Healthcare economy is undeniably complex, and there remains very little possibility in discussing a healthcare system that does not involve interplay with pharmaceutical companies, free vs controlled market economics, bureaucratic interest, or party politics; because of this, healthcare is very seldom a stagnant, nor simple, system. In order to fulfill its potential, a good healthcare structure is pliable, anticipatory, and wide-reaching, with the ability to protect all citizens in an efficient and cost-effective manner. Legislation regarding healthcare is never perfect and can generally always be improved upon. In the United States, this generalization seems especially fitting, as every election year healthcare rises as one of the most contentious topics of debate. With a new American federal administration comes a new direction in healthcare, and though the recently implemented Affordable Care Act (ACA) is irrevocably flawed, a swift GOP change in healthcare would be disastrous to the average American; even with the new ACA system, the United States lags behind other developed countries in regards to effective healthcare, sacrificing the safety and health of its citizens for protection from the dirty word, “universal.”
Though recognized as a global economic and political power, the United States practices a hybrid healthcare system that is primitive, ineffectual, and needlessly confusing, even for healthcare, when observed in an international context. According to the Department for Professional Employees (DPE), in 2014, 48% of U.S. healthcare spending came from private funds, 28% from households, and 20% from private businesses. The federal government accounted for 28% of spending, while state and local governments accounted for 17%; even if some aspects of healthcare are federally financed, the majority of American healthcare is privately delivered, with systems like Medicaid and Medicare federally subsidized to help cover elderly or poor demographic groups. In 2014, 89.6% of people in the U.S. were insured with some type of healthcare insurance, 66% of which were covered by a private health insurance plan. The same study concluded that 36.5% of the American population was insured through coverage by the federal government through Medicare (accounting for 50.5 million people), Medicaid (61.65 million people), and military care (14.14 million people); in 2014, almost 32.9 million people in the U.S were not covered by any form of health insurance (DPE). This statistic comes after the implementation of the ACA—The Kaiser Commision on Medicaid and the Uninsured reported in 2015 that the number of the non-elderly uninsured has decreased by 13 million since 2013, though 28.5 million people remain without coverage (Kaiser Family Foundation). The United States’ hybrid system of private and public coverage leaves thousands uninsured, yet is often accused of being too progressive. In reality, legislation has formed the ACA into a weak mimicry of other, more effectual healthcare systems, while still attempting to appeal to right wing Republicans, forming a system that invariably leaves millions falling through the cracks, observable when compared against the healthcare systems of other countries.
In an international context, the United States falls short in terms of healthcare efficiency among other countries within The Organization for Economic Co-operation and Development, the United States government spending the most on per capita healthcare than any other country, but still not receiving the most advanced and attentive services for all its citizens. Of all the OECD member states, the U.S. government is the least involved in financing health care on a national level, that duty largely placed upon private insurers, yet per person in the U.S., government spending on healthcare is greater than all other OECD countries except Norway and the Netherlands. This paradoxical situation is due partly to the high cost of health care in the U.S., the high cost pharmaceutical companies place upon drugs, and administrative expenses. In 2013, the OECD found that the U.S. spent 16.4% of its GDP on health care, while the OECD average was 8.9% per person (DPE). According to a study within the World Health Report 2000, the U.S. ranked first in per capita healthcare spending, but fifteenth in overall quality of service. When cost vs quality were evaluated together, the United States ranked 37th overall; France came first in overall ranking with a two-tier healthcare system, and Italy came in second with a universal healthcare system. Nearly all of the countries ranked within the top ten overall healthcare systems (cost compared with quality) have implemented either a two-tier healthcare system or a universal healthcare system; contrastingly, the United States practices a tentative insurance mandate system (Taylor and Blackstone).
Though the U.S. spends the most on healthcare per capita, much of this expense is misleading, needless, and wasteful, with a large percentage of government spending never directly helping individual citizens. Due to the high cost of American health care, many Americans risk their health by cutting down trips to the doctor to save money, for example, one study concluded that 59% of U.S. physicians noticed that their patients have trouble paying for healthcare, with 31% of uninsured people citing cost as the reason for refusing or delaying medical care; comparatively, only 5% among those privately insured and 27% covered by federally financed systems were recorded to refuse treatment (DPE). The astronomically high prices of medical care in the United States have a direct impact on the health of literally millions, and much of the cost that inhibits American citizens from adequate care is unnecessary; Some health economists estimate that about 1/3 of U.S. medical costs do not improve overall care (Cutler).
The most influential factor raising healthcare costs in the United States stems from unnecessary administrative expenses. About 25% of money used to finance the American healthcare system is used for insurance administrative purposes, an amount much greater than most other countries generally considered “developed” (Cutler). These costs prevail in the U.S. healthcare system because of its heavy reliance on private insurers, as the government outsources administrative duties, such as coding and billing, to private for-profit firms. Additionally, no link has been found that connects higher administrative spending to better quality healthcare (Himmelstein). The DPE estimates that of the $361 billion spent annually on healthcare administration, nearly half is used wastefully (DPE).
