Rethinking Healthcare in the U.S.

The United States healthcare system can be considered both highly successful or failing, depending upon the lens it is examined with.  For instance, 10% of the 2011’s top 50 most profitable companies in America are part of the healthcare system; they are in order of profitability, Pfizer, Eli Lilly, United Healthcare, Abbot Laboratories, and CVS Caremark (CNNMoney, 2011).  When thinking about the healthcare system in terms of profitability, it is filled with members of a highly paid profession (Brym & Lie, 2007), it is a highly profitable business for many companies (CNNMoney, 2011), and companies involved in the system have figured out how to get U.S. residents and the U.S. government to spend more than 18% of the entire U.S. GDP on healthcare (Altarum Institute, 2012).  So if we consider the success of our healthcare system based on profitability, the U.S. has the most successful healthcare system on the planet.

It is likely that some might disagree with profitability as an appropriate measure for the nation’s healthcare system.  Davis, Schoen, and Stremikis (2010) have developed an international scorecard for the healthcare systems of top industrialized nations and found that the U.S. “underperforms relative to other countries on most dimensions of performance” (p. v), despite our impressive spend.  The scorecard ranks the top seven industrialized countries based on quality care, access, efficiency, equity, ‘long, healthy, productive lives’, and health expenditures per capita, outlined in Figure 1 below (Davis, et al., 2010):

Figure 1 – The Commonwealth Fund’s Overall Ranking of Healthcare Systems.

Some might argue that the U.S. healthcare system was never intended to provide equal access or solve equity problems, perhaps a fair argument.  According to Davis, et al. (2010), “even when access and equity measures are not considered, the U.S. ranks behind most of the other countries on most measures” (p. vi).  The question we should be asking our healthcare providers, citizens, and government, is “do we deserve better value for our investment?”  Given that we spend more per capita, more as a percentage of GDP, and more in absolute dollars than any other country on earth, shouldn’t U.S. residents live the longest, healthiest, and most productive lives?  Should the U.S. have the lowest infant mortality rate?  Shouldn’t U.S. residents receive the highest quality care?

Another implication of the scorecard, when including equity and access rankings is that other countries are providing higher quality care to more of their population for less money.  Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom all run more efficient and effective healthcare systems, and most of them provide universal coverage (Davis, et al., 2010). Therefore, should it be possible, given the U.S. healthcare spend, to provide access to quality healthcare for all residents?  Of course it’s possible.  However, many things about our current national healthcare system would have to change, including the profitably, perhaps even the viability of some of the most profitable companies in the United States, and there is the real rub.

In 2011, the healthcare industry spent nearly $500 million dollars lobbying the U.S. government, more than any other industry; and since 1998 the industry has spent more than $4.5 billion dollars; yes, billions (Center for Responsive Politics, 2011).   I wonder whose war chests the money went towards?  It is no mystery where political parties landed on the Obamacare debate, with Democrats largely for the measure and Republicans largely against; an outcome that wouldn’t surprise Brym and Lie, given the variation in class support between Democrats and Republicans.  Brym and Lie (2007) suggest that “organization is a source of power” (p. 371) that accounts for the success of political parties or legislation.  $4.5 billion dollars buys a lot of organization.

The good news is that the passage of Obamacare may provide opportunities to increase access to the nation’s healthcare system for many.  In addition, as more low-income patients receive care, inequality in the system may be reduced.  However, it is unlikely that any existing measures to improve the nation’s healthcare system will address reduced spending or better healthcare outcomes, as fundamentals of the system remain overly capitalistic.  As a result, the success of the nation’s system will likely remain measured based on the balance sheets of our nations healthcare companies, rather than the lives of our citizens.

References

Altarum Institute. (2012). Health Sector Economic Indicators: Spending Brief (pp. 1-2). Ann Arbor, MI: Center for Sustainable Health Spending.

Brym, R. J., & Lie, J. (2007). Sociology : your compass for a new world (Brief ed.). Belmont, CA: Thomson/Wadsworth.

Center for Responsive Politics. (2011). Lobbying Spend Database  Retrieved February 20,, 2012, from http://www.opensecrets.org/lobby/top.php?showYear=2011&indexType=c

CNNMoney. (2011, May 23, 2011). Fortune 500 2011: Top Performers – Most Profitable Companies: Profits  Retrieved February 20,, 2012, from http://money.cnn.com/magazines/fortune/fortune500/2011/performers/companies/profits/

Davis, K., Schoen, C., & Stremikis, K. (2010). Mirror, mirror on the wall:  How the performance of the U.S. health system compares internationally (pp. 1-22). Washington DC: The Commonwealth Fund.