We had two guest speakers come to our meeting last week to explain to us some of the foundations of how the health care system works in the US especially in terms of how it does or does not prioritize health as a human right. The presentation started with several visual statistical presentations on inequalities, then a brief synopsis of the Affordable Care Act’s effect on these numbers, and finally a suggestion of another possible solution.
One of the biggest indicators of the dysfunctions present in our system is the dismal numbers, especially when compared to the health systems of other developed-world countries such as Canada, UK, Germany, France, Sweden, and Italy. The life expectancy in the US is between 2 to 4 years lower than all these countries. Infant mortality is higher in the US than any of these countries, at 6.1 deaths in the first year of life per 1000 live births. Maternal mortality in the US is 12.7 deaths per 100,000 live births, the highest of the developed world, and over 6 times Australia’s, which is at 2.
We also saw graphs of the problems faced by the poor and uninsured, the numbers of which have increased four fold since the early 80’s. Most of people who go through medical-related bankruptcy had health care coverage, and increasing under-insurance is a problem. With rising economic inequality comes a widening gap in life expectancy between high and low earners. There are persistent racial inequalities and immigrants get little care. It is very much a women’s issue as well since 1 in 5 women are uninsured. Women utilize more health care services, typically have lower incomes or are more likely to hold part-time employment without benefits.
Interestingly, for all of these worse outcomes, the public spending per capita (not the including private spending), for health care in the US is greater than the total healthcare spending (public and private) of any other country. The ACA, which would expand a Medicaid-like program to provide free care for poor, subsidies for low income groups, and buy-in insurance without subsidies for others. The number of uninsured would be reduced from ~50 million to ~30 million, however safety-net hospitals funding through medicare would be cut by $36 billion through 2019. In this system, public money is under private control.
Health care is different from most market commodities because it is technically complex, expensive, poor choices cannot be reliably revisited, and providing it requires good clinical judgment. Perhaps for these reasons, all other industrialized democracies have taken health insurance out of the marketplace and provided their citizens with a national health insurance program. A functional health system has to balance two equal and opposite forces: the desire to control costs spent on someone else and the desire for the best possible care for loved ones.
A single-payer health care system provides health insurance that is universal, comprehensive, portable, able to control costs without micromanagement, and accountable to the people. It achieves this by collecting money and paying bills without intruding in any individual doctor-patient relationship to make a profit. Enrollees are the shareholders in a health care system motivated to both provide the best possible care while controlling costs, thus eliminating hidden sources of waste.
The presentation (and this subsequent blog post) was based heavily off of information and slides from pnhp. To learn more look up Physicians for a National Health Program www.pnhp.org and Single Payer Now http://www.singlepayernow.net