U.S. Healthcare: Getting Less for More

Once upon a time in the bad old twentieth century, any American family caught dead without its very own funeral plot would be publicly shamed. That changed as Americans began to believe that living in the world’s sole superpower made them invincible. Having a funeral plot at the ready seemed unnecessary. According to disturbing reports from major health foundations and the CIA, Americans might be advised to revive that “quaint” custom and put cemetery plot purchase at the top of their to-do list.

By one measure the U.S. has fallen from superpower to banana republic in less than two decades. According to the CIA’s World Factbook, average life expectancy in the U.S. in comparison with every other country in the world has gone from respectable (1999- 24^th) to abysmal (2010-49^th) back up to terrible (2016 – 42^nd with a life expectancy of 79.80). That ranking puts us south of Greece (that’s right Greece which managed a respectable 35), Japan (3) and would you believe it the recipient of more US largesse than any other country, Israel (at 11, one step away from the coveted top 10, perhaps they should start sending the U.S. aid). Before you get too carried away by those Israeli statistics, note, not all things Israel are equal. Far from it. A huge differential exists between living in Israel and living under the boot of the Israeli occupation. The facts of the divide are cringe-worthy. In the two occupied territories, Gazans are in 125^th place (out of 224 countries) and live on average 73.9 years; West Bank residents, in 111^th place, live slightly longer at 74 years. Not even close to the 82.40 average life expectancy of Israelis.

Get out the crying towel, the worst is yet to come. Among the 35 OECD countries (Organization of Economic Cooperation and Development, the most advanced Western “democratic,” free market economies), the U.S. clocks in at 26 trailing Japan (#1), and almost all western European countries. Adding insult to injury, with an average life expectancy of 79, the U.S. is one of only 9 nations whose citizens, on average, do not live into their eighties.

Infant mortality is another huge chink in the U.S. colossus. According to the 2016 Annual Report of the United Health Foundation, infant mortality in the U.S. is a major health issue. Only six OECD countries have higher rates of infant deaths. In over one-third of OECD countries, the infant mortality rate is one-half that of the U.S. While we’re on the subject, other statistics that put the U.S. in the top ten on the wall of shame—highest child and infant mortality rate along with body mass index (we’re too fat) of any high-income country. In a quirky but telling measurement — the U.S. is the first among wealthy nations to experience a halt, possibly even reversal of increases in height among the adult population. (No doubt from the official U.S. diet — fat, fat, and more fat).

After all this gloom and doom, it is reassuring to note the one metric that puts the U.S. in first place, head and shoulders above its rivals. In 2015, U.S. health expenditures, as a percentage of GDP, clocked in at 16.9%. Contrast that with the most recent Centers for Disease Control longevity report that found U.S. life-expectancy dropped for the first time in more than 20 years in 2015. The only top ten killer disease that saw an increased survival rate was for cancer.

Other than Switzerland which spends 11.5% of GDP on health care, the other 33 OECD countries spend less than 10% of their GDP annually on public and private healthcare. The kicker — every single, last one of them has lower infant mortality and longer life expectancies.

How could this be? According to most health policy experts, the U.S “uniquely inefficient” health care system is the little engine that could when it comes to producing profits for the hydra-headed monster that is the American free-market healthcare system. Not on the gravy train —patients. In a society studded with inequalities, meet a couple more. Free market healthcare —winners and losers. Not hard to figure out who the losers are. Every single American who needs health care and is forced to get it in this fee-for-service environment with its skyrocketing insurance premiums, unaffordable co-pays and deductibles, and exploding prescription drug prices. And the winners —the oligarchs who own both America’s healthcare system and America’s leaders.

As American healthcare representatives boast of life-saving procedures, innovative drugs for almost any condition and diagnostic tests that can spot disease before it becomes life threatening, the ever-mounting costs of diagnosis and treatment leave most Americans on the outside looking in. As costs rise, fewer Americans fill those life-saving prescriptions, undergo those life-saving procedures and often reject the diagnostic screenings that keep a little problem from becoming a life-ending disaster. How do we square a country so blessed with technological know-how, world-class research facilities with a population with the lowest life expectancy in the developed world and conversely some of the highest infant mortality?

A superpower with escalating obesity rates, an opioid crisis that is the leading cause of death for Americans under 50, a gun culture with the highest per capita gun ownership in the world, and millions who cannot afford even the most basic healthcare is not really a superpower at all. Is it?