When Italian Prime Minister Silvio Berlusconi needed a heart operation in 2011, he went to the Cleveland Clinic. When the late King Hussein of Jordan needed treatment for lymphoma, he sought help at the Mayo Clinic. Heads of states, important political figures and wealthy individuals often seek medical care in the United States. We often hear that Canadians wait much longer for procedures than Americans. House Speaker John Boehner commented recently that implementation of the Affordable Care Act “is going to destroy the best health care delivery system in the world.” These anecdotes lead Americans to believe that we have the best system in the world – but do we?
John F. Kennedy said: “No matter how big the lie, repeat it often enough and the masses will regard it as the truth.” The reality is we do not have the best health care system. The Social Progress Index 2014 rates the U.S. as 70th among 132 nations in health and wellness. A 2013 Institute of Medicine report titled “U.S. Health in International Perspective: Shorter Lives, Poorer Health” ranks the U.S. near last among 17 high-income nations in several categories ranging from infant mortality and low birth weight to life expectancy. The Commonwealth Fund analysis also ranks the U.S. last among seven nations in health care. The U.S. ranks worst among 16 developed countries in preventable deaths, according to a 2011 study published in Health Policy. There are some bright spots: Survival with some cancers (cervix, breast, prostate) is better in the United States, but this may be because of better screening.
These poor ratings do not stem from a lack of resources: We spend $2.3 trillion annually on health care, about 18 percent of our Gross Domestic Product and more than twice what most advanced nations spend. This is roughly $8,500 per person in the U.S. compared to $5,670 in Norway and $5,645 in Switzerland, the two next-highest countries.
What do we get for spending so much? Let us review some figures.
According to Commonwealth researchers, 37 percent of Americans do not seek a physician’s help when sick or fail to fill prescriptions due to high cost, compared with 4-6 percent in Britain and Sweden. About 23 percent of Americans had problems paying or did not pay medical bills, compared with only 6 percent or fewer in Britain and Sweden. About 75 percent of Americans said the health care system required fundamental changes; in contrast, 50-63 percent of Europeans were happy with their systems. Americans in fact wait longer than most Europeans to see a primary care doctor: 63-76 percent of Europeans see a doctor within one to two days, compared with 48 percent of Americans; only Canada scores worse (41 percent).
Why do we spend so much and get so little? Because the money is diverted from patient care toward wasteful practices, overburdened bureaucracies and excessive profits to businesses (hospitals, drug and medical device companies, insurance companies, physicians).
First, our system has waste due to excessive bureaucracies. About $750 billion, almost a third of the nation's annual health care spending, was wasted in 2009. One-third of health care dollars are spent on administrative overhead, far higher than other countries.
Second, Americans pay more for patented drugs, medical devices, procedures, hospital care and physicians’ fees. Patented drugs cost two or three times more in the U.S. compared with Canada or Europe. For example Sofosbuvir, which treats hepatitis C, costs $84,000-$168,000 (for three to six months) in the U.S. and only $900 in Egypt (the cost to the company is $136 per course, which translates into about 100,000 percent profit in the United States). Hip replacement costs $80,000 in the U.S. and less than $14,000 in Europe. MRIs cost $1,145 in the U.S. and $138 in Switzerland. Nexium, which treats acid reflux, costs $215 in the U.S. and $20-60 in Europe. Some variations are incomprehensible. Routine colonoscopies in one area, New York, ranged from $740 to $8,500. Medicare data from 2013 show the cost of treating an ankle sprain ranging from $100 to $24,000.
Wealthy individuals and others with good insurance may have access to the best health care in the world. But significant health care and wealth disparities, and high uninsurance rates (15 percent) or poor insurance expose poor and vulnerable Americans, even those in the middle-class, to financial ruin and worse medical outcomes when they become sick. As a result, the average quality of health care in the U.S. is significantly worse than that in comparably wealthy countries. In other words one can't receive the best health care in the world without having access to it.
How can we improve things? Some solutions are obvious: Eliminate waste, reduce bureaucracy and administrative expenses, suppress fraud, negotiate better prices for procedures and drugs and work with the health care industry (pharmaceutical companies, insurance companies, hospitals, drug distributors, physicians) to deliver care at reasonable profits.
But despite the data, most Americans still believe we have the world’s best health care system and are surprised to find that they and their families have, on average, worse health than people in equivalent high-income countries. The first step to real change is to reverse this perception through outreach campaigns that highlight the U.S. disadvantage. Only then will Americans coalesce around strategies to improve the Affordable Care Act. Through additional legislation, an improved law can offer high-quality universal health care at affordable prices for individuals and the U.S. health care system.