Is Health Care Really Better Outside of the United States?
There is certainly a lot going on in the world right now: Far-right politics are seeing a new rise, World War III might be on the horizon, and the American political system is in crisis.
But one of the biggest topics in the United States right now is health care reform: it’s one of the hardest issues that Trump and the GOP have had to face and one of the biggest targets of the new administration. They want to dismantle the Affordable Care Act (ACA), lower premiums for average (read: non-sick) Americans, and allow insurance companies to compete on the free market. But this is just the tip of the iceberg considering the other ever-changing health care legislations passing through Congress: everything from ACA repeal (the “skinny bill”) to smaller bills about financial costs and reimbursement laws.
But as the health care debate rages on in the Senate, the American public is becoming more and more attached to their Affordable Care Act privileges. Although the 2010 “Obamacare” bill has its own list of issues, the alternative seems to be increasingly more terrifying for even average Americans.
However, it brings up the age-old question of American health care: is it really so great here? When discussing universal or social health care, many Republican leaders (and their supporters) seem to parrot the same excuses: “Social health care is bad because it limits the choices you have, increases the amount of time you have to wait for medical treatment, and decreases your access to top-notch care.”
But if that were true, other countries that already have social health care would be in shambles. Instead, they’re thriving. So what is it about our American health care system that is so wrong? Is health care really that much better outside of the United States? Let’s find out:
Where Does All the Money Go?
Money is definitely the biggest concern surrounding health care. For one: prescription medication and care is expensive. Bills for simple services can be astronomical: with reports showing some hospitals charge $7 for an alcohol swab, or $37 for a single Tylenol pill. The American public knows that those services should never be that expensive, but hospitals are charging through the roof for them. Why is that?
Diving to the bottom of many of life’s mysteries is Adam Conover, star of “Adam Ruins Everything.” His latest episode tackled some of the more common misconceptions about health care costs and treatments. According to his thorough research, almost all the prices come from a hospital’s “chargemaster:” a master document (normally on their computer network) that determines the price for every activity and item used. How do they get these prices?
Turns out it has nothing to do with politicians or even the cost of the item, but it has everything to do with insurance demanding a discount from these hospitals.
Prior to health insurance being an industry in the United States, many hospitals only charged a small amount over the cost of a service to stay profitable. When health insurance started becoming more popular, these services demanded a rigorous discount from the hospitals in exchange for providing them with patients. Those price cuts, however, were undercutting hospitals, making them struggle to afford insured patients at all.
So instead, they created the chargemaster — a list of prices that are far over the actual cost so they can provide a “discount” to insurance companies and remain profitable — that has since dictated how all their services are priced. However, this has resulted in massively inflated prices for all their services, and those prices are used for all insured and uninsured patients, as well as those that are not covered within the network.
Health insurance itself can get pretty complicated. After the ACA was put into practice in 2014, there was an expansion of insured individuals, but many of them still struggle to pay their bills despite the insurance discount. Now the options available in the US are term, ACA, Medicaid or Medicare, and employer provided insurance, but they each come with their own list of pros and cons. Some cover pre-existing conditions, while others don’t. Some provide a wide network of providers to choose from, while others limit those providers to just a handful or one.
To top it off, some of these plans only cover a fraction of the services you might need during an emergency situation: meaning it’s easy to get slapped with an astronomical bill if you’ve had an accident or suffered from a surprise heart attack.
But in the end, where does all this money go? As research has revealed, the majority of these profits are funneled up to the top pharmaceutical and hospital CEOs, as well as insurance company leaders in health care.
In an interview with NPR, reporter Bob Herman answered the question of “why” when considering the skyrocketing cost of health care in the United States. Why are CEOs paid so much, and what does that say about health care in the United States? His answer: “For the longest time, health care inflation has really blown away the rate at which the rest of the economy is growing. And a big reason why is because health care executives are not paid to slow spending. Because so much of their pay comes in the form of stock, their incentive is to do whatever it takes to make that stock go up. So that means selling more drugs; raising prices above inflation; performing more procedures; getting more people into the hospital. And those are the exact opposite things that health policy experts believe would benefit the broader system: lower prices; eliminating unnecessary care and drugs; coordinating better care.”
And so it is that the people are suffering under astronomical medical bills, without any sign of relief. But it is profitable for the CEOs and leaders to continue to push and lobby for ACA repeal or against a single-payer option. Obviously health insurance and health care is not something that should be left to the free market, but the billion-dollar health care industry doesn’t want you to know that.
Health Care Outside of the United States
However, if health care in the United States is so out of control, then how does it work so well for those outside of the US? How is health care in Europe, Canada, Japan, or Australia?
Europe is a glowing example of how universal health care should work for the masses. Health care coverage is determined at the national level, but universal coverage is also accepted for all participating European Union national members and their citizens through an international pre-paid emergency card. Taxpayers help pay for the universal coverage, and the price for services is not astronomical.
Many would assume that these countries do not utilize the same equipment to help cut costs — the various radiological and imaging technologies can cost thousands (even millions) of dollars to install in a hospital, and in the US patients can be charged thousands of dollars for their use — but the fact is many countries have the same equipment and will even use them more often due to their reasonable prices.
France, for example, has more cancer radiation equipment options than the United States, and Japan utilizes more MRI scans for hip and knee replacement than the United States. Additionally, many American drug companies will actually sell their medications overseas, often with a different name (same ingredients) but at a much lower price. Thus it is that access to care is not a concern because the price is accessible to the general population.
The next most common myth is that those with universal health care have little choice of when they get to see health professionals. But this myth has been busted time and time again, as European countries have considerably better wait times than the United States.
Research has also shown that the lifespan of people in these countries is higher due to universal care. People don’t have to struggle to get the financial help they need to stay alive; they are instead presented with exceptional modern care with only a minor dent in their finances.
To top it off, private insurance still exists in these countries, but it’s seen as an added benefit for those who can afford it. Switzerland has an abundant private health care system, but it doesn’t affect the overall cost of care for those outside of the private network. Australia also has private options for businesses that want to provide a service to their employees, and the countries incentivizes these businesses with FBT tax cuts to help them save money and build a stronger, long-lasting group of employees. But — again — it doesn’t affect the price of care for the general population.
Health care should be a human right, not a capitalist cash grab for health care leaders and pharmaceutical CEOs.
How Should This Shape the US Health Care Debate?
Is health care better outside of the United States? Yes, especially in the European Union, Australia, Japan, and Canada. The proof and research is easily available, and experts all agree that things in the US need to change if the country wants to support its citizens.
But will things get better in the United States? Probably not. In 2013, Time Magazine writer Steven Brill dug deep into the health care industry to try to discern why Americans were suffering so much from astronomical bills. His discovery proves that health care most likely won’t change anytime soon: “According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.”
However, there are some positive signs coming out of the health care debate. Many lobbying groups that represent nurses and doctors are showing support for the ACA and rejecting any attempts to repeal or replace the 2010 bill. However, this support for Obamacare is also a potential rejection of any alternatives: possibly even the alternative of universal health care.
Dan Munro, a writer with Forbes, sees it a bit differently. Although we are the wealthiest nation in the world, we are not immune to the downfall of a tiered-priced health care system. Someday soon, the conversation will switch from a fiscal discussion to a human rights discussion, simply because our current setup is failing. He writes on the importance of single-pricing, saying: “Universal health coverage isn’t a matter of if–only when–and not just because it’s the right thing to do, but because it’s in our collective economic and clinical interest to end tiered pricing as the way to maximize revenue instead of optimizing for health.”
Until we make that switch to a more universal system, the health of the population will continue to decline. Our current system is simply not sustainable, and other countries around the world have shown us how it should be done. Will American politicians listen? We can only hope that they will soon heed all the warnings.