The second largest expense in the healthcare budget simply exists because services and products cost more in the United States than in other countries (Cutler). A 2013 study found that the U.S. spent more than double the per capita OECD average for pharmaceuticals, spending about $1,026 per person annually on drugs (DPE). The International Federation of Health Plans (IFHP) 2013 Comparative Price Report concluded that drug prices in the US are often nearly 10 times higher than those in most industrialized nations; for example, the drug Gleevec, used to treat some forms of Leukemia, costs around $989 in New Zealand, but up to $6,214 in the United States (IFHP). This large disparity between drug prices in different countries can be attributed once again to the United States’ use of private insurers—Because of competition between insures in the U.S., pharmaceutical companies have greater control over the prices of drugs. In single-payer healthcare systems, only one “umbrella insurer” (usually, the federal government) exists, meaning the umbrella insurer has greater leverage with pharmaceutical companies, as it can refuse to include over-priced drugs on annual formularies. Because there are many private insurers in the U.S., if a drug is not included on one insurance agency’s formulary, it has the possibility of being representing on a different company’s formulary and being sold to its customers for a large profit (Consumer Reports). Additionally, doctors, physicians, and nurses on average are paid much more in the United States than in other countries. In France, for example, the average annual salary for a general practitioner is $95,000; in the United States, general physicians are paid about $100,000 more than that annually (Pho). These unnecessary costs exist even after the passing of the ACA; many medical economists estimate that prices will only increase if the ACA is repealed too swiftly and replaced with a GOP proposed counterpart.
A GOP repeal and replacement of the United States’ current healthcare system would be disastrous at worst, and unfortunate at best for the common American. Though Obamacare and the ACA are not by any means perfect, they have significantly improved American healthcare compared against the U.S.’s old healthcare market. With implementation of the ACA, insurance companies could no longer legally discriminate against buyers with pre existing conditions, nor on the basis of gender. Additionally, elderly who qualify for Medicare coverage now face lower prices for the same services and drugs, the ACA dropping costs by mandating coverage of young adults. Obamacare dropped costs and improved the services of those covered by Medicare by limiting the increase of payment rates to hospitals and private insurers (Luhby). The ACA also allowed for children to stay on their parents’ insurance plans until the age of 26, one component of Obamacare most Republicans want to stay.
Though the ACA brought healthcare coverage to millions previously uninsured, critics have condemned Obamacare as “Un-American,” due to its federal insurance mandate that forced millions of people into the healthcare market (Chappelear). Although there are some aspects of the ACA the Trump Administration has approved of, such as anti-discriminatory regulations, most GOP republicans are united around one common desire: the repealment and replacement of Obamacare. This desire, however, is illfounded; an Obamacare repeal would scare the majority of private insurers out of the individual market, as 16.4 million people previously covered by federal healthcare systems would flounder without coverage (Silvers). One of the largest problems facing potential GOP replacements is that no concrete plans have been drafted, even though repealment of the ACA has been one of the hottest talking points of politicians in 2016; The general consensus of the GOP is that a new plan will phase out the ACA insurance mandate and will dramatically shrink the size of government financed services, placing an even heavier reliance on already volatile private insurance agencies (Rubin). According to J.B. Silvers, a former health insurance company chief executive, after, “insurers leave the private market, the damage will spread to doctors and hospitals, whose bad debt will skyrocket when patients miss copays and drop coverage while providers and hospitals still must continue care” (Silvers). The many needless expenses of the current American healthcare system would only increase with the implementation of a GOP replacement plan, as private insurance would grow alongside administrative, pharmaceutical, and service costs.
Regardless of party alliance, the healthcare system of the United States is in need of positive change, as legitimate healthcare possibilities and improvements are often sacrificed for recycled partisan talking points. Bureaucrats who propose progressive healthcare change are often labeled as socialists or communists; moderate proposals can bring about the word traitor, but are generally more likely to be accepted in Congress and the House. The ACA was one of such compromises, though it often appears sweepingly liberal in the limited perspective of American politics. The United States suffers from rampant political polarization—this is undeniably present in the legislative opinions of healthcare, very much split along party lines (Fisher). Because of this, only three real options are achievable in election: liberal Democratic proposals, conservative Republican proposals, and a moderate compromise that appeases legislators, yet ignores the health of millions.
Universal healthcare (UHC), when proposed in an American legislative body, is generally regarded as a liberal pipe dream; critics of this highly successful healthcare system cite that the United States is either too large or too poor to support a single-payer system (Rmuse). However, research shows that countries far larger and far poorer than the U.S. have seen incredible improvements to the efficiency of their healthcare when UHC has been implemented; Mexico, Brazil, and Thailand, after enacting legislation encouraging UHC, have seen significant drops in mortality rate, without unreasonable tax burdens falling upon their citizens (Sen and Lamont). Additionally, other developed countries that practice universal or nationalized healthcare are extremely successful—France, Japan, Germany, Canada, Sweden and more all have universal care in place; They have also all outranked the United States in terms of overall healthcare in study after study (Taylor and Blackstone). In terms of cost, a switch to UHC would actually lower government spending, as private insurers are cut out of the market. Every developed country that uses a universal health care system spends less on per capita healthcare than the United States (DPE).
American healthcare is broken, and there will be no quick fix; the ACA acted as does a bandaid on a bullet wound, with its intention to heal a plague of unfair coverage and its inability to end heavy reliance on private insurers that has resulted in inevitable hemorrhaging of the private market, as premiums and deductibles rise to still make a profit despite government subsidies. Healthcare is in a dire need of change, not towards a greater dependence on said private, for-profit firms, nor with the implementation of yet another, slightly tweaked, rewrite of an already condemned compromise, but with a new system that provides fair and efficient healthcare coverage to all U.S. citizens. Achieving this goal is daunting and not uncomplicated—healthcare reform would invariably bleed into other sectors of public works, as the healthcare market is indirectly and directly linked to education, pharmaceutical economics, minimum wage, paid sick leave, drug research, and retirement plans. Amends must be achieved slowly and in a nonpartisan manner, the results of years of tireless toil towards a government that protects all of it citizens equally, regardless of socioeconomic standing—the health and safety of all human beings is neither a privilege, nor a personal responsibility, but rather a government protected right.