My latest appeared on March 25, 2020 in the International Policy Digest.
The spread of
Covid -19 across the US is perplexing.
If, in the words of Georgia Congressional Representative Buddy Carter:
“We have the best healthcare system in the world,” why does it appear the US is
one of the hardest hit nations in the world and on the brink of shutting economy
down to try to prevent its spread?
Should not a country that spends more of its gross domestic product
(GDP) than any other country in the world on health care be better prepared to
confront this medical emergency than other countries? The answer is no, simply because while the US
may have a great private health care insurance and delivery system, it has an
exceedingly weak public health system.
In
2019 the US spent 17.8%
of its Gross Domestic Product (GDP) on health care expenditures. Its next closest rival was Switzerland which
spent 12.1%
of its GDP. Per capita, the US spends
more than
$10,000 per year on health care, 20% more than Switzerland.
Despite this spending, the US ranks 46th
in the world in life expectancy, 55th
for infant mortality rates, and a prevalence of incidence
of infectious diseases at 9%, triple that of China and
Japan at 3%, and 50% larger than the incidence of 6% in many European Union countries. These three factors are traditional markers
of health across the world.
Moreover,
compared to other advanced countries,
91.7% of the US population has health care insurance, ranking 35th
in the world and far behind most other rich countries across the world which
have 100%
or universal coverage. In essence, the
US has the most expensive health care system in the world and it does not cover
everyone and it does not produce the best outcomes. We pay too much for too little. It is hard to argue that we have the greatest
health care system in the world based on these statistics.
We
pay too much and get too little for at least two reasons. One, compared to other countries we have highest
drug
and administrative costs
in the world. But equally important, the
US has among the weakest public health care delivery systems in the world. By public health care, one needs to look at
what we spend for example on long
term care, preventive care, the gathering of health care epidemiology statistics,
and perhaps even on nutritional and diet programs. Looking at those factors we lag behind many
countries in the world. We have not built
a public health care infrastructure that is as well suited as is other
countries to addressing public health crises such as the rapid spread of an
infectious disease as Covid-19. As has
become clear, the funding for the Center for Disease Control is behind what it
needs to be to do the research and tracking necessary for health care issues,
and there seems to be no federal infrastructure in place to coordinate a
national health emergency. States appear
to be left on their own, ill-suited or prepared to address a national or global
health emergency.
The
US has a terrific private health care delivery system, for those who can afford
it. For those who want and can afford a
doctor it is terrific. For those who want
and can afford elective surgery, it is terrific. For those who want treatment for highly personal
health care problems and can afford it, it is terrific. For those who want can afford a wonder drug,
it is terrific.
But
in terms of treating or preventing basic maladies, the US health care delivery
is weak. It is weak because it is a
system based upon a privatized notion of health and health care. Health is a personal not a public issue, as
is the cost or responsibility for paying for it. Health and health care are seen not as public
goods but as private or individual commodities that we each individually are responsible
for. Moreover, health care reform in the
US has, at least since the failed Clinton reforms of the 1990s and the passage
of the Affordable Care Act (Obamacare) of 2010 been focused on insurance and
not on improving the structure of the actual delivery system for health care,
let along for the public aspect of it.
The
US spends a lot of its effort on providing insurance to access a health care
delivery system seen as more of a private good than something that is universally
important. We have under-invested in the
public aspect of health care compared to many other countries, rending the US
far less prepared to confront a public crisis such as Covid-19 compared to
other nations in the world. If we have
learned anything from the current crisis, we need to invest more in public
health than we currently do.
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