• U.S. health care ranks low
    November 21,2013
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    As they go about their various efforts to undermine the Affordable Care Act, Republicans regularly declare that the federal law is a dire threat to the best health care system on the planet.

    Mind you, this is hardly the first time conservatives have had a problem with perspective. Recall that Ronald Reagan once warned Americans that if Medicare passed, “you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.”

    These days, when senior care is the topic, Republicans are more likely to be found criticizing President Obama for trimming Medicare to finance the ACA.

    The ACA itself, of course, is viewed as a wrecking ball aimed at a health care system that GOP leaders see as without parallel. Senate Minority Leader Mitch McConnell calls it “the finest health care system in the world.” House Speaker John Boehner declares it “the best health care delivery system in the world.”

    It’s certainly the most expensive system in the world. Based on 2011 data, the U.S. spends about $8,500 a year per person on health care. Switzerland and Norway both expend about $5,700, the Netherlands about $5,000. In 2011, France spent less than half of what we did, or about $4,100 per capita, while Sweden clocked in at about $4,000.

    Given our per-person costs, it shouldn’t come as a surprise that, even without universal coverage, the U.S. spends a larger percentage of Gross Domestic Product than other industrial democracies. We’re at about 18 percent of GDP; the Netherlands, France, Germany, Canada, and Switzerland all spend between 11 and 12 percent. Norway and Sweden shell out less than 10 percent.

    Ah, a skeptic — or a Republican congressional leader — might reply, but the U.S. system offers better care. Not so. Not in the eyes of recipients, anyway.

    The latest evidence comes from public-opinion surveys that sampled at least 1,000 people in each of 11 countries, research sponsored by the nonprofit, nonpartisan Commonwealth Fund.

    So which country had the largest percentage of people reporting that, because of the cost, they hadn’t seen a doctor when they should have? That would be the United States, at 32 percent. It’s quite a drop to the number two position, shared by the Netherlands and New Zealand, at 20 percent, or to third, shared by France and Australia, at 14 percent.

    Which country had the highest percentage saying they hadn’t filled a prescription or had skipped doses to save dollars? Once again, the United States, at 21 percent. No other country was even in double digits.

    In light of the controversy over the ACA, here are two other interesting findings. Even among those who reported they were insured all year in the United States, 21 percent still said they had forgone a doctor’s appointment for cost reasons. Meanwhile, 42 percent of insured Americans said they had more than $1,000 in out-of-pocket medical expenses. Next closest? Australia, where 25 percent report spending that much.

    Nor does the average American share the rosy Republican view of U.S. health care.

    Only a quarter of Americans said the U.S. system worked well enough to need only minor changes, while almost half said it required “fundamental changes,” and another 27 percent said it should be completely rebuilt. That far outstrips the level of discontent reported in the other countries. The closest were Germany and Canada, where only 42 percent thought their systems worked relatively well; but even there, the percentages who said health care in their nation needed a complete overhaul were less than half of the U.S. figure.

    Meanwhile, other data shows that U.S. life expectancy is well back in the pack of the 34 countries of the Organization for Economic Cooperation and Development, behind all of western Europe.

    “The U.S. often thinks its health care is the best, but we really don’t stack up very well when we compare ourselves to other high-income countries,” notes Cathy Schoen, senior vice president at the Commonwealth Fund. “We spend a lot more, our access is often worse, we face more medical debt, and our health outcomes are often worse.”

    The point, then, is a simple one. Yes, the ACA’s roll-out has been a frustrating mess. But the idea that Obamacare will somehow ruin a uniquely stellar health care system just doesn’t scan, because that’s not the system we have.



    Scot Lehigh is a columnist for The Boston Globe.
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