier this year. “So rather than getting that new iPhone that they just love and want to go spend hundreds of dollars on that, maybe they should invest in their own health care.” House Speaker Paul Ryan (R-Wis.) has declared that “we don’t want to turn the safety net into a hammock that lulls able-bodied people to lives of dependency and complacency, that drains them of their will and their incentive to make the most of their lives.” And Vice President Mike Pence offers this alternative: “What the American people need is not more health care. What we need is more Jesus care.”
Health care should be a right, not a commodity. Governments throughout the capitalist world recognize this. Treating health care as a commodity—as we do in the US—enhances corporate profits while vulnerable people suffer and die. A for-profit health care system leaves millions of vulnerable US residents—especially the poor, the elderly and those with health issues—inadequately protected.
The US health care system is expensive, inequitable, inefficient, and mean. The GOP is determined to make things profoundly worse.
It's not all that complicated.
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