Saving on health care at the cost of people’s health
Health care spending in the US has slowed because fewer people can afford health services.
Last Modified: 27 Feb 2013 15:13
Nearly 50 million people in the US have no insurance at all, while tens of millions more are “under-insured” [Reuters]
In his recent State of the Union speech, President Obama remarked in one short sentence that “Already, the Affordable Care Act [ACA] is helping to slow the growth of health care costs”. That was the extent of his comments on the historic health care bill he signed into law in March 2010 after more than a year of pushing health reform through Congress. It is true that total health care spending in the US has slowed, but it does not have much to do with the ACA. Instead, it is another symptom of the ailing market-based health system in the US which is causing poor health outcomes and growing inequality.
The US is unique among industrialised nations when it comes to health care. All other wealthy nations have some type of national universal health system that is publicly financed. The US relies primarily on a market-based health care system in which most private health insurance is tied to employment. There are public programmes, Medicaid, for those who are in extreme poverty, but these are subject to state-balanced budget pressures and struggle to meet the needs of their populations. And there is a public-private system for people 65 years of age and older, Medicare, that is financed through taxes at the Federal level. Overall, health coverage is private except for many people who do not qualify for public programmes and find private health insurance unaffordable.
Privatised health system: A failed experiment
The US health system is a failed experiment. Since the 1980s when the US moved aggressively to privatise the financing and delivery of health care, the cost of care, health disparities and the number of people without insurance have climbed. The US spends more per capita on health care than any other country and has excellent health facilities, but in the US, patients receive the amount of health services they can afford rather than what they need.
In fact, health care spending per capita in the US is two and a half times what the average OECD (Organisation for Economic Co-operation and Development) nation spends. Total health spending constitutes a greater piece of the Gross Domestic Product (GPD), currently at 17.9 percent, than the OECD average of 9.5 percent. Yet, nearly 50 million people in the US have no insurance at all. And tens of millions more are under-insured, meaning they have insurance but suffer significant financial barriers to care and face bankruptcy in the event of a serious accident or illness.
A study using data from 2007 found that 62 percent of all personal bankruptcies were due to medical illness and costs and nearly 80 percent of those who experienced medical bankruptcy had some sort of health insurance. In the US it is not uncommon for communities to hold fundraisers when someone is diagnosed with cancer or other significant health conditions. It is also not uncommon for parents to forego care when they have a terminal illness and die prematurely rather than leaving their family behind with no home or other assets.
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