Why we need health care reform
With recent publicity about problems with the HealthCare.gov website, it is a good time to step back and consider why reform of the U.S. health care system is so important. We often hear that our health care is the best in the world, but is that really true?
While we do have some of the best medical training and technology, we also have by far the most expensive health care of any industrialized country, and we have relatively poor results to show for it. Several large-scale studies over the years point to the same conclusion: Americans are being short-changed by a for-profit system that lags behind the rest of the world in delivering decent health care at reasonable cost.
How bad is it? In the year 2000, the World Health Organization undertook the first analysis of the world’s health systems. Their conclusion: “The U.S. health system spends a higher portion of its gross domestic product than any other country, but ranks 37th out of 191 countries according to its performance.”
More recently, a 2010 Commonwealth Fund study ranked the U.S. dead last among six other industrialized countries: “Despite having the most expensive health care system, the United States ranks last overall compared to six other industrialized countries ... on measures of health system performance in five areas: quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives.”
Another recent analysis provided by Bloomberg.com rated countries of the world on their health care efficiency. Out of the 48 leading economies in the world, the U.S. ranked a dismal 46th in overall efficiency, meaning that U.S. consumers are paying dearly for mediocre health care outcomes.
So, why are we paying so much for so little?
For one thing, the U.S. is unique in the world with our reliance on for-profit insurers, and we are the only industrialized country that does not provide universal health care. While many other countries have simplified their health systems by providing government health insurance for all, the U.S. has resisted such reforms, resulting in a patchwork of for-profit insurance plans that tend to siphon off resources for CEO pay and the shareholders. A definitive study of the administrative costs of the U.S. health system published in the Aug. 21, 2003, edition of the New England Journal of Medicine concluded that the average overhead among private U.S. insurers was 11.7 percent, compared with 1.3 percent for Canada’s single-payer system and 3.6 percent for Medicare. If we streamlined our system to Canadian levels, we could prevent enough administrative waste to provide comprehensive health insurance to all Americans.
The Affordable Care Act seeks to increase the coverage and efficiency of the U.S. health care system through common sense insurance reforms and by setting up a marketplace that allows consumers to comparison-shop for plans. The ACA is in no way “socialized medicine” (like the VA system) or even “socialized health insurance” (like Medicare). The ACA does not provide universal health care, although its goal is to cover 33 million of the 50 million or so Americans who are uninsured. The ACA suffers as a result of political compromise, which ruled out the kind of single-payer insurance system that is used throughout much of the industrialized world. Instead, the for-profit insurance companies were dealt in by agreeing to a series of reforms that curbed the worst of their practices in exchange for receiving profits from millions of new customers who couldn’t previously qualify for coverage or afford it.
The ACA was modeled after Massachusetts’ RomneyCare and ideas originally supported by conservatives. Even the dreaded individual mandate was first proposed by the Heritage Foundation in 1989 as a way of promoting individual responsibility (similar to requiring drivers to carry liability insurance). Yet the ACA has been subject to fierce organized opposition. Why? As always, follow the money. An expensive and inefficient health care system means that a few politically powerful corporations are making a lot of money off of the needs of the many.
No one would say that the ACA is perfect, but it is an important step on the path of helping the United States catch up with the rest of the world.
Jon White, 58, of La Grande is a technical writer for a Portland software company.
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