The American Health Care System Sucks

Business Insider

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Politicians say a lot of dumb things, but perhaps the dumbest thing they say is that the U.S. has "the finest health care system in the world." Senate Minority Leader Mitch McConnell (R-Ky.) said that in 2012, echoing a common Republican talking point in opposition to health care reform.

No. Stop saying this. The American health care system sucks.

We spend about twice as much money per person as our peer countries to achieve roughly the same health care outcomes — and despite all that spending, 48 million people in America lack health insurance coverage.

Health care spending in the U.S. is astronomical. In 2010, Americans consumed nearly $8,000 worth of health care per capita, twice as much as most other rich countries. The second-highest spending country, Switzerland, spent $2,640 less per person than we did.

I've been to Switzerland. A cappuccino at Starbucks in Zürich costs $8. Nothing should be 50% more expensive here than it is there.

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per capita health spending

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U.S. health care spending per capita was nearly $8,000 in 2010. That's $2,640 more than the second-highest spending country, Switzerland.

We don't have much to show for all that spending. Our health outcomes are pretty similar to those in other rich countries. A 2011 Commonwealth Fund study concluded:

Despite much higher spending, U.S. performance in terms of quality is variable relative to other countries. While cancer care in the U.S. seems to be of particularly high quality based on five-year survival rates, the high rates of hospital admissions for chronic diseases suggest opportunity for improvement. These results echo previous comparative studies that find the U.S. to have middling or highly uneven quality. A 2010 cross-national study conducted by The Commonwealth Fund ranked the U.S. sixth of seven countries in terms of quality, with average performance on effectiveness and patient-centeredness and low performance on safety and coordination.

And while we enjoy those high costs and middling quality, we leave one in seven U.S. residents without a good way to pay for health care they might need — care that is drastically more expensive here than it would be anywhere else on a pre-insurance basis.

In a sane world, "This health reform plan will make America like France!" would be praise, not a dire warning.

But instead, politicians run around talking about how wonderful American health care is. Republicans have a de-facto agenda of opposing any reform to the health insurance system. Democrats are reduced to lying and saying their reform efforts won't change anything for people who like the coverage they have, because huge numbers of Americans have decided for some insane reason that they like the crazy expensive, often spotty, not-especially-effective coverage they have.

I support Obamacare because I believe it will improve our terrible health care system on the margins. Subsidies will tend to be shifted toward people who need them and away from those who don't. More people will be covered. Modest cost control improvements will be implemented, such as through a tax on high-cost plans and new payment systems that encourage providers to focus on producing good outcomes rather than providing expensive treatments.

But the real problem with Obamacare is that it does not change the American health care system enough in the direction of other countries' systems. Republicans are wrong to warn that Obamacare will turn America's health care system into a European-style one. I wish they were right.



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