- The Guardian
- Issue #2041
Photo: Images Money / TaxRebate.org.uk – flickr.com (CC BY 2.0)
In Michigan, a man falling off his bicycle had obvious injuries and I offered to drive him to a public hospital for treatment. He refused, saying he could not, as he had not worked for some time. Not having “enough credit” meant he could not be admitted. In Los Angeles, I met a woman who was charged US$15,000 to have her baby, with no complications in the delivery. She could not pay. There is a multitude of such stories.
Unlike television shows that portray great health care provision, the US healthcare system has deep-seated problems, because it is based on profit maximisation. When doctors go into poor areas to work for free, it is because the poor cannot get into hospitals, or cannot get the medication they need. The United States has the worst health care system in the developed world.
It is not just that the majority of hospitals in the USA are privately owned, it is also because health care and medications are so expensive. The charge to call out an ambulance is US$2,500. Over 25 per cent of well-insured US citizens struggle to pay their medical bills. Of these, 63 per cent had depleted their savings and 42 per cent had to get an additional job to pay their bills. Medication is far more expensive in the USA than in Canada or Australia.
A vial of insulin costs US$32 in Canada, while in the US the same drug costs US$300. In Australia Novorapid costs $34.20 for 5 injection pens. It is on the PBS (Pharmaceutical Benefits Scheme) list and the federal government subsidises the medication. Surgical procedures at US hospitals can cost over US$80,000. The patient is forced to get a second job or get another mortgage on the family home. The US system is the most expensive healthcare system in the world.
The USA is the only country in the OECD (Organisation for Economic Cooperation and Development of developed countries) without a system of universal healthcare. A major contributing factor to their present mortality rate is that a large proportion of the population are unable to afford health insurance.
Healthcare is provided by insurance companies, healthcare providers, hospitals, and independent providers. According to “Fast Facts on US Hospitals” by the American Hospital Association, healthcare facilities are mainly owned and operated by the private sector. Of the community hospitals 58 percent are non-profit, 21 percent are government-owned and 21 percent are for-profit. The Hill-Burton Act, passed in 1946, provides federal funding for hospitals in exchange for treating poor patients.
According to the Grattan Institute’s The Conversation (19th November, 2020) an armed services veteran has access to a comprehensive, centrally coordinated, government-run health service. Those over 65 are covered by Medicare, which is a federally funded insurance-based system. For those on a low income, Medicaid is available. As it is partially federally funded and state-run, eligibility is means tested. For someone employed, their employment package may include health insurance coverage and they can choose their own insurer.
The US Postal Service (USPS) and businesses with a high union presence have good health packages. In the prison system 40 per cent of those incarcerated have chronic health conditions. According to Sojourner Ahébée on PBS Radio (9th April, 2021) there is a need for quality health care in correctional facilities across the country.
The United States spends more on health care services than does any other nation, more than twice as much per person as the other OECD countries. As noted, healthcare coverage is provided through a combination of private health insurance and public health coverage, such as Medicare and Medicaid.
In 2021 the US government spent US$3.69 trillion, US$10,738 per capita, which is 17.9 per cent of its GDP (Gross Domestic Product). This is twice the per capita cost of the Australian health system. Healthcare expenditures are financed by a complex mixture of public payers (federal, state, and local governments), as well as private insurance, and individual payment.
The US primarily relies on employers to voluntarily provide health insurance coverage to their employees and dependents. Unions negotiating contracts barter for a health care plan. Government programs are confined to the elderly, the disabled, and some of the poor. In 2017, over twenty-eight million people (more than the population of Australia), 8.8 per cent of the US population were without health insurance coverage.
The report Mirror, Mirror 2021 – Reflecting Poorly: Health Care in the US shows that getting quality, essential health care in the US depends on income. Half of lower-income US adults reported that they could not afford much needed health care, compared to 27 per cent of higher-income adults.
Adults reported that their insurance denied payment of a claim or paid less than expected. The US performs poorly in maternal mortality, infant mortality, life expectancy at age 60, and deaths that were potentially preventable, if they had timely access to effective health care. The US rate of preventable mortality is 177 deaths per 100,000 population, which is double that of Switzerland, with 83 deaths per 100,000.
According to the Commonwealth Fund, an independent research organisation on health care issues, the best health care systems in the Developed World are in the United Kingdom, the Netherlands, and Australia.
The US is a glaring example of the inherent contradiction of the for-profit system. Based on the drive for profit, it is a failure in both human and material terms.
There is a lack of insurance coverage, especially in those states that did not expand Medicaid, and more especially if you are an undocumented worker; a maze of insurance plans that cover different treatments and procedures; and, primary care, fragmented, inefficient, and under-resourced.
The report “Maternal Mortality in the United States: A Primer” (16th December 2020) found that the US had 660 maternal deaths in 2018, a maternal mortality rate of 17.4 per 100,000 pregnancies. The maternal death ratio for Black women is 37.1 per 100,000 pregnancies, which is 2.5 times that for white women at 14.7, and three times that for Hispanic women at 11.8 per 100,000 pregnancies.
In 2019, the under-five infantile mortality rate was 6.5 deaths per 1,000 live births, placing the USA at 33 of 37 OECD countries. The worst infant mortality was amongst Black families with 10.6 deaths per 1,000 births. A Black mother with a college education is at a 60 per cent greater risk for a maternal death than a white or Hispanic woman, with less than a high school education. The US mortality rate is therefore dependent on race and ethnicity as well as income.
The US healthcare system falls far behind that of the former Soviet Union, where people mattered more than profits. I have spoken to people who had been to Soviet hospitals where they were well treated as a human being, something missing from a system created by US capitalism.
Today, Americans travel to Cuba to have operations because it is affordable and of such high quality. “Medical tourism” is allowed by the US Treasury Department on a case-by-case basis. While the pharmaceutical and healthcare corporations make massive profits, Americans struggle daily with their health and medication bills. It is a path to disaster that Australia needs to reject.
“Why American Healthcare is the Worst in the Developed World.”