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Why is the U.S. the only wealthy nation that doesn’t cover everyone?

As I rediscovered last week, many opponents of universal health care in the U.S. like to say, and applaud anyone else who says, that the United States has the greatest health care system in the world. There is basically no reasonable way to back this statement up with a statistic that measures health outcomes. Americans have shorter life expectancies, infant mortality rates are higher here, and perhaps most relevantly, those who measure the rate of deaths that could have been prevented by medical care show the U.S. system to be below many of the wealthy industrialized nations of the world.

And, as everyone must know by now, ours is the worst system in the world as measured by cost efficiency.

It probably is true, that if you have unlimited resources and an illness requiring the most advanced technology, the U.S. may provide the best care, which is why some of the wealthiest people in the world come here for treatment. But this seems a bizarre and absurd way to measure the overall value of the U.S. system to average Americans, especially those without insurance and those with pre-existing conditions.

This jingoistic, almost faith-based belief that our system is the best also interferes with the ability to look around the world and see whether we could benefit from any other country’s experience.

T.R. Reid, a distinguished and experienced foreign correspondent, has been studying the health care systems that outperform ours for some years. His new book, “The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care,” summarizes what he has found. And he talked about it in an interview Friday night on the Newhour with Jim Lehrer.

I found it an extremely understandable and reasonable presentation. (One point that he makes, which you don’t hear all that often, is that most of the countries that provide universal health coverage, do it through private insurance companies and those systems cannnot reasonably be called “single-payer” or “socialized medicine.”)

Anyway, my main purpose in this short post is to provide this link to that excellent nine-minute interview.

At the end, Reid says that he figured out why all those countries decided that everyone should have access to health care and he figured out how they provide it, but the biggest mystery is why the United States, alone among the countries that could afford it, has decided not to do so.

Comments (14)

  1. Submitted by James Hamilton on 08/31/2009 - 09:14 am.

    There is no mystery about why the U.S. has decided not to provide universal access to health care. The question has never been presented squarely and fairly to the people or allowed to come to a full vote in Congress because too many vested interests have exercised too much influence over the process. Our political system is extremely effective if one wants to prevent action; it’s a disaster when it comes to bringing people together for rational action.

    Even now, we’re not considering a plan which truly rolls all of our health care costs into a single plan. For example: so far as I can tell, workers’ compensation and automobile bodily injury related medical costs will continue to be covered by independent, state-mandated insurance programs, both of which are horrendously inefficient and regularly abused by all involved, be they providers, individuals, attorneys, employers or insurers.

    Despite the furor, funding universal health care is not rocket science. Whatever the immediate funding mechanism, it is the American public that will pay for it, just as we do now for the hit-and-miss coverage available today. We do so through taxes, higher prices, lower wages agreed to in exchange for medical insurance benefits, or through payroll deductions. Deciding what will be covered and what will not will be difficult, but not impossible. What apparently is impossible is getting people to quite playing politics with the lives of the American public and deal with this issue on a rational, fact-based basis.

  2. Submitted by Henry Wolff on 08/31/2009 - 09:28 am.

    For anyone that has health care coverage (the vast majority of Americans) and actually gets sick, the United States has the best outcomes in the world.

    Why Democrats would be suprised there is opposition to changing this system is a bit puzzling.

    You can cherry pick statistics that make it look like the U.S. is bad, for example on life expectancy and some such. But the differences in life expectancies, infant mortality rates, etc. are de minimus and driven more by demographics or the different standards of measurement than healthcare systems.

    Outcomes for patients with cancers, etc., are better here if you have health insurance.

    And let’s face it, the vast majority of people that really need subsidized health care–those over 65–have Medicare.

    So when you combine the fact that 1) for most people it’s working just fine and 2) seniors worry (rightfully or wrongfully) about impacts on Medicare, it’s not surprising that changes to healthcare are going to be an uphill battle.

    Also, claims of cost savings or cost neutrality are just not credible.

  3. Submitted by Duke Powell on 08/31/2009 - 10:43 am.

    I’m done with Eric Black and MinnPost and the adult children who populate these pages.

    Next time you get sick, move to Canada, Britain, France or Cuba. See how you like it.

  4. Submitted by Brian Simon on 08/31/2009 - 11:53 am.

    Henry Wolff writes
    “Outcomes for patients with cancers, etc., are better here if you have health insurance.”

