America’s Healthcare Checkup: Part 3

Policy

Dec 5

A group of healthcare professionals have their hands together in the center of the image, like a team chant.

American healthcare is a mess. In our previous articles, we broke down the structure of our private/public healthcare system, how it works, and how it doesn’t. We also explored what’s driving high costs and who exactly is shouldering that financial burden. We know the sticker price is high, but we’ve always hoped the promised quality of care is equally high. Unfortunately for American patients, our healthcare is not worth the cost, in fact, it’s often much worse care for a much higher price.

In our final installment of America’s Healthcare Checkup, let’s talk about our quality of care, and how we might make our healthcare system work better for everyone.

American Health Outcomes

There are a few key indicators used to judge the effectiveness of a healthcare system: namely, life expectancy and contact with the healthcare system, as well as more stark indicators like infant mortality.

Unfortunately, the United States does not score very well on any of these indicators, made even more shocking given the price we pay for healthcare, as discussed in the previous articles.

Since 1980, life expectancy has gone up significantly in most countries around the world as healthcare technology improves, but the United States has lagged behind, and grown at a much slower rate. This has been made even worse with the COVID-19 pandemic, which saw a massive drop in life expectancy in the United States, a drop that was not matched by other wealthy nations. The average life expectancy rate in other OECD countries remains at least five years longer than the average American citizen. This puts the average life expectancy of Americans in line with the average life expectancy in Turkey. But for that same life expectancy, Turkey pays $857 per capita – to our $13,493.

Additionally, our infant mortality rate, (the percentage of infants dying in the first year of life), is at 5.7 deaths per 1000 born, compared to the OECD average of 4.2. The maternal mortality rate (percentage of mothers dying in childbirth per 100,000 people), is 23.8, compared to the OECD average of 9.8.

But healthcare is about more than life and death. It’s also about standards of care and quality of life. How does the United States stack up there?

Generally speaking, the United States scores low on most health metrics, from obesity to accidental death. The most extreme outlying score is from deaths by assault, with a 7.4 out of 100,000 ratio compared to the 2.7 out of 100,000 OECD average. The US obesity rate is also about double the OECD average, and Americans are more likely to suffer from multiple chronic conditions.

But it’s not all bad news. Americans have a higher rate of preventative screening than most other wealthy countries, including cancers, and a higher vaccination rate for influenza, (but lower for COVID-19).

These more positive measures actually line up fairly well with the major causes of death in the United States — save one. The top three causes of death in the US are heart disease, cancer, and accidental death (which includes drug overdoses, car crashes, and suicide).

Preventative care is fantastic, but does little for that last measure — accidental and unintentional death — which is a fast-growing and wildly disproportionate cause of death in the United States, currently at a ratio of 336/100,000, compared to the OECD average of 225/100,000. Even worse, in most other countries, this ratio is declining, but in the US, it’s been increasing at a faster and faster rate.

Getting a bit more granular, and looking at the differences within the United States will help reveal the solution to our healthcare woes.

Differences within America

There are substantial differences in health outcomes between different races and ethnicities in the United States, as well as between genders and sexual orientations.

The graph below shows life expectancy by ethnicity in 2021. As the graph illustrates, the range can be quite striking, with Asian residents tending to live the longest, with a life expectancy of 83.5 years, while at the lowest end, American Indian/Alaska Native residents have a life expectancy of only 65.2 years — an almost 20-year difference. These differences become more clear when looking at state-level statistics, which confirms some of these trends, and explains some of the differences.

*Data sourced from: Agency for Healthcare Research and Quality (2023 National Healthcare Quality and Disparities Report)*

One of the biggest determinants of living a healthy life is where you live. The social determinants of health, from diet to climate, to the number of physicians in your immediate vicinity are all incredibly important factors. So let’s take the ethnicity example a level deeper and talk about statewide results.

The next figure from the Commonwealth Fund features a breakdown of accidental death by ethnicity and state. It confirms the positive health totals for Asian residents across the board and helps explain the low American Indian/Alaska Native totals. Those numbers vary wildly by state, likely due in part to the number of people that live on reservations, (which have poor coverage, low economic opportunity, and poor social determinants of health), vs. in the general population.

These graphs are important not only because of what they tell us about ethnic health outcomes in the United States but also because of what they tell us about the differences between states and regions of America.

It would be easy to think that the major differences are between Democratic and Republican states, and that is notable, but generally speaking, much of our healthcare systems are national, from Medicare and Medicaid to the massive private insurers that we spoke about in the previous articles. Instead, the states that have great health outcomes, (from the US perspective, not international), have a few things going right that we can learn from.

The state that scores the highest for overall health outcomes in almost every metric year over year is Hawaii. To get one obvious point out of the way, the fact that Hawaii is a series of islands helps with physician density, people live closer to each other when they can’t spread out. However, the real differences are likely due to other factors.

Hawaii has a life expectancy of around 80.9, (equivalent to Chile and the United Kingdom but far lower than almost all other OECD countries), which makes it the highest life expectancy state in the nation, closely followed by California and New York.

Hawaii stands out in healthcare policy in a few areas, the first of which is its near-universal healthcare program, which mandates coverage for anyone working more than 20 hours per week. Hawaiians are therefore less likely to report missing appointments or skipping out on prescriptions due to cost and visit the doctor more often. Hawaii also joined many other states in expanding Medicaid coverage, which has been shown to increase life expectancy and decrease costs.

