Though we speak of healthcare in the U.S. as a system, it’s less a system, per se, more a situation. We have mega-industries sewn into a patchwork by (sometimes the same) mega-insurance companies hawking plans to employers. And, the situation will only grow less competitive. Consulting firm Deloitte predicts that only 50% of companies will exist at the end of the next decade. As they bloat, mega-companies become home to divisions with goals at odds with each other. Insurance companies like CVS own pharmacies. Non-profit hospitals use for-profit billing companies.
Before the ACA, working Americans who didn’t have an employer large enough or didn’t have the “right” job, lacked either employer-based insurance and an affordable private option. This list included, but was not limited to entrepreneurs running their restaurants, janitorial or trade companies; the “self-employed” such as clergy, hairdressers, or daycare providers; service industry workers such as ABA therapists, not to mention low-income positions at places Walmart (until recently) or Kroger, as well as people who work multiple part-time jobs, even teachers without support from national unions.
All of this bodes ill for Americans. While the popular narrative about U.S. healthcare is that it fosters cutting-edge research, treatments and therapies and that wait times are shorter here than in other nations, particularly those with a universal healthcare system, those claims don’t reflect two outcomes. Are Americans healthier and living longer? Can they afford the care that the healthcare industry purportedly offers?
Here are some outcomes, and some data points, reported by Balancingeverything.org sourced from a diverse number of non-partisan organizations.
The 30-day mortality for strokes is lower in the U.S. than in comparable countries, on average.
Maternal mortality rates in the U.S. have risen over time and are much higher than in peer countries.
Hospital admissions for diabetes and congestive heart failure were more frequent in the U.S. than average across comparable countries.
More cesarean sections, which are higher risk, are performed in the U.S. than in comparable countries.
Obstetric trauma during vaginal delivery is more common in the U.S. than in most comparable countries, especially when instruments are involved.
Post-operative complications — such as pulmonary embolism or deep vein thrombosis — are more common in the U.S. than most peer countries.
Post-operative sepsis is less common in the U.S. than in most peer countries.
The U.S. has higher rates of reported medication and treatment errors than most comparable countries.
The U.S. has higher rates of consultations missed due to costs than comparable countries in 2020.
Life expectancy in the U.S. has dropped compared to other developed nations. More people go bankrupt from medical bills in the U.S. In short, our healthcare options are failing to increase the length and quality of American live, and they are bankrupting us. This year, companies are negotiating in healthcare with intense concern because they’re seeing 20%-plus increases in 2024 healthcare plans.
It’s not a new problem. Fifty years ago, the GOP and Dems wrote party platforms to address the skyrocketing cost of healthcare and increasing chronic disease conditions, as well as shortages of maternal, infant and mental healthcare.
In 1972, the GOP called for “reasonable costs,” pledging to balance demand for services and providers, and bragging about Nixon’s proposal for “one of the most all-inclusive health programs in our history.” The GOP promised to educate more providers and ensure more services in underserved rural and urban areas, such as MontCo in 2023. The GOP called for innovation, promising to increase “freedom of choice of medical providers” to lower inflation to curb costs. The GOP believed that the best way “to assure access to basic medical care for all our people” was employer-based insurance but also said the Federal Government needed to play a role, though they left it undefined.
“We oppose nationalized compulsory health insurance. This approach would at least triple in taxes the amount the average citizen now pays for health and would deny families the right to choose the kind of care they prefer. Ultimately it would lower the overall quality of health care for all Americans. We believe that the most effective way of improving health in the long run is by emphasis on preventive measures.”
Calls for physical fitness and an “all-out assault against cancer” as well as “a new major attack on sickle cell anemia, a serious blood disorder afflicting many black Americans,” as well as help for renal failure. They called for support for “comprehensive community mental health centers” and offered evidence that they’d already progressed in supporting these, especially leaning on private insurance to cover mental illness.
Fifty years later, the need for more physical fitness still contorts health experts. Processed foods, additives, mental illness, cancer, cardiovascular diseases and kidney disease are worse, though some treatments, such as treatments for some forms of cancer are better. Nevertheless, American life expectancy, as noted, is lower. Harvard’s T.H. Chan School of Public Health found a steep decline in U.S. life expectancy, with younger people dying at higher rates than other nations. Researchers concluded that the structure of our system focuses on rescue or acute care rather than an overall infrastructure focused on health, including clean water, air, safe homes, education and clean food. Meanwhile, spending per American on healthcare has risen disproportionately high since the Reagan years.
For their part, the Democratic party wrote, “Good health is the least this society should promise its citizens.” The party called for “a system of universal National Health Insurance which covers all Americans with a comprehensive set of benefits including preventive medicine, mental and emotional disorders, and complete protection against catastrophic costs, and in which the rule of free choice for both provider and consumer is protected. The program should be federally financed and federally administered. Every American must know he can afford the cost of health care whether given in a hospital or a doctor’s office.”
The Democratic Party proposed incentives to: bring healthcare back to rural and inner city areas, secure more consumer control over healthcare institutions, and fund more research and preventative care for heart disease, hypertension, stroke, cancer, sickle cell anemia, occupational and childhood diseases. Because drug prices were already prohibitive, they called for generic brand drugs and use of anti-trust laws to keep prices affordable for those who need them. They also supported “drug abuse treatment and education, especially development of non-addictive treatment methods” and, finally, they supported family planning services for all without coercion and discrimination “regardless of sex, age, marital status, economic group or ethnic origin.”
It’s clear the ‘72 Dems were closer to today’s LWV, whose stance reads: “The US healthcare system should provide a basic level of quality healthcare at an affordable cost to all US residents. Basic care includes disease prevention, primary care (including prenatal and reproductive health), acute long-term care, mental health care, as well as health promotion and education. Health care policy goals should include the equitable distribution of services and delivery of care, advancement of medical research and technology, and a reasonable total national expenditure level.“
While the claim that the American healthcare landscape leads to better health is dubious, it’s not surprising that the 1972 Republican party supported employer-based, competitive healthcare options. In the past, Republican principles were fiscal restraint and smaller government, so supporting employer-based, private insurance was consistent.
But over the past four decades, the deficits of the government increased under Republican presidential leadership and dropped during Democratic, as fact-checked by Politifact in 2019. During and post-pandemic, both parties supported larger budgets and government expansion. Presently the parties now differentiate less on fiscal policy and more on which big budget items to fund and which cultural values define the country. The question for citizens is whether the right to healthcare supports our “life, liberty and the pursuit of happiness” and while we’re at it, if it improves our economy because preventative, universal healthcare just costs less than reactionary, sick care.
The League of Women Voters, a non-partisan, multi-issue organization encourages informed and active participation in government, works to increase public understanding of major policy issues and influences public policy through education and advocacy. All men and women are invited to join the LWV where hands-on work to safeguard democracy leads to civic improvement. For information, visit the website www.lwvmontcoin.org or the League of Women Voters of Montgomery County, IN Facebook page.