US healthcare system: Chasing its terminal end?
Let me begin with the basic US healthcare data, that was 'leaked'! The World Health Organization (WHO), recorded that in the past year, United States had spent $9,403 on healthcare per capita, and 17.1 per cent on healthcare, as percentage of its GDP. Mind you, dear readers, Healthcare in the US coverage is provided through a combination of private health insurance and public health coverage (like Medicare, Medicaid). Do we really believe in comparative data studies? Imagine if a political party in the UK included in its manifesto, a pledge to increase public spending on the NHS by 55 per cent! Such a pledge would be derided by Neoliberals. Who are they, anyway?
Neoliberals or 'neo-liberalism' is the 20th-century resurgence of 19th-century ideas, associated with laissez-faire economic liberalism and free market capitalism. It is paradoxically being claimed that the only way forward is privatizing the NHS in order to improve its efficiency. Comparative studies between health care costs between the US and the UK show that it is the Neoliberal assumptions that are actually delusional, and that private sector health care is astonishingly bad value for money.
In 2018 the UK spent 18 per cent (£145.8 billion) of the total government budget in order to provide free universal health care. By contrast, in 2018 the US spent 28 per cent ($1.5 trillion) of the total government budget in order to apparently subsidies a woefully inefficient private health care sector. The US Administration spends 55 per cent more than the UK government on health care: yet somehow fails to be able to offer free universal health care for all its citizens.
It would appear that in relying upon private sector health care provision the US taxpayer is getting spectacularly bad value, for their tax dollars. Indeed anyone looking at this spending difference would assume that the country spending 28 per cent of its budget was the one providing free health care and the country spending 18 per cent was more likely using the private sector model. Of course, it gets a lot worse for US citizens when one also includes their unconscionable private health care costs, on top of their tax contributions.
The OECD health data from 2016 has shown that including public and private spending on health care, the US citizen is forking out nearly 3 times as much as a UK citizen ($9,086 per year, as opposed to the UK spend of $3,364). The average US citizen privately spends an additional $4,516 on top of the $1.5 trillion national budget. One would have supposed, this massive extra spending would lead to a big difference in health care outcomes but nothing could be further from the truth. Life expectancy in the US was 78.8 years compared to the UK's 81.1 and infant mortality rates were almost double at 6.1 per thousand compared with the UK's 3.8 per thousand.
This is made even more curious by the facts that the UK had a 20 per cent population of daily smokers compared to the US rate of 13.7 per cent and that the UK had a population of 17.1 per cent aged 65 and over compared with the US level of 14.1 per cent. Let us endeavor to examine what factors had made the US performance, worsen?
From a US perspective, it should be a matter of general concern that of the 65+ population demographic, that 68 per cent of them suffer from two or more chronic conditions compared to 33 per cent in the UK. Of course, we cannot assess these issues, purely in financial terms but should also consider additional costs or factors. The exorbitant cost of health care in the US is in itself detrimental in that it leads to highly increased insecurity, depression and anxiety which in themselves have a negative impact on health.
Let us also examine what was made manifest, in a US survey by Gallop published in April 2019?
Given the nature of the crisis in the US health care system then it is risible for Donald Trump or indeed anyone to suggest that the UK should open its health service provision to corporates operating in the failed US system. Neoliberal Blairite privatization, PPPs and PFIs etc have been a disaster for taxpayers as Liam Halligan has shown in the expose for 'Dispatches', aired on BChannel 4.
The private sector Neoliberal approach in the US strongly suggests that rather than the UK following the US route and privatizing its health care system it is clear that it should be the US which should be following the UK and European models.
Given that they are already spending 55 per cent more than the UK in terms of public spending, then $1.5 trillion should be more than enough to give them an excellent free universal health care system: indeed it should be vastly superior to the UK system.
These figures clearly expose the economic fallacies and deceit of Neoliberal capitalism and its corrupted practices of private sector outsourcing. Across Europe, the public sector health care model is superior by orders of magnitude and it would be utter lunacy to abandon it in favour of the failing and ludicrously expensive US Neoliberal model.
According to the Commonwealth Fund, which regularly ranks the health systems of a handful of developed countries, the best countries for health care are the United Kingdom, the Netherlands, and Australia.
Who really is the lowest performer? Obviously, the United States, among the developed nations....even though it spends the most. 'And this is consistent across 20 years,' said the Commonwealth Fund's president, David Blumenthal, on Friday at the Spotlight Health Festival, which is co-hosted by the Aspen Institute and The Atlantic.
Blumenthal laid out three reasons why the United States lags behind its peers so consistently. It all comes down to:
The current system has exhibited a shocking lack of insurance coverage. A common talking point on the right is that health care and health insurance are not equivalent--that getting more people insured will not necessarily improve health outcomes. But according to Blumenthal: 'The literature on insurance demonstrates that having insurance lowers mortality. It is equivalent to a public-health intervention.' More than 27.0 million people in the United States were uninsured in 2016--nearly a tenth of the population--because they simply could not afford coverage, lives in a state that didn't expand Medicaid, or were undocumented. These are certainly not the problems that people in places like the United Kingdom, have to worry about.
US Senator Blumenthal had said 'We waste a lot of money on administration'. According to the Commonwealth Fund's most recent report, in the United States, 'doctors and patients (report) wasting time on billing and insurance claims. Other countries that rely on private health insurers, like the Netherlands, minimize some of these problems by standardizing basic benefit packages, which can both reduce administrative burden for providers and ensure that patients face predictable copayments.'
In other words, while insurance coverage in general is great, it's not ideal that different insurance plans cover different treatments and procedures, forcing doctors to spend precious hours coordinating with insurance companies to provide care. Underperforming primary care has continued to bog us, for a very long time. 'We have a much disorganized, fragmented, inefficient and under-resourced primary care system, Blumenthal has further added, in 2016.
Incidentally, Commonwealth Fund had found that 'many primary-care physicians struggle to receive relevant clinical information from specialists and hospitals, complicating efforts to provide seamless, coordinated care'. On top of a lack of investment in primary care, 'we don't invest in social services, which are important determinants of health' Blumenthal had remarked. Things like home visiting, better housing, and subsidized healthy food could extend the work of doctors and do a lot to improve chronic disease outcomes.
Connect the dots together, and the blur moves away from the picture. Indeed theses reasons helped explain why U.S. life expectancy has, for the first time since the 1960s, recently gone down for two years in a row. Far from there being no alternative to Neoliberalism it transpires that the public sector alternative we already have in the UK is vastly superior. This is undoubtedly the rule and not the exception.
May God respond, to the needs of all those who are lacking healthcare coverage in America!
The author is a former educator based in Chicago