Hawaii’s success can be contrasted with the two lowest-performing states, Mississippi and West Virginia. Both states have low life expectancy, (ranking just below Mexico’s rate at around 74.4), and low scores in accidental death, infant and maternal mortality, and social determinants of health.

Mississippi did not expand Medicaid, while West Virginia did, showing that just Medicaid expansion is not fully determinative of health outcomes. These are tools that can move the needle a lot or just a little based on the situation of each state. There is no silver bullet. But that doesn’t mean we don’t have a real answer to our broken healthcare system, proved by other nation’s successes, and the positive outcomes from some of our own states.

What Really Works

Generally speaking, the states that expand publicly-funded coverage do better than the ones that don’t. When people can afford to go to the doctor, they do. When people can’t afford to go, they get sick and die earlier.

It’s not rocket science.

The truth is, private health insurance is a broken system. We are paying too much money for far too little care, while major companies rake in billions.

Every other nation in the OECD scores better on almost every health metric while costing their taxpayers much less than our private system charges through the fees we discussed in the first article in this series.

Other nations have much lower administrative costs because they don’t need to haggle over coverage. They don’t make money by turning people away. Nobody feels the need to skip out on care because of cost. They don’t have multi-billion dollar companies selling them drugs at the Super Bowl.

America deserves better. We can afford it: in fact, we even provide better care for other nations. Israel, historically the largest receiver of billions of American taxpayer-funded military aid — has single-payer healthcare. We subsidize their defense and they enjoy the care we say Americans can’t afford. But even that comparison is burying the lead somewhat. Because the truth is, it’s not even a question of cost.

We can afford universal single-payer health coverage. We know because we already pay more than we would if it was implemented.

The popular Medicare-for-All plan proposed by Senator Bernie Sanders would not cost Americans anything more than they already pay in taxes and fees to their private insurance companies. In fact, it would shrink US healthcare spending by 13%, while providing full healthcare coverage to every single American.

To reiterate, that is $450 billion a year in savings — while covering every single American from cradle to casket.

Single-payer healthcare would do for the US what other countries have had for decades, slash the useless administrative costs, end profiteering on healthcare, and ensure universal coverage. Even a Republican mega-donor Koch brothers-funded study found that Medicare-for-All would save 2 trillion dollars over the next decade.

And that kind of coverage is more than a cost-cutter, it’s a true lifesaver.

A recent Yale University study conducted after the COVID-19 pandemic found that a single-payer healthcare system would have saved close to 335,000 lives during the pandemic, bringing us more in line with the death toll of other nations.

The truth is simple — It’s not our diet. It’s not the states. It’s not our complicated social problems.

As much as Americans like to claim we are unique, we really aren’t — we all need healthcare, and Americans are suffering physically, mentally, and economically for no reason other than profit for a few major corporations.

Time to Act

It’s past time Democrats stopped tinkering around the edges. Even Obamacare was a Republican plan that Nixon had created decades before. Teddy and Franklin Roosevelt had proposed a national healthcare system decades before that, around the same time European nations did. It used to be the standard of our party.

Democrats can’t run from this anymore. The time for the real healthcare fight is now, and it’s only getting more urgent. This is more than good policy, it’s fantastic politics. Medicare-for-All is a political winner nationally. Pew Research states that “63% of U.S. adults say the government has the responsibility to provide healthcare coverage for all.” Additionally, a majority of Democrats favor Medicare-for-All, as well as a majority of Independents, and between a third to half of Republican voters.

If the pandemic lives lost and billions of dollars taken from sick Americans as profit in the past few years didn’t wake the nation up, then perhaps nothing will. It’s up to political campaigns and professionals to make the case for universal healthcare and communicate the true costs of care that Americans live with every day.

This issue, like so many in America, is allowed to persist because money continues to muddle the conversation, and our politicians fail to make the case clearly. Progressives and Democrats don’t have an excuse anymore. Armed with decades of data showing the financial, moral, and mortal cost of healthcare, they can make the case for universal care with data to back them up, and they can lay out exactly how Americans stand to benefit from a change.

We can’t afford to wait for the next pandemic. The time to push for real healthcare reform is now, and it’s up to Democrats and progressives to lead the charge.

Conclusion

In the past three articles, we’ve looked into how the US healthcare system functions and how it doesn’t. We dove into the costs of health insurance and care, where that money is going, and how it stacks up to other countries. Lastly, we explained what quality of care Americans are getting for their healthcare dollar, as well as what parts of the state are doing better or worse.

We hope that this series helps you understand how the system fails by taking a little off at each level of care, ballooning costs for healthcare while providing subpar coverage. Even at our best, American states are not doing all that well. What we need is a complete overhaul, one pitched almost a century ago, and echoed now by the majority of the American people.

We need single-payer healthcare. It is the common-sense solution that protects both our health and our wallets. With rapidly increasing costs, global pandemics, and ever-worsening health outcomes, this has to be one of the biggest concerns for lawmakers and political professionals around the country.

The next health crisis could easily spell disaster for our healthcare system, and it’s time we get proactive, take a lesson from the countries that do well, and invest in our own national healthcare system.

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