Imagine walking into a car showroom and asking to see their best vehicle. The salesman proudly leads you to an impressively shiny vehicle.
“This is our best car,” he announces.
You ask, “Is it reliable?”
“Well, not so much,” he confides, “every other car in the showroom is more reliable.”
“What about the quality?” you ask.
“Not so much.”
“Gas mileage?”
“Well now, if you buy a top of the line vehicle like this, you are not thinking about mileage.”
“But based on its size and complexity, it must be a safe vehicle?”
“Oh dear no. It is unquestionable the least safe vehicle of any major manufacturer.”
Perplexed, you ask, “So what makes this the best car?”
“Why the price, of course.”
“How does that make it the best?”
“Because it is the most profitable for me,” answers the sales agent.
That is the deal Americas are being sold on healthcare.
We are paying the most money for the lowest quality medical care in the industrialized world.
Let’s look at COVID-19 as an example of the failure of the American healthcare system. The United States population makes up only 4.25%1 of the world population. Yet America accounts for 20.5%2 of all the Coronavirus cases and 19.8% of3 all the world’s COVID-19 deaths. That is five times as many cases and deaths as our population would suggest is our fair share.
I know what you are thinking, “We may have more cases, but thanks to our advanced healthcare, we have better care for those who get sick.”
When I computed the numbers, the US mortality per infected individual is 2.6% vs. only 0.25% for the world as a whole. Now I admit, there may be some problems with the world statistics that could skew these numbers. Still, the US death rate is ten times that of the world as a whole. It will take a lot of explaining to erase a margin that wide. It’s like if any team beat the Lakers by 600 to 60, LeBron James would need an awfully long press conference to explain away a loss like that.
Unless you are the President of the United States with access to a private suite at a premier hospital, an army of expert doctors and therapeutics not available to the general population, you have a surprisingly high risk of dying from COVID-19 in the United States.
Add to that the fact that in 2018, over 27,000,000 million Americans (8.5%) were at risk of going without medical treatment because they are uninsured. With the pandemic’s job losses, the number of uninsured is undoubtedly higher than that today.
Americans pay twice as much for the lowest quality.
Despite all of these problems, Americans pay twice as much for healthcare as the other 19 countries that make up the Organization for Economic Co-operation and Development (OECD). The United States spends 17.0% of GDP on healthcare compared to an average of only 8.6% for the other nations.4
So what do Americans get for all that extra money?
Let’s take a look;5
- Twice the rate of obesity.
- Less access to doctors
- Fewer doctors visits per year.
- More invasive (read expensive) procedures.
- The highest rate of hospitalization for preventable causes
- The highest rate of avoidable death
- Highest suicide rate
- Lowest life expectancy
Is that looking like a bargain to you, twice the cost for the worst quality healthcare in the developed world?
So with all of these failures, where is American medicine succeeding? The answer in one word: profit. American hospitals operate at a profit margin of 8%, which is twice that of the average restaurant in America6. However, hospital profits are chump change compared those of device manufacturers (12%profit) and pharmaceutical companies (26%profit).7
American healthcare succeeds at one thing.
I want to make clear that I am not anti-profit. I do question whether profit is the best metric to measure the success of our healthcare system.
I want to make a living as much as the next guy. I expect to be paid based on the value I deliver to others. What I am questioning is whether our healthcare system is generating value commensurate with its cost.
If you were in the car dealership, would you buy the gas guzzler that is unsafe, unreliable, and twice as expensive to purchase and operate? I don’t think most people would be that foolish with their auto buying dollars. So why do we accept such a poor bargain in our healthcare system?
Now What?
I have heard all the arguments as to why it has to be like this in the United States. Endless explanations for why healthcare needs to cost so much. Excuses for why Americans are the least healthy people in the industrialized world. And I don’t buy any of it for one reason: every other first world nation is providing better care for less cost.
It clearly can be done, just not by the people in charge of our system. If our leaders can’t get it done, then it is time to vote them out of office and give someone else a chance. I don’t accept that our system cannot be improved; all I accept is that the people currently in charge are either unable or unwilling to do it. If that is the case, there is something we can do on election day. Vote out those who say it can’t be done. It can be done, just not by them.
Read more on the ChuckBPhilosophy.com Blog.
1 https://www.worldometers.info/world-population/us-population/
2 Statistics computed from John Hopkins data on October 27,2020 by myself.
3 Statistics calculated from John Hopkins data on October 27,2020 by myself
4 https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019
5 https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019
6 https://upserve.com/restaurant-insider/profit-margins/
7 https://www.americanprogress.org/issues/healthcare/reports/2019/06/26/471464/high-price-hospital-care/