    Given that ~47 million Americans – out of about 300 million, which comes to roughly 15%, give or take – don’t have health insurance, isn’t that a sign that our system, at a minimum, should be improved? Consider further that some of those people that do have health insurance might not be covered for particular ailments if they’ve changed insurance providers after first being diagnosed?

    And even then, for those of us that do have insurance (largely through our employers), costs have been rising at astronomical rates – 3x the rate of inflation. Is that a characteristic of a sustainable system? It doesn’t seem like it to me.

  5. Submitted by Paul Brandon on 08/31/2009 - 12:59 pm.

    A good part of the reason is historical accident:
    During WWII wages were frozen and workers were scarce.
    So, employers competed for workers by offering generous benefits; particularly health insurance.
    As a result, many (most?) Americans have no idea how much they’re paying for health care, since they have no idea how much more they’d be earning if they received less of their total compensation in the form of wages.
    They also overlook the fact that this part of their compensation is subsidized (paid by the public) since it is not subject to income tax.

  6. Submitted by Paul Udstrand on 08/31/2009 - 03:57 pm.

    //”Outcomes for patients with cancers, etc., are better here if you have health insurance.”

    Again, this is simply not true. If the only people suffering were the uninsured we wouldn’t have such bad metrics by comparison. Insured Americans are paying way more, for less quality, they are not getting the best outcomes.

  7. Submitted by Thomas Swift on 08/31/2009 - 04:35 pm.

    Can someone tell me how this isn’t Eric throwing up his hands and shouting “Why do Americans hate teh sick people?”?

    Can someone tell me how that isn’t a declaration of capitulation?

  8. Submitted by Joe Johnson on 08/31/2009 - 05:01 pm.

    Eric – I know you won’t say what you want, so I will. George H.W. Bush. If you can roll the health care super-mega crisis that is destroying America one second at time with former President Bush you should be able to give the talking points a day off. Write something that doesn’t involve copy paste paraphrase.

  9. Submitted by Richard Schulze on 08/31/2009 - 05:14 pm.

    Perhaps the question that really needs to be asked is whether this is news, opinion or commentary?

    Not to characterize Mr Black as a pundit, but clearly there are many such individuals on the cable news networks and talk radio that air their personal opinions. Which has nothing to do with fact based news. As such these pundits and their opinions should be taken for what they are, opinions. It is not as if they have to back-up their opinion or personal views up with facts. Although it would appear that many of the folks in their audiences seem to take what these pundits say to be either news or to be factual content.

  10. Submitted by Paul Udstrand on 09/01/2009 - 09:45 am.

    Sadly the reason we haven’t covered everyone is simply because way too many Americans believe in magic. Despite a popular Fox television show that weekly exposes the illusions of making things like the Statue of Liberty disappear, people still persist in this irrational belief. Maybe what we need is a similar show that will weekly expose the illusions of magic “markets” and “invisible hands”.

    The illusion of magic is powerful. In a consumer society it frees people of all civic responsibilities. All you have to do is keep shopping and the market magic will take of the rest.

  11. Submitted by John E Iacono on 09/01/2009 - 01:05 pm.

    “This jingoistic, almost faith-based belief that our system is the best…”

    It seems to me that’s a pretty hard statement.

    I’ve been thinking about it this way:

    If I live in a large metropolitan area, where there are lots of doctors (both family physicians and specialists), lots of medical facilities, and lots of competing health insurance plans, one would think that I would be in a good position to receive that “best medical care.”

    But the facts say otherwise.

    I am served by a large west suburban clinic and hospital. The buildings are beautiful and the equipment new and shiny. There is a hospital, an ER, an urgent care, and a clinic near my home, and lickety-split ambulance service if I need it. BUT:

    >My wife’s co-pay for our primary policy has grown by leaps and bounds each year, and each year our deductibles and co-pays also go up, forcing her to put more and more into a cafeterial plan for uncovered medical expenses. In the years since I qualified for Medicare Part A as secondary insurer Medicare has yet to pay one dime. So each time I have to see a doctor I have to decide if I will stop driving or eating for a few months to cover what our “good” health insurance does not pay. From the standpoint of affordability, it does not seem to me we have the “best” system.

