The Only Option for Health Reform Is the Public Option

By Guy T. Saperstein, AlterNet. Posted August 5, 2009.

The United States has the most-expensive, least-efficient and, in many ways, most-ineffective health care system in the world.

But you wouldn't know it if you listened to Republicans talk about the private health care insurance system or Democratic Blue Dogs whine about the costs of reform and complain about how unfair it would be to have private health insurance companies compete with a public health care option.

The World Health Organization ranks health care systems based on objective measures of medical outcomes, and the United States' health care system ranks 37th in the world, behind Colombia and Portugal (which both spend far less on health care than the U.S.).

The United States ranks 44th in the world in infant mortality, behind many impoverished Latin American countries. Although infant mortality in the United States is skewed toward poor people, who have rates double the wealthy, the top quintile of the U.S. population has infant mortality rates higher than Canadians in the lowest quintile of wealth.

Not only are 47 million Americans uninsured (approximately 18.5 percent of the insurable market), 41 percent of Americans with incomes of $20,000 to $40,000 did not have health insurance for at least part of 2007, up from 28 percent in 2001; 53 percent with incomes under $20,000 lack health insurance.

There are additional costs to the haphazard U.S. health care system: More than 50 percent of the U.S. population has medical debt problems; between 1981 and 2001, medical-related bankruptcies increased an astounding 2,200 percent, and 55 percent of personal bankruptcies are now caused by illness or medical debts, despite the fact that more than 75 percent of the bankrupted individuals had health insurance at the onset of bankruptcy and illness.

Contrary to popular conceptions, the average medical bankruptcy was a 41-year-old woman with children and with some college education; more than half owned homes, and more than 80 percent were in the middle or working classes.

The number of people without health insurance rose 18 percent from 2001 to 2007; average health insurance premiums for a family of four are more than $13,000, which exceeds the annual gross income of a full-time, minimum-wage worker.

The lack of insurance causes 18,000 excess deaths a year; people without health insurance have 25 percent higher mortality rates; and, 59 percent of uninsured people with chronic conditions such as asthma or diabetes skip medicine or go without care -- and get sicker.

Out of 30 developed nations, life expectancy in the United States ranks 21st: Life expectancy in the United States is 4.6 years less than Japan, 2.1 years less than France and 2.6 years less than Canada.

The United States has fewer physicians, nurses and hospital beds than most developed nations. In the United States, 28 percent say it is "difficult to get care"; in most European countries, Japan, Australia and New Zealand, 15 percent say that. In terms of continuity of care (i.e., five-plus years with the same doctor), the United States is the worst among developed nations.

By every objective measure, the United States has a second-rate health care system.

The Truth About Health Care Costs

Even including the 47 million uninsured, the bloated, inefficient U.S. health care system costs more than double per capita what single-payer health care systems in Europe, Japan and Canada cost.

In the United States, health care costs were $6,001 per person in 2007. By contrast, in Japan, with life expectancy 4.6 years more than the United States (presumably a cost-increasing factor), health care costs were $2,139 per person; in the United Kingdom, $2,232; Sweden (the ultimate "welfare state"), $2,520; France, $2,903; and Canada, $3,001.

And, this is not just an individual problem; this is a national problem. Health-care system costs in the United States are 17 percent of gross national product (and currently increasing 12 percent per year). No other country in the world has health care costs that exceed 11 percent of GNP, and the average among developed nations is 9 percent.

These high costs are making the U.S. uncompetitive in many areas. For example, U.S. carmakers spend $1,500 per car on health care -- more than the cost of the steel in cars -- and are competing against European and Japanese carmakers who spend nothing for health care.

See more stories tagged with: health care, reform, health care system, public heath care

Guy T. Saperstein is a past president of the Sierra Club Foundation; previously, he was one of the National Law Journal’s "100 Most Influential Lawyers in America."

Liked this story? Get top stories in your inbox each week from Health and Wellness! Sign up now »