Sick But True-Healthcare in America

For some time, the conservative "position" on health care has been a stalwart commitment to the status quo, resisting any proposals for sweeping reform. Two new studies comparing global health data — one by American Progress distinguished senior fellow Tom Daschle, another by the Commonwealth Fund — spell out what this position entails: conservatives apparently are content with a health care system that ranks #37 in the world (behind both developed and developing countries); a system that has the highest rate of medical mistakes, medication errors, and inaccurate or delayed lab results of any of the six nations surveyed by Commonwealth (Australia, Canada, German, New Zealand, and the United Kingdom); and a system that forces fully half of sick adults to report cost-related barriers to needed care. This disparity is not simply about health practices or economics; it is about our most basic values as Americans: our current health care system violates our core commitment to the common good, and betrays the simple notion (articulated by Sen. Daschle) that the "world’s wealthiest country should be its healthiest." (The Center for American Progress, unlike the Bush administration, has developed a real plan for making America healthier. Read all about it, or watch the flash video.)

THE MORAL COST OF THE STATUS QUO: The most substandard element of our health care system is arguably also the most morally troubling. As Paul Krugman explains, "Americans are far more likely than others to forgo treatment because they can’t afford it. Forty percent of the Americans surveyed failed to fill a prescription because of cost. A third were deterred by cost from seeing a doctor when sick or from getting recommended tests or follow-up." That citizens must regularly deny themselves and their families medical care is bad enough; that it happens in the wealthiest country in human history is almost unbelievable.

THE ECONOMIC COST OF THE STATUS QUO: Employment-based health insurance "is the only serious source of coverage for Americans too young to receive Medicare and insufficiently destitute to receive Medicaid," yet it’s becoming increasingly difficult to obtain. The reason? The strain of health care costs for employers is growing, "possibly to a breaking point." The average total premium for an employer-based family plan was $9,979 in 2005, representing nearly the entire annual income of a full-time, minimum-wage worker. The cost of premiums for employer-based plans has outpaced wage growth by nearly fivefold since 2000. According to one report, by 2008, health costs will exceed profits at Fortune 500 companies. Comparing the U.S. system to countries with universal coverage, Sen. Daschle found that "in general, their predictable and broadly-financed costs along with their outcomes — improved health and productivity of workers — tend to benefit their businesses, and give them a competitive advantage over ours."

MYTH: COVERING ALL AMERICANS WILL LEAD TO RATIONING: As with the positive aspects of the U.S. system, the negative aspects of other countries’ systems are frequently exaggerated. One such myth relates to waiting lists. Americans typically fear that any universal coverage system will require them to wait longer for needed services. Yet, 30 percent of sick Americans have access to same-day care, compared to 41 percent in the United Kingdom, 54 percent in Australia, and 60 percent in New Zealand. Americans are also more likely to have to wait to see a specialist than sick people in Germany. Additionally, among developed nations, waiting lists are not a major factor in explaining lower costs. Examining Organization for Economic Cooperation and Development (OECD) nations, one study identified twelve countries that had waiting lists for elective surgeries and seven countries besides the U.S. that did not have these waiting lists. In 2002, per capita health spending averaged $2,366 in the countries with waiting lists, $2,696 in the non-U.S. countries without waiting lists, and $5,267 in the U.S. Thus, waiting lists are neither inevitable nor necessary in systems that cover all of their people.

MYTH: WE CANNOT AFFORD TO COVER ALL AMERICANS: As it stands today, "America’s health care system spends more, for worse results, than that of any other advanced country." In 2003, for instance, the United States spent $5,635 per person on health care. Canada spent $3,003; Germany spent $2,996; Britain spent only $2,231. "Yet the United States has lower life expectancy and higher infant mortality than any of these countries." Moreover, much of this cost is born not by government or government, but by ordinary Americans (in fact, the government share of health spending in the U.S. is the lowest among all OECD nations). Nearly twice as many Americans as Australians spent more than $1,000 out-of-pocket on health care in 2003 (26 compared to 14 percent). Sicker Americans fare even worse. Over one-third of sicker Americans have medical expenses exceeding $1,000, compared to 14 percent of sicker Canadians and 4 percent of sic
ker adults in the United Kingdom. As Sen. Daschle writes, "The truth is we can’t afford to not reform the health system."