    >When I had a heart attack a year or so ago, this health care system really worked well. In minutes I was being treated in the ER, and within a couple of hours had three stents in me, put there by an expert cardiologist. I was back at work by noon the next day, and have been relatively well since. And not one person asked about my health care coverage. From the standpoint of quality care provided in an emergency, my experience says we have the “best” system — provided we live in the right place. I doubt, however, it would be equally true if we were on vacation on the North Shore — or even at most places in between, for that matter.

    >When it was time to schedule routine medical care it was quite another story. Two months for a physical, and four months for a “needed” test. And from past experience I knew that for the most part the exam would be cursory, and the test would most likely be of little value. I also knew that — once again — I would have to start over with a new internist, because my prior one had left the clinic. I knew that the whole thing would cost me big time. And I knew if I went in for that test I ran a good chance of getting some esoteric disease as a result poor sanitation. I decided not to go in at all. From the standpoint of routine care, we don’t have the “best” system.

    >When I have to renew my two meds, one is on the four dollar list, but the other costs over four hundred dollars, with a co-pay by me of about ninety dollars. Just for a little bottle of tiny pink pills that I suspect cost the drug company about fifteen dollars to make in some foreign country. From the standpoint of affordable medication treatment, we don’t have the “best” system.

    >When the cost of my cigarette tobacco (can’t afford “tailor mades”) doubled last spring, I felt a taste of “Big Mother” trying to force me to live my life without one of the few pleasures I still have (the meds make food taste funny). But from my standpoint, my ability to tell my cardiologist I plan to quit two days after I’m buried says that from the angle of control over my life and health care we still have the “best” system here.

    On balance, it seems to me that we DON’T have the best health care system in the world, even though I discount all the “prove what you wanted to prove” statistics which ignore important variables every time. It needs to be fixed. Just not the way our agenda driven pols would like to see.

  12. Submitted by Karen Sandness on 09/04/2009 - 06:20 pm.

    Duke Powell, I personally know people who have received medical care in all the countries you mention, plus Costa Rica, Norway, Germany, Japan, and Sweden, and they all received excellent emergency care.

    They couldn’t receive on-going care, because they aren’t permanent residents of those countries, but they had no complaints about either the treatment or the facilities.

    I know an American citizen who was diagnosed with a heart condition while living in Japan. He HAS to live there now, because his condition has to be monitored regularly, and he’s uninsurable here.

    In fact, a lot of people with pre-existing conditions are uninsurable here, in the sense that they can’t buy any policy that they can afford.

    That simply doesn’t happen in other Western countries. A few countries have co-pays, but I don’t know of any that have deductibles, exclusions, rescissions, premiums above a modest percentage of the individual’s income, or annual or lifetime limits on care.

  13. Submitted by Wally Carr on 09/05/2009 - 02:51 pm.

    The US does not have the best health care system in the world, period. We have the worst system in the developed world, and we are behind many second world countries in the care we provide. We have the least cost-effective system in the world. Of course these statements are only valid if one uses objective, impartial, and scientifically valid methods to evaluate the situation.

    The really tragic part of this is what happens to people who think they have coverage just because they and their employer pay a premium for insurance*. The insurance companies exist and function for the enrichment of their executives, not for the benefit of the policy-holders or even their stockholders. Case in point, United Health and the 1.75 BILLION to a single individual, at least half of which was fraudulent.

    The opponents of reform are unable to muster any rational defense of the status quo, so they make up lies.

  14. Submitted by Glenn Mesaros on 09/06/2009 - 08:23 am.

    We do not have a Medicare for all system because Banker’s Boy Biden and Barack gave all the $750 billion to bail out the banks, plus another $750 billion in contingency bailouts in the $3.5 trillion budget. In addition, the never audited Federal Reserve has guaranteed $23 trillion in official figures for the financial system. Therefore, the official Obamacare plans to “save”, i.e. cut 1 trillion in Medicare costs to further appease these bankers. The Lapdog liberals Franken/Klobuchar/Ellison/McCollum plan to vote for this policy, and call it the “public option”. NO wonder citizens are upset.

    Look at the irony of the FAILED stimulus package this week in Minnesota: Last April Biden and Klobuchar held a closed “town meeting” at the St. Cloud Flyer Plant to promote “cash for buses”. This week the same plant laid off 13 % of its workers.

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