Why The U.S. Health Care System is Substandard

Introduction

Many opinions exist about quality of American healthcare and many are not based on factual findings. So how much does the American health care system cost? And why, in such a prosperous country, is it so inaccessible? How well does the U.S. healthcare system really perform compared to other countries?

The U.S. healthcare system has been a part of debates in both politics and American households for decades. There is an active debate on whether or not it is a right of an American citizen to receive healthcare, and a right to have access, fairness, and quality of healthcare. Some argue that the cost is not equivalent to the value. Though America has the most expensive healthcare system, millions remain uninsured and do not receive the care they need. Most Americans receive healthcare through their employers while millions continue to not have coverage due to the inaccessibility of healthcare caused by cost. While most medical facilities are owned and operated by private companies, the quality of care provided by these companies continues to be inefficient and lacks the quality expected. Still some people believe that the American health care system is among the best of health care systems. However, research suggests that the American healthcare system is substandard because of its cost, its inaccessibility, and its poor performance. In this paper, the results of research concerning these issues will be discussed.

Costs

The U.S. is one of the most successful and prosperous countries. However, the cost of healthcare in the U.S. is the highest of any industrialized country and, in fact, any country in the world (Bureau of Labor Education., 2001). In 2006, the U.S. spent 5.3 percent more than Canada, 4.3 percent more than France, and 4.7 percent more than Germany with Switzerland being the close second at 11.3 percent of gross domestic product (GDP) compared to America’s 15.3 percent of GDP .(Kaiser Family Foundation, 2009). But considering the total cost of health care expenditures at the time in America and Switzerland, the U.S. actually spent almost twice the amount per person with Switzerland spending about $2,794 per person and America spending about $4,178 per person (KFF, 2009).

In 2007, the U.S. spent $2.2 trillion on healthcare which is more than $7,400 per person (National Center for Health Statistics, 2010). That number continues to rise as costs for hospital care, medicine, and other types of medical care become more expensive. $2.2 trillion is 2 percent higher than the cost of American healthcare in 2000. It is estimated that these costs will reach $4.3 trillion by 2018. That is $13,100 per person in the U.S. (KFF, 2009). Also personal health care expenditures have risen considerably since 1990. The cost of private health insurance has risen from a total of $200 billion to about $680 billion. At the same time, out of pocket expenses have risen from about $100 billion to about $280 billion (NCHS, 2010). With healthcare being as costly as it is in the U.S., it has contributed greatly to the personal debt of its citizens. . One third of adults has debt due to the cost of healthcare or reported having problems paying their medical bills (The Commonwealth Fund, 2006).

The especially high cost of American health care can be attributed to many factors. Healthcare administration in 1999 accounted for 31 percent of healthcare spending in the U.S. (Woolhandler, S., M.D., M.P.H., Campbell, T., M.H.A., and Himmelstein, D. U., M.D., 2003). That is $294.3 billion of the total cost of health care ( Woolhandler et al, 2003). This number was also high compared to other industrialized countries. For example, Canada spent only $9.4 billion on health care administration in 1999 or only 16.7 percent of their total health care expenditures ( Woolhandler et al, 2003). Other spending accounted for the rest of healthcare expenditures including hospital care, prescription drugs, and medical technology as well as a lack of competition in the medical sector and a need for more doctors. Also contributing to the costs are the uninsured and underinsured. Without preventative care, conditions that would have been cheaper to treat at earlier stages become a health crisis. Once they reach this stage, treating the condition becomes much more expensive. And as the condition progresses to even more serious, more dangerous stages they become even more costly due to, in part, the care needed to treat them such as intensive care and expensive medical techniques and medicines.

Inaccessibility

The lack of accessibility of health care in America is another reason that the U.S. healthcare system is not meeting standards. America is one of the two countries in the world that does not provide health care for its citizens. This lead to an overwhelming amount of citizens who do not receive care for chronic conditions and they do not receive the preventative care needed. In 2009, 50.7 million Americans were uninsured. Of those, 10 percent or 7.5 million were under the age of 18. In 2005, 21 percent of people under 18, 19 percent of those 18 to 24, and 25 percent of those 25 to 34 were uninsured in 2005. Those 35 and older accounted for another 38 percent of the American population who was not insured (U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation, 2005). In 2010, 21.5 percent of Americans under 65(18-64) years of age were uninsured. Also, a high percentage of people tend to be underinsured. In 2003, 16 million adults were underinsured or uninsured at some point during that year (The commonwealth Fund, 2006).

The percentage of people without insurance continues to increase. Since 1987, the number of uninsured people in the U.S. has increased from about 30.5 million to 50.7 million (U.S. Census Bureau, 2010). The percent uninsured in 2009 increased from 15.4 percent in 2008 to 16.7 percent (U.S. Census Bureau, 2010). The uninsured rate for people under 65 years of age increased in 2009 from 17.3 percent to 18.9 percent. And according to the Centers for Disease Control (2010) 38 million people were uninsured in 1999, but that increased significantly to about 46 million by 2009.

