Why America Needs a National Health Service
The COVID-19 pandemic is proving to be a profound challenge for billions of individuals.
But, it is also challenging the basic assumptions underpinning our societies.
One of these assumptions is the American societal refusal to treat healthcare as a universal right.
The U.S. Health System Today
In the midst of the COVID-19 pandemic, the U.S. health system is struggling to cope. The complex network of public health agencies, medical care systems, insurers and state-specific aid has made it difficult for a necessary and coordinated response to be made. As Tim Putnam, chief executive of Margaret Mary Health in Indiana, told the FT:
“People talk about the United States healthcare system like there is one. There really isn’t.”
The majority of U.S. healthcare is funded privately, and a market-competition mentality has affected the response to coronavirus; hospitals, cities, and state governments have waged bidding wars for essential equipment. Many hospitals have had to resort to donations for masks.
Hospitals face critical cash shortages, even after a $175-billion bailout. Thousands of medical workers have been laid off at a time when they are most needed.
The impact this uncoordinated response has had on individuals has been horrific; the U.S. has had more coronavirus cases than any other country. Over 100,000 people have died. Tens of millions have been made unemployed. And because employers often pay for health insurance, people made unemployed have also lost their health coverage at a time when they most need it.
In normal times, the U.S. healthcare system seems to punish poorer people and minorities; every year, 30,000 people die in the U.S. because they couldn’t afford to get to a doctor when they needed to see one.
In the middle of one of the worst pandemics for decades, this financial and racial disparity has been made worse. 30% of reported coronavirus deaths in the U.S. are African American individuals, even though they make up less than 15% of the population.
The most unconscionable stories are of the individuals affected by the inadequacies of the U.S. health system.
In any country, it’s unthinkable that a coronavirus patient’s tragic last words would be:
‘Who’s going to pay for it?’
For the richest country in history, it’s shameful.
The Cost of Healthcare
Unlike the U.S., the UK National Health Service (NHS) is funded largely through general taxation. The services offered are free at the point of use, meaning that at any time of day (or night), you are given care at no cost, with often no forms or bureaucracy involved.
UK citizens are often astounded when they hear about the extortionate amount U.S. individuals have to pay for routine operations and basic medicines. This incredulity is captured in this viral video by JOE UK.
Perhaps you’re thinking the reason why U.S. healthcare seems so expensive to Brits is that healthcare costs are (at the point of use) invisible to individuals.
It’s not as simple as that, though. The expenditure on healthcare in the UK is actually far less than in the U.S.
Let’s break down the figures.
- The U.S. spends $3.6 trillion per year on healthcare or $10,207 per person.
- The UK spends $244 billion per year on healthcare or $3943 per person.
Shockingly, even though the U.S. spends 158% more per person on healthcare than the UK, health outcomes are worse in the U.S.
Life expectancy in the U.S. is 78.9 years, which is substantially lower than the UK’s 81.2 years.
Frequently, commentators in the U.S. claim that single-payer healthcare systems are:
- Horrendously expensive.
- Unfair on workers who would face a higher tax burden.
- Damage Innovation.
But, this disguises the real truth: that the U.S. healthcare system is the most expensive, inefficient, and bureaucratic in the world.
Inefficiencies occur for a host of reasons within the United States:
- Resources devoted to health insurance marketing.
- Insurance administration and billing.
- Uneven insurance coverage leading to a misallocation of resources.
Much of the inefficiencies stem from the fragmented state of the health system. Adam Gaffney, an instructor of medicine at Harvard Medical School, and a critical care doctor writes:
“We have a completely fragmented, privatised health system that continues to fail us.”
To quantify the scale of U.S. healthcare inefficiencies, a 2014 study found that 25.3% of U.S. healthcare expenditure, or nearly a trillion dollars, was spent on administration costs instead of care. For context, this amount could fund the UK’s annual healthcare budget three times over.
To reduce the scale of this wastage by bringing in a single-payer system would be immediately significant in improving health outcomes in the U.S., and also lead to lower costs imposed on individuals.
Reducing wastage like the marketing and administration costs of the health insurers doesn’t mean losing out on innovation, a common claim against single-payer healthcare. For example, some of the most promising coronavirus vaccine research is being undertaken in countries with universal healthcare systems, like the innovative vaccine being developed at the University of Oxford in the UK.
The Path to Progress
Despite what you may hear, the vast majority of Americans want reforms to the healthcare system, and 69% of Americans support providing universal Medicare. The main obstacle for change is lobbying from the billion-dollar health insurance industry. Unfortunately, despite attempts at smaller reforms like the Affordable Care Act, it’s still common for people to be bankrupted by medical bills.
The path to progress may be slow. But, with greater support than ever for healthcare reform — and the potential for a shift in political discourse after the coronavirus outbreak — we can still hope.