Senior National Editor
The United States has the best health care system in the world – don’t mess with it!
The U.S. health care system needs to be fixed so that everyone can afford the care they need!
Those competing refrains from the 2009 summer of contentious health care reform town halls (example: Ybor City, Florida) will be heard again March 26-28 when the Supreme Court of the United States hears three days of historic argument over whether elements of the Affordable Care Act signed into law by President Obama in two years ago this month violate or are within the bounds of the U.S. Constitution.
Interestingly, 14 percent of Americans believe the Supreme Court already has struck down the Affordable Care Act, according to a new poll by the Kaiser Family Foundation. In line with other polls, most respondents (51 percent) to the Kaiser survey believe the law’s requirement that Americans purchase insurance is unconstitutional, while 28 percent felt it constitutional. By a similar margin of 53 percent to 33 percent, most respondents expect the Supreme Court to overturn the law.
Pending those rulings by the Supreme Court, provisions of the law will continue to take effect.
"I believe that the health care bill that was enacted by the current Congress will kill jobs in America, ruin the best health care system in the world, and bankrupt our country," House Speaker John Boehner, A Republican from Ohio, said in November 2010. "That means we have to do everything we can to try to repeal this bill and replace it with common sense reforms to bring down the cost of health care.”
Wendell Potter, a former executive of the CIGNA insurance company and a critic of the industry, this past November wrote a rebuke to the opinion voiced by Boehner and others: “Well, those guys need to get out more. Out of the country, in fact. They need to travel to at least one of the many countries that are doing a much better job of delivering high quality care at much lower costs than the good old USA.”
If you like your doctor, if your insurance works, if you feel that you’re getting good value for your health care dollar, then in your view the U.S. system may rank high. If you don’t have a regular doctor, if you’re without insurance or underinsured, if you’re swamped by medical bills, then in your view the U.S. system may not rank so high. And this is aside from debate over the role of government in the health care system.
Americans spend the most money on health care, both when measured per capita and as a share of the nation’s Gross Domestic Product. In 2010, Americans spent a record $2.6 trillion on health care, roughly $8,400 per American, equal to 17.9 percent of the GDP and a “mere” 3.9 percent more than the year before, as the economic slowdown gripped even this area of spending.
The federal Centers for Disease Control and Prevention recently reported on the burden of health care costs at the dining room table: “In the first 6 months of 2011, one in three persons was in a family experiencing financial burden of medical care. One in 5 persons was in a family having problems paying medical bills, 1 in 4 persons was in a family paying medical bills over time, and 1 in 10 persons was in a family that had medical bills they were unable to pay at all.”
"Accelerating health care costs are a primary reason that the so many American families feel like they are just treading water financially," said David Auerbach, an economist and lead author of a RAND Corporation study on health care spending. "Unless we reverse the trend, Americans increasingly will notice that health costs compromise their other spending options."
The Organization for Economic Cooperation and Development, which includes the United States, late last year reported that that Americans pay two-and-a-half times more per capital for health care than the average of the 40 nations, including the U.S., included in its survey. The OECD reported that on average Americans spend 60 percent more on hospital treatment than the average of five other countries deemed relatively expensive (Switzerland, Canada, Germany, France and Japan); spending on drugs and other medical supplies is much higher and administrative costs are more than two-and-a-half times higher.
What do Americans get for all that spending? The OECD report puts the U.S. number one in five-year breast cancer survival rates and second (behind Japan) in five-year colorectal survival rates. The U.S. also ranks first in knee replacements and second (again to Japan) in the number of magnetic resonance imaging (MRI) machines per one million people.
On the negative side of the ledger, the U.S. ranked 29th in the number of hospital beds per person, 29th in the average length of a hospital stay, 26th in the number of physicians (notably primary care of family doctors) per 1,000 people and 28th in life expectancy. The average age of death in the U.S. was 78.2 years, compared with an average of 79.5 years in the other OECD countries.
A study released in October by the Commonwealth Fund offered more bad news. The “National Scoreboard on U.S. Health System Performance, 2011” held that the U.S. is losing ground to other countries in assuring citizens equal access to affordable, efficient care. Based on a review of 42 “performance indicators,” the U.S. score of 64 out of a possible 100 showed costs rising, access to care declining and outcomes falling behind the benchmarks. On top of which, the U.S. was falling behind gains made by other nations, ranking last out of 16 countries when judging deaths that could have been prevented by timely and effective care.
The Commonwealth Fund report cited insurance – an issue at the heart of the spending SCOTUS arguments – as a major issue, stating that last year 81 million adults in the U.S. (44 percent of all adults under age 65) either were uninsured or underinsured at some point during the year. As a result, the report said, Americans are more likely than their counterparts in other nations to die from preventable or treatable conditions.
All of this will come into play as the highest court in the land hears arguments over the health care law inside its chambers, while outside the Supreme Court that refrain – “America has the best health care system in the world” – will be heard and debated anew.