Based on research from many sources, there seems to be an obvious correlation between the inaccessibility of health care and the cost of healthcare. Healthcare costs have been increasing three to four times as fast as wages (The Commonwealth Fund, 2006). As health care costs rise, so does the percentage of people that are uninsured or underinsured. People earning less are more likely to have a lapse in health care coverage during a period of twelve months as well. For instance, Citizens below the federal poverty level make up 13 percent of the total population. 25 percent of those were uninsured in 2005. In that same year, 28 percent of those below 200 percent of the poverty level, 19 percent of those under 300 percent of the poverty level and 11 percent of those under 400 percent of the poverty level were uninsured (HHS, 2005). Therefore, as the financial capability of a person rises they are less likely to be uninsured.

Performance

In addition to being extremely costly and inaccessible, the American health care system performs poorly in providing the care needed by its population. Measures used to determine the over-all performance of a country’s health care system are most commonly infant mortality rates, life expectancy, and disability- adjusted life expectancy. Also to be considered is the health care system’s responsiveness, fairness in financing, and the population’s satisfaction with the health care system.

Though infant mortality rates have decreased since 1960, the U.S. has an infant mortality rate of 7.2 infant deaths per 1,000 live births (BLE, 2001). This is the highest among Organization for Economic Co-operation and Development (OECD) countries with America ranking 26^th among industrialized countries. However, this is some what skewed. The infant mortality rate for black Americans is higher than that of white Americans. Comparatively, there were 14.3 out of 1,000 black infant deaths in 1998 while there were 6 out of 1,000 white infant deaths (BLE, 2001).. There are also some disparities among the state statistics. For example, Alabama’s infant mortality rate for black Americans in 1999 was 16 out of 1,000 live births(BLE, 2001). The U.S. is ranked low on disability-adjusted life expectancy as well. The U.S. ranked 27^th, only higher than Denmark in OECD countries, on disability-adjusted life expectancy meaning that Americans are more likely than most industrialized countries to “experience more years of disability”(BLE, 2001). Fairness in financing is an indicator of how financial contributions to a health system are distributed and whether they are distributed fairly among government entities and the population. The U.S. is one of two countries ranked lowest in this area. It was “tied for 54^th and 55^thplace” (BLE, 2001). Also there are some documented issues with the quality of care that Americans receive. Though it has been shown that preventative care has positive benefits, only 49 percent of adults received preventative care according to age guidelines in 2006 (The Commonwealth Fund, 2006). Approximately 80,000 deaths in 2006 caused by conditions “amendable to healthcare” could have been prevented had those people received “timely, effective medical care” (The Commonwealth Fund, 2006).Also, it is estimated that 20,000 to 40,000 deaths caused by high blood pressure and diabetes could have been prevented. Furthermore, those who are uninsured or underinsured are less likely to be satisfied with the care provided to them and any chronic conditions they may have are more likely to be improperly managed (Davis, K., Ph.D., 2007)..

The satisfaction of the population with the healthcare system should also be considered. Here the U.S. was ranked low as well. Only 40 percent of the population claimed to be satisfied or fairly satisfied with the healthcare system.

Discussion

Though it is obvious that there is a wide range of issues with the healthcare system in the U.S., politicians and health insurance companies are still avoiding any changes that may make the healthcare system less costly, more accessible, and better performing. Reports in the U.S. show a rising dissatisfaction with their healthcare system and an interest in single payer systems has become apparent. However, worries that it would eliminate private insurance companies and be even more costly have caused some to shy away from the idea. In 1991 both the U.S. General Accounting Office and the Congressional Budgeting Office released reports stating that a single payer system would more than pay for itself(BLE, 2001). It would do so by allowing those currently uninsured to get the preventative care they need while decreasing administrative costs and making healthcare more accessible to those in need. At the same time they reported that it would most likely not affect private insurers due to the fact that a single payer healthcare system would offer basic healthcare. Some have suggested just expanding Medicare since it is already an existing program with little administrative costs. This would eliminate difficulties transitioning into a new system and allow for speedier changes. On the other hand, some states have already begun to implement changes to allow for better healthcare. Massachusetts implemented a plan to make coverage affordable to the uninsured in its state in 2006 They began using state funds to subsidize care for the poor as well as expanded the Medicare program. They also require businesses to provide healthcare or to pay $295, a significantly lower cost than the average annual healthcare costs paid by most, to a fund to help finance coverage(Davis, 2007).Still drastic changes are needed to change the healthcare system as a whole.

Conclusion

The American healthcare system is substandard because it costs more than any healthcare system in the world. America spent 2.2 trillion on healthcare in 2007 and it is estimated to cost 4.3 trillion by 2018( NCHS, 2010). It is also substandard because the U.S. does not provide healthcare for their citizens and it has become overwhelmingly inaccessible to the lower and middle class due to the high cost. The American health care system was found to not provide to its citizens the expected care leaving it with a low rating for overall health and well-being. In conclusion, the American health care system is overly costly, inaccessible, and underperforming. All of these aspects are what make health care viable and yet research has shown that the U.S. health care system is not up to par with what is expected.

REFERENCES

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U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation. (2005).Overview of the uninsured in the United States: An analysis of the 2005 current population survey. Retrieved from http://aspe.hhs.gov/health/reports/05/uninsured-cps/index.htm

Woolhandler, S., M.D., M.P.H., Campbell, T., M.H.A., and Himmelstein, D. U., M.D. (2003) Costs of health care administration in the United States and Canada. The New England Journal of Medicine, 349,768-775. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa022033#t=abstract.