These Videos Explain Why America Ranks Dead Last in Healthcare Among Developed Nations

November 15th 2014

Many opponents of health care reform (and, in particular, Obamacare) worry that it might interrupt the status quo in America, which purportedly has "the best healthcare in the world." Look no further than this Daily Show clip for evidence.

But America's health care system is much worse than most people think. In a study by The Commonwealth Fund this year, the U.S. actually ranked dead last among eleven developed nations in health care outcomes. The 32-page report used prior surveys and national health system scorecards, as well as data from the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD). The sobering graph below delineates how we fared. 

The Commonwealth Fund

One common assumption about the healthcare in the U.S. is that since it is the most expensive in the world, it must also be the most advanced or of the highest quality. The Commonwealth study systematically broke down quality into five core metrics that do not support this assumption. In terms of efficiency, the U.S. ranks lasts due to unnecessary costs associated with administrative hassles, avoidable emergency room visits, and duplicative medical testing. As far as equality goes, the U.S. ranks last as Americans with below-average incomes were much more likely than their counterparts in other countries to report avoiding care for financial reasons. One in three lower-income adults said they went without needed care because of costs in the past year.

Not surprisingly, the U.S. also ranked dead last in areas like access due to our absence of universal healthcare. If this feels like a recurring theme, that's because it is echoed numerous times throughout the report. Not having universal healthcare is analogous to our senseless avoidance of the metric system. We reject it despite it being empirically superior. In fact, one of the most salient points in the report singles out this problem. From the report:

"The most notable way the U.S. differs from other industrialized countries is the absence of universal health insurance coverage. Other nations ensure the accessibility of care through universal health systems and through better ties between patients and the physician practices that serve as their medical homes." 

So what do we use instead? Something called "Selective Health Coverage" (SHC), which has several distinct effects that make us unique among the 11 countries considered in this study. We are the only country where medical expenses contribute to personal bankruptcies, and we are the only country where healthcare coverage plays into employment decisions (taking one job or another because it has better benefits, etc.). Finally, we are the only country, until the Affordable Care Act, in which 84 million non-elderly persons were underinsured or uninsured completely. That's right folks, from sea to shining sea.

We recently published a piece about the absurdity of healthcare costs in the U.S. You can also watch this video for a quick explanation:
The Affordable Care Act has been successful in terms of increasing access and coverage, but has done little to reduce our National Health Expenditure (NHE). The graph of per capita spending with respect to life expectancy is particularly disconcerting. 
As far as alternative solutions, one major idea is to eliminate America's system of fee-for-service, in which doctors can charge patients for each procedure and test they administer, as opposed to a one-time fee or a payment based on outcomes. Our fee-for-service system poorly aligns incentives for doctors, encouraging them to give more care, but not necessarily better care. Our system of Medicare is also much more efficient because a collective pool of millions of patients have more negotiating power to lower prices than fragmented groups covered by various insurance companies. Watch Governor Howard Dean explain why fee-for-service is problematic and journalist Steven Brill explain why we should expand Medicare in this video below: