Originally Published: 7/4/2007
By The Issue Wonk
Updated 11/3/07. Updates in red.
Today, more than 45 million Americans lack health insurance1 and health care costs are increasing faster than wages.2 6 in 10 Americans are “worried about being able to afford the cost of their health insurance over the next few years.”3 In the wake of the release of Michael Moore’s new movie, SICKO, I thought it was time to take a close look at the health care system in the United States.
Health care in the United States, per capita, is higher than in any other country.4 While everyone talks about the great health care in the United States, some even say it’s the best in the world, this is not necessarily true.5 Let’s look at the issues.
The Cost of U.S. Health Care. Health care costs have increased over 87% over the last five years.6 According to a 2004 study, “one-quarter of U.S. adults (both insured and uninsured) spent more than $1,000 out of pocket on health care in the past year, far exceeding expense burdens in the other countries.”7 In fact, health care spending per capita in the U.S. is “much higher than in other countries – at least 24% higher than in the next highest spending countries and over 90% higher than in many other countries that we would consider global competitors.”8
The Quality of U.S. Health Care. American on average die at a younger age compared to the average age of death of comparable nations.8 According to the Brookings Institute, the infant mortality rate is 6.9% per 1,000 births. (Japan and Sweden have rates below 3.5%.) Obesity among adults is 30.6%, the highest of all developed countries and 21% higher than Mexico, the second highest rate. An estimated 45% had a chronic illness in 2000 and that number is projected to rise to 50% by 2020. The number of people with diabetes has doubled in the past 15 years and 1 in 3 people born in 2000 can expect to have diabetes in his/her lifetime.9
One in three Americans who seek medical care suffer “some type of error,” and U.S. patients experience somewhere between 44,000 and 98,000 medical deaths per year.10 “More people die in a given year as a result of medical errors than from motor vehicle accidents, breast cancer, or AIDS.9 Thus, the United States is a poor performer when it comes to health care. The “likelihood of surviving a kidney transplant is 6% higher in Australia, 13% higher in Canada, and 4% higher in the United Kingdom and New Zealand than in the U.S.”5 A “hallmark of high-quality primary care is an emphasis on preventive care, counseling, and awareness of patients’ health concerns.”7 Yet about 70% of deaths and health costs in the U.S. are attributable to chronic disease, which are largely preventable.11
What Do U.S. Citizens Want? Polls indicate that people are becoming more and more in favor of health care provided by the federal government. An NBC/Wall Street Journal Poll conducted in January 2007 found that 53% said they would be willing to pay higher taxes “so that everyone can have health insurance.” And, according to a CNN poll taken in May, 2007, 64% of the public believes that government should provide a national health insurance program, even if it means an increase in taxes. (73% believe the government should provide health care for all children under the age of 18.) Even as early as January 2006 a CBS News/New York Times Poll found that, when asked about the overall view of the health care system in the U.S., 90% said changes are needed: 56% said fundamental changes are needed and 34% said the system should be completely rebuilt.12
Clearly, health care in our country is a huge cost for most and non-existent for many. The system is broken. The public doesn’t have to be convinced of that – they know it. And they want it changed. Only the health care industry, which is making billions of dollars off sick people, wants to leave things as they are. Is anyone surprised? Most of the candidates for the Democratic nomination for president are in support of some kind of health care reform. Some proposals are better than others. However, as noted in The Weekly Wonk, (The Supremes on Campaign Financing, 6/30/07), the recent Supreme Court decision allowing unlimited corporate support for issue ads will assure us that, during the presidential race, we’ll be regaled with TV commercials misrepresenting the facts. It will be up to ordinary citizens to explain the facts to their friends and families if we want to see any changes.
According to a new census by the U.S. Census Bureau, in 2006 another 2.2 million people had no health insurance, bringing the total to 47 million, or 15.8% of the population. Uninsured children rose to 11.7%, up from 10.9%. Also, the number of people who get health insurance through their jobs, which began falling in 2001, has dropped to 59.7%, down from 60.2%. Health insurance premiums rose 7.7% last year, hitting $11,480 for a typical family plan offered by employers. And, while low-income households have the highest uninsured rate, the rate rose fastest among those living in households with annual incomes above $75,000, hitting 8.5%, up from 7.7% in 2005.13
According to a Harvard study, 1 in 8 of the uninsured is a veteran or member of a veteran's household. Uninsured veterans totaled 1.8 million in 2004, up 290,000 from 2000. "Like other uninsured Americans, most uninsured vets are working people -- too poor to afford private coverage but not poor enough to quality for Medicaid or means-tested VA care," said Harvard professor Dr. Steffie Woolhandler. The study noted that "many uninsured veterans are barred from VA care because of a 2003 Bush Administration order that halted enrollment of most middle income veterans." (Physicians for a National Health Program)
1 U.S. Census Bureau. Census Bureau Revises 2004 and 2005 Health Insurance Coverage Estimates. March 23, 2007.
2 Allegretto, Sylvia and Bernstein, Jared. The Wage Squeeze and Higher Health Care Costs. Economic Policy Institute, January 27, 2006.
3 Kaiser Family Foundation. Summary and Chartpack: Health Care in America 2006 Survey. October 16, 2006.
4 Schoen, Cathy; Osborn, Robin; Huynh, Phuong Trang; Doty, Michelle; Zapert, Kinga; Peugh, Jordon; & Davis, Karen. Taking the Pulse of Health Care Systems: Experiences of Patients With Health Problems in Six Countries. Health Affairs, November 3, 2005.
5 Daschle, Tom. Paying More But Getting Less: Myths and the Global Case for U.S. Health Reform. Center for American Progress, November, 2005.
6 The Kaiser Family Foundation and Health Research and Educational Trust. Employer Health Benefits. 2006 Annual Survey.
7 Schoen, Cathy; Osborn, Robin; Huynh, Phuong Trang; Doty, Michelle; Davis, Karen; Zapert, Kinga; & Peugh, Jordon. Primary Care and Health System Performance: Adults’ Experiences in Five Countries. Health Affairs, October 28, 2004.
8 Organisation for Economic Co-Operation and Development. Health Care 2006. How Does the United States Compare.
9 Lambrew, Jeanne M. A Wellness Trust to Prioritize Disease Prevention. The Hamilton Project Discussion Paper 2007-04. The Brookings Institute, April 2007.
10 Institute of Medicine. To Err is Human: Building a Safer Health System (2000). Executive Summary.
11 McGlynn, Elizabeth A.; Asch, Steven M.; Adams, John; Keesey, Joan; Hicks, Jennifer; DeCristofaro, Alison; & Kerr, Eve A. The Quality of Health Care Delivered to Adults in the United States. The New England Journal of Medicine, 348:2635-2645(26), June 26, 2003.
12 CNN/Opinion Research Corporation. Health Care Delivery. PollingReport.com, May 4-6, 2007.
13 Appleby, Julie. Census: Health Benefits Scarcer. USA Today, 8/29/07.
© The Issue Wonk, 2007