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COVID-19 Reveals the Weakness of the U.S. Public Health Infrastructure

The spread of COVID-19 across the U.S. is perplexing. If, in the words of Georgia Congressional Representative Buddy Carter: “We have the best healthcare system in the world,” why does it appear that the United States is one of the hardest-hit nations in the world and on the brink of shutting the economy down to try to prevent its spread? Should not a country that spends more of its gross domestic product than any other country in the world on healthcare be better prepared to confront this medical emergency than other countries? The answer is no, simply because while the U.S. may have a great private healthcare insurance and delivery system, it has an exceedingly weak public health system.

In 2019, the U.S. spent 17.8% of its gross domestic product on healthcare expenditures. Its next closest rival was Switzerland which spent 12.1% of its GDP. Per capita, the U.S. spends more than $10,000 per year on healthcare, 20% more than Switzerland. Despite this spending, the U.S. ranks 46th in the world in life expectancy, 55th for infant mortality rates, and a prevalence of incidence of infectious diseases at 9%, triple that of China and Japan at 3%, and 50% larger than the incidence of 6% in many European Union countries. These three factors are traditional markers of health across the world.

Moreover, compared to other advanced countries, 91.7% of the U.S. population has healthcare insurance, ranking 35th in the world and far behind most other rich countries across the world which have 100% or universal coverage. In essence, the U.S. has the most expensive healthcare system in the world and it does not cover everyone and it does not produce the best outcomes. We pay too much for too little. It is hard to argue that we have the greatest healthcare system in the world based on these statistics.

We pay too much and get too little for at least two reasons. One, compared to other countries we have the highest drug and administrative costs in the world. But equally important, the U.S. has among the weakest public healthcare delivery systems in the world. By public healthcare, one needs to look at what we spend for example on long term care, preventive care, the gathering of healthcare epidemiology statistics, and perhaps even on nutritional and diet programs. Looking at those factors we lag behind many countries in the world. We have not built a public healthcare infrastructure that is as well suited as is other countries to address public health crises such as the rapid spread of infectious disease as COVID-19. As has become clear, the funding for the Center for Disease Control is behind what it needs to be to do the research and tracking necessary for healthcare issues, and there seems to be no federal infrastructure in place to coordinate a national health emergency. States appear to be left on their own, ill-suited or prepared to address a national or global health emergency.

The U.S. has a terrific private healthcare delivery system, for those who can afford it. For those who want and can afford a doctor, it is terrific. For those who want and can afford elective surgery, it is terrific. For those who want treatment for highly personal healthcare problems and can afford it, it is terrific. For those who want and can afford a wonder drug, it is terrific.

But in terms of treating or preventing basic maladies, U.S. healthcare delivery is weak. It is weak because it is a system based upon a privatized notion of health and healthcare. Health is a personal, not a public issue, as is the cost or responsibility for paying for it. Health and healthcare are seen not as public goods but as private or individual commodities that we each individually are responsible for. Moreover, healthcare reform in the U.S. has, at least since the failed Clinton reforms of the 1990s and the passage of Obamacare of 2010 has been focused on insurance and not on improving the structure of the actual delivery system for healthcare, let alone for the public aspect of it.

The U.S. spends a lot of its effort on providing insurance to access a healthcare delivery system that is seen as more of a private good than something that is universally important. We have under-invested in the public aspect of healthcare compared to many other countries, rendering the U.S. far less prepared to confront a public crisis such as COVID-19 compared to other nations in the world. If we have learned anything from the current crisis, we need to invest more in public health than we currently do.