For the past three columns, I’ve covered a 2018 scientific study published in the Journal of the American Medical Association (JAMA) that found that the U.S. spends nearly twice as much for health care as the average of 10 other high-income countries while consistently achieving the worst health outcomes in key areas such as life-expectancy, maternal mortality, and infant mortality, among others.
I typically aim to keep my column series to no more than three columns at a time, however the outpouring of emails and responses I’ve received have been unprecedented. These have ranged from resounding endorsements to criticisms of the content. Because of this, I want to cover this topic in a bit more detail. Specifically, I want to cover some of the common objections that come up regarding substantial change to the U.S. health care system.
Before we dive in, though, I want to reiterate that what I have provided through the past three columns is a review of objective data. It is not my personal opinion. In fact, it has been found in study after study that we spend far more on health care per person and as a percent of GDP than other high-income countries and we consistently have the worst outcomes. I didn’t believe it either the first time I studied it. If you’d like further detail on the components of the study I’ve already covered, please check out southstrandnews.com.
First, let’s define a few terms. Although they are commonly grouped together, “national health system,” “single-payer system,” and “universal health coverage” are not exact synonyms. Universal health coverage means that everyone or very nearly every citizen of the country has health insurance. A national health system, on the other hand, implies universal coverage, however it often takes it a step further. National health systems are financed by the government but, as is the case in the U.K., the government also is the only payer for health care services and they even own the hospitals and employ the doctors and nurses that work for the hospitals. Single payer, similarly, means that the government is the only payer for health care services but it doesn’t mean that the government owns the hospitals or employs the bulk of doctors and providers.
So why is this important? Well, there are many different types of health systems in other countries and they each have their pros and cons. One of the first oppositions often heard when comparing the U.S. to other countries are the long wait times that some countries have for health care services. However, does it hold up that the U.S. always has the best wait times?
The 2018 study found that there was a large difference in wait time depending on the structure of the health system. In the U.S., six percent of people experienced a wait time of two months or longer to see a specialist. For all countries combined, the mean wait time was thirteen percent. However, countries who had universal health coverage with insurance-based systems, such as the Netherlands, Germany, and France had far lower wait times to see a specialist (7%, 3%, and 4% respectively) than those with national health service and single-payer systems, such as Canada (39%) and the U.K. (19%).
This is a point I want to emphasize. In this study, countries with tax-funded health care for all citizens in an insurance-based system performed right around the same as the U.S. in regard to two month or more wait times to see specialist, and two performed better than the U.S. As for the ability to get a same- or next-day appointment, the U.S. actually ranked in the middle of the pack behind all of the mandatory health insurance system countries. Mandatory health insurance systems, in many outcomes that I’ve reviewed, appear to outperform, not just the U.S., but notably national health systems and single-payer systems. This is part of the reason I do not support “Medicare-for-all.”
Since I’m sure many people are not familiar with the setup of these national health insurance systems, let me briefly give a high level overview. Taxes are collected by the government to finance health care in these systems. However, those taxes don’t simply go to the government to later pay directly to providers. Instead the taxes are paid out to not-for-profit insurance companies, who then pay providers for the services. In some instances, a public insurer, such as Medicare, is part of this marketplace. This fosters competition amongst the insurers. These insurers provide a government mandated base level of insurance and many countries allow citizens to purchase private insurance above the base package.
I want to point out something important about the fact that these insurance companies are mandated by the government to be not-for-profit. In the first quarter of this year, UnitedHealth, one of the nation’s largest insurers, posted a $3.5 billion profit. Three-and-a-half billion dollars of profit while medical bills are the reason for nearly two-thirds of bankruptcies in this country and many go without needed health care, drugs, and services.
Check back at my next column as we continue to discuss common objections to substantial change in the U.S. health care system. And if you don’t agree, I am always open to a respectful discussion including objective (i.e. scientific and statistical) facts so feel free to reach out via email.
Nick McClary earned his doctor of physical therapy from the University of Tennessee. He also holds a masters in business administration. He was born and raised in Georgetown, lives in Pawleys Island, and works in Murrells Inlet. Send him your health and fitness questions at: nmcclaryDPT@gmail.com.