Global Health Blogs with Professor Swahn

Everyone knows that the United States is a first world country, but does a first world country forget to prioritize healthcare? The United States is a democracy with a commercial economy, laws set in place, and a high standard of living. Other countries with lower incomes and less stable democracies often look at us, the United States, to aid them and assist them with their issues and problems. The reality of this is that while the United States is a first world country with money and resources to help others, we often fail to help our own people. We have tremendous health disparities in our country and even those who are well off can sometimes not get the care or medicines they need.

The United States suffers in more ways than one when it comes to treating our people equally. Systemic racism has become embedded in our culture, which leaves this to trickle into other systems, including schools, workplaces, and even healthcare. The largest problem that sets the United States apart from other well-established, first world countries is our culturally implemented view on racism.  Until this is handled on a cultural level, meaning that we eliminate racism from an everyday standpoint, we will never eradicate racism in the healthcare system.

Whether you are a newborn who cries to convey your feeling of unease, or a twenty-eight-year-old woman screaming from giving birth to her first child, we know what it feels like to be sick, in pain, and in need of help from a medical professional. Unfortunately, the access and quality of care provided to these individuals varies greatly by where they live. Hawaii, Minnesota, and Connecticut have life expectancies equivalent to high income countries, like Germany and Great Britain. The life expectancy in these states and countries is around 80 years old. Mississippi has the lowest life expectancy, at roughly 75 years old. From the map you can see that the average life expectancy greatly varies by state. Even though we are considered the United States, we do not always seem to be so united.

The United States spends more per capita on health care than any other country yet has worse outcomes than other comparable developed countries. An estimated three trillion (that is after million and billion — a total of twelve zeros) dollars is spend per year on healthcare in the united states. As of 2019, roughly 29 million Americans are without insurance; or approximately 8.8% of the total population. This number includes individuals and families who are completely uninsured but fails to mention the amount of people without access to healthcare. Being insured and having full access to healthcare are two completely different phenomenon’s that should go hand in hand, but in this country they do not. 

Dr. Ashish K. Jha is a medical doctor at the Harvard T.H. Chan School of Public Health. He also received his Master’s in Public Health and is the senior author of ‘Health Care Spending in the United States and Other High-Income Countries.’  In this video, he discusses the differences in United States healthcare versus other comparable countries. In terms of structural capacity (hospital beds, number of physicians and nurses, special scanning machines), access and quality of care (immunizations, wait times, preventative screenings), and healthcare utilization (medical imaging, surgery) the United States does not differ that much from other leading countries.

Dr. Jha is confident in the fact that utilization of services is not the main problem, but more so the cost of services and where the prices vary. Drug cost is 10-15% of healthcare spending, and administrative costs account for roughly 8% of overall spending. Other countries spend approximately only 1-5% of healthcare spending on administrative services, which includes insurance claims, billing, coding, and government reporting. The problem is that these numbers do not add up when you look at the map of life expectancy ages for the United States. With this much spending going out, our life expectancy should be higher, and our health insurance prices should be lower.

Looking at this graph, you can see just how steep the spending in the United States healthcare system is:

 

Taking a closer look at the second highest spending country, Germany, there are many notable differences compared to the United States. First, health insurance is mandatory in Germany. That means everyone has to have it; and Emergency Rooms of public hospitals are not flooded with uninsured patients they are required to treat. In fact, over 86% of the country is enrolled in a government health insurance plan that covers inpatient and outpatient care, as well as mental health services and prescription drug coverage. Sickness funds are even financed through wage contributions, so a portion (~1%) of paychecks are supplemented for healthcare purposes. Click here to watch a detailed video explaining how healthcare works in Germany.

 

Canada has a program called Canadian Medicare that is a universal publicly funded system. Each providence in Canada, similar to each state in the United States, has its own insurance plan and options, but they all receive assistance directly from the federal government. “All citizens AND permanent residents receive medically necessary hospital and physician services free at the point of use.” As an American, it is extremely difficult to imagine walking into a hospital without having to pay a dime. The government fully pays for their medical care and emergency expenses; yet the country as a whole spends less than half of what the United States does on healthcare costs.

 

 

The bottom line is that for the United States, the health care system and its prices are for profits. This makes the underlying problem within the United States healthcare system vividly open and obvious — the system is designed to generate profits. This is a major barrier to making progress and to take better care of our many unmet health issues and health disparities.

Most of us studying public health, agree with other countries and the WHO who clearly state that we should not put a price tag on health. Health is a human right.