Aaron Carroll (among other things, a Professor at the IU School of Medicine) has a good column at The Incidental Economist entitled “Why the U.S. Still Trails Many Wealthy Nations in Access to Care.” He acknowledges that many people are unhappy with Obamacare. But, he notes that it has been successful in its primary objectives: expanding the safety net, reducing the number of uninsured, and regulating the non-employer provided private insurance market.
Other countries provide their citizens with much better access to health care. Most of their citizens were better able than Americans to get care promptly and do so without having to go to the emergency room. Those countries had far more primary care physicians per capita than the U.S., and their citizens were less likely to skip necessary care due to expense. And, maybe most telling, citizens in those countries were more likely than Americans to be happy with their country’s health care system.
I’m not a huge fan of how Obamacare is structured, but I have not forgotten that the pre-Obamacare system was awful as well. As Carroll says:
Perhaps most telling, when adults were asked about their views of the health care system in 2013, 75 percent of Americans said that it needed fundamental change, or that it needed to be completely rebuilt. This percentage was higher than for any other country surveyed, Canada included. Primary care physicians feel similarly. Yet years after the Affordable Care Act was passed, Americans are still litigating whether to return to the previous system.
Access was a problem before. Access is a problem now. Americans can’t seem to have a discussion on how to make that better. Without that, it’s hard to see how things will improve.
Other countries have figured this out. A better health care system is possible. We need to identify the problems with Obamacare, see how other countries have addressed similar problems, and pass legislation to make those changes. For the moment, many lawmakers are choosing not to make things better.
It’s ridiculous that, wealthy as our country is, healthcare is in such a state (and has long been in such a state) that — in Indiana’s campaign for governor, John Gregg is being attacked for having state-paid insurance due to his having been a legislator for many years. We regard health insurance as some kind of decadent luxury that a legislator could obtain only through the rankest corruption.
Like I said, it’s not just pie-in-the-sky wishful thinking that we should have a system where health insurance is affordable and actually provides access to health care. It’s being done with greater and lesser success in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the U.K., should we choose to study them.
A bit word-smithing here, but I would phrase it as ‘… We need to identify the problems with The American Health System [not Obamacare per se which is a flawed attempt at a fix], see how other countries have addressed similar problems …’
As long as people thing that there is a problem with Obamacare then the solution is simple — get rid of Obamacare. But the real problem — as you pointed out in your article — is The American Health System. This is what needs fixed. Focusing on Obamacare does not fix the American Health System problem. Fixing Obamacare does not fix the American Health System unless you take the stance that Obamacare equals the fixing of the American Health System.
I know that the difference is subtle and that it is mostly just word-smithing but words do matter.
Why is it that Republicans think the United States, the richest and greatest country on the earth, can’t cover all of our citizens and aren’t even willing to try?
Just pisses me me off daily.
The Incidental Economist is a great site. And the quoted article was very well presented. By nearly every measure, American Healthcare is a train wreck. When I hear a politician say that “America has the greatest heathcare system in the world” I move them into the liars column. I heard John Boehner say that shortly before he was ousted as Speaker. What is really interesting is complaints about “access.” The problem may be perceptual, however. Here is what Aaron Caroll said:
Access is about more than insurance, though. Every few years, the Commonwealth Fund conducts an international survey of patients. The last time the fund fielded the survey was in 2013, and it sampled patients in 11 different countries, all of them on the high end of the worldwide socioeconomic spectrum.
When asked if patients could get a same-day or next-day appointment with their provider when they were sick or needed care, 52 percent of Americans said no. This placed the United States next to last among these countries. Only Canada (59 percent) was worse.
Yes, we beat Canada. There’s a reason that politicians always seem to reach into that bucket when they want to provide evidence of American health care exceptionalism. But comparing ourselves with only one country is cherry-picking. Many other countries outperform us.
This is very interesting and presents quite a conundrum. It is Econ 201 analysis of American Healthcare that it will not make a hard choice in the “two out of three” dilemma. This is the dilemma, and it is a common one in project management and manufacturing (and many other industries and services). It goes like this:
If you Want it Cheap and Good, you will not get it Fast.
If you Want it Cheap and Fast, it will not be Good.
If you want it Fast and Good, it will not be Cheap
It plays out in American Healthcare in this way:
If you Want Cheap Healthcare and the Highest Technology(Common use of latest technology, such as MRIs for conditions that could be diagnosed with X-rays and the newest and most expensive prescriptions), you Cannot Have Immediate Access to elective services.
If you Want Cheap Healthcare and Immediate Access, you Cannot have the Highest Technology.
If you Want the Highest Technology and Immediate Access, it Will not be Cheap. (This is Where We Are Now)
It was generally considered by healthcare economists and policy makers that America had generally immediate access to emergent issues and elective services (conditions that were extant but could wait, like a vasectomy, torn rotator cuff or or surgery for a nagging, but not dehabiitating separated shoulder.) A great example was an observation from the early 1990s. At that time, Orange County, California had more MRI machines than all of Canada. And by objective measures, Canada had enough of them.
It could be mostly a perceptual thing, however. The analysis from the Incidental Economist was based upon surveys of patients, and not hard data. Hard data might reveal a different picture, however.
But if America, which has made choice three in the two out of three dilemma, we no longer have immediate access, we are really gettting a pooch schtupp.