We are a nation of patsies when it comes to health care.
We’re paying roughly twice what other wealthy nations pay for medical care that seems no better.
We citizens put up with a system that enriches insurers, hospitals, drug manufacturers and many doctors while bankrupting ordinary Americans. For all of our extravagant spending, Americans have a life expectancy a little lower than Costa Rica and Chile.
We ignore proof that people in other developed nations get equal or better health results at half the price.
The depth of our folly is laid out in reports by the National Institutes of Health and the Organization for Economic Cooperation and Development. They chart the dismal health and sky-high medical prices of the United States compared to other nations.
Together, the reports spell out four related problems:
High cost: As of 2013, health care spending in America averaged $8,713 per person, says the OECD. Canada, a very similar nation, spent $4,351 on average per person.
America’s per-person spending is roughly double that in France, Germany and most of Western Europe. The United Kingdom averages $3,235. Japan and Australia come in under $4,000.
President Barack Obama’s landmark health care law, the Affordable Care Act, was aimed at providing health insurance to more people. But the law known as Obamacare, which went into effect starting in 2010, didn’t really succeed in controlling costs.
Poor health: Despite extravagant spending on health care, Americans at all ages are sicker than people in other rich nations, and die sooner, according to the Institute of Health in a 2013 report. That’s in part because of our behavior — we have more drug abuse, violence and accidents than in other rich countries. We’re also fatter, although we smoke less than people elsewhere. We’re about average in alcohol consumption.
Poor access: Because care here is so expensive, and insurance often skimpy, too many people skip doctors until they’re very ill, contributing to our high sickness rate. In Canada, where medical care is nearly free to citizens, doctor visits average eight per person per year. In the U.S., it’s four.
All this adds up over time. For instance, 68 percent of Americans over age 65 suffer from two chronic diseases. It’s 56 percent in Canada, and 33 percent in the United Kingdom.
Quality of care: Once Americans seek care, the quality seems good but not excellent, although the cost here is double.
The OECD tracks medical results across 34 member nations. Most are wealthy or near-wealthy, although Greece, Turkey and Mexico are also included. The data show that medical outcomes — what happens to people who get sick — are a mixed bag here.
For instance, the American system does very well in treating heart attacks, according to OECD figures. We rank fifth in survival rate among 32 OECD nations reporting figures. We’re third in survival after a stroke. We rank second in survival for breast cancer among the 25 nations that report results.
But we’re 22nd out of 25 in cervical cancer and ninth among 23 in colorectal cancer. We’re in the middle of the pack, or a little above, for surgical complications.
COPD (chronic obstructive pulmonary disease), asthma and congestive heart failure can be controlled in a good outpatient primary care system. To judge if that system is working, the OECD looks at how often such patients end up in the hospital.
The U.S. ranks eighth worst for COPD and asthma admissions among 34 nations. We’re sixth from the bottom for congestive heart failure admissions.
We have the sixth worst rate of low birth-weight infants, and the fourth worst rate of infant mortality, which can indicate lack of prenatal care.
That gets us back to the access issue. Every other wealthy nation provides universal health care coverage for its citizens, either through a government-payer system or quasi-public insurers. That lets government or its stand-ins control costs.
The U.S. does neither. There is no cost control here. As of this year, 9.1 percent of Americans are uninsured, down from 13.3 percent before the Obamacare health insurance marketplaces began operating in 2014. Deductibles, which average $2,000 for employee coverage at big companies, discourage people from seeking care.
The ultimate measure of a health care system is how long we live, and life expectancy in the U.S. is surprisingly bad. At birth, it is 76 for men and 81 for women as of 2013, ranking us 28th among 35 OECD nations. We are behind all our wealthy peers in Western Europe, Japan, Canada and Australia.
Overall, we’re paying more dollars for shorter lives. It doesn’t have to be that way, and we’ll explore alternatives in next week